💗NEW 2023 @escardio guidelines on Cardiomyopathies #ESCCongress2023 #cardioEd #Cardiology #Cardiotwitter
‼️New guideline, not an update of existing ones
Exception: HCM 2014 ESC Guidelines. As such, most of the recommendations in this guidelines are NEW
🧵Some points⬇️⬇️⬇️
‼️New guideline, not an update of existing ones
Exception: HCM 2014 ESC Guidelines. As such, most of the recommendations in this guidelines are NEW
🧵Some points⬇️⬇️⬇️
🔵A new phenotypic description of cardiomyopathies
✅HCM
✅DCM
✅NDLVC 🆕
✅ARVC
✅RCM
🚫ACM: lacks morphological or functional definition consistent with the existing classification scheme
🚫LVNC
🚫Tako-Tsubo
✅HCM
✅DCM
✅NDLVC 🆕
✅ARVC
✅RCM
🚫ACM: lacks morphological or functional definition consistent with the existing classification scheme
🚫LVNC
🚫Tako-Tsubo
🚫LVNC: does not consider to be a cardiomyopahty. “Hypertrabeculation” is recommended, particularly transient or clearly adult onset
🚫Tako-Tsubo: given the transient nature, the Task Force does not recommend its classification as a cardiomyopathy
🚫Tako-Tsubo: given the transient nature, the Task Force does not recommend its classification as a cardiomyopathy
🔵Cardiomyopathies 2nd external factors
🍺Cardiomyopathy (13.5%) TTNtv
☠️Cancer therapy-induced cardiomyopahty (7.5%) TTNtv
🤰PPCM (15%) truncating variants in 8 genes & 2/3 TTNtv(10%) others DSP, FLNC and BAG3
🦠Acute miocarditis (8-22%) genes in DCM, NDLVC & ARVC
🍺Cardiomyopathy (13.5%) TTNtv
☠️Cancer therapy-induced cardiomyopahty (7.5%) TTNtv
🤰PPCM (15%) truncating variants in 8 genes & 2/3 TTNtv(10%) others DSP, FLNC and BAG3
🦠Acute miocarditis (8-22%) genes in DCM, NDLVC & ARVC
🔵Multidisciplinary Cardiomyopathy Teams
📍Creation of local/regional/national/international networks
🌏ERN GUARD-Heart: allows clinicians and health professionals to share information, for the benefit of cardiomyopathy patients
Link guardheart.ern-net.eu
📍Creation of local/regional/national/international networks
🌏ERN GUARD-Heart: allows clinicians and health professionals to share information, for the benefit of cardiomyopathy patients
Link guardheart.ern-net.eu
🔴Recommendations for management of atrial fibrillation & atrial flutter in patients with cardiomyopathy
🟩🟦Oral anticoagulation all patients with HCM or Cardiac Amyloidosis (unless contraindicated)
🟩🟦Oral anticoagulation all patients with HCM or Cardiac Amyloidosis (unless contraindicated)
🔴Recommendations for 💊treatment of LVOTO
🟩🟦Non-vasodilating BB 1st line therapy improve symptoms in LVOTO
🟩🟦Verapamil/Diltiazem intolerant or contraindications BB
🟩🟦Disopyramide in addition if LVOTO persist
🟨Mavacamten considerer i addition if LVOTO persist
🟩🟦Non-vasodilating BB 1st line therapy improve symptoms in LVOTO
🟩🟦Verapamil/Diltiazem intolerant or contraindications BB
🟩🟦Disopyramide in addition if LVOTO persist
🟨Mavacamten considerer i addition if LVOTO persist
🔴Recommendation for prevention SCD in HCM
‼️Task Force does not recommend the use of sarcomeric variant(s) to guide decisions around ICD implantation for PP with LOW or INTERMEDIATE risk score
‼️Task Force does not recommend the use of sarcomeric variant(s) to guide decisions around ICD implantation for PP with LOW or INTERMEDIATE risk score
🔴Recommendations for an ICD in DCM & NDLVC
🧬PLN, DSP, LMNA, FLNC, TMEM43 and RBM20⬆️⬆️rate of major arrhythmic events⚡️
🧬PLN, DSP, LMNA, FLNC, TMEM43 and RBM20⬆️⬆️rate of major arrhythmic events⚡️
🔴Spectrum of restrictives heart diseases
🔴Syndromic and Metabolic cardiomyopathies: Anderson-Fabry and Amyloidosis
🔴Syndromic and Metabolic cardiomyopathies: Anderson-Fabry and Amyloidosis
🔴Exercise recommendations for cardiomyopathies
🧬DCM and NDLVC: not recommended symptomatic, LVEF<40%, exercise-induced arrhythmias or LMNA or TMEM43
🧬DCM and NDLVC: not recommended symptomatic, LVEF<40%, exercise-induced arrhythmias or LMNA or TMEM43
🔴Key messages I
✅Cardiomyopathies are more common than previously thought
✅Aetiology fundamental to the management. Morpho/Functional PHENOTYPE crucial 1st step
✅Multimodality Imaging
✅GENETIC testing: Dx/Prognosis/risk stratification/Tx/Counselling
✅Cardiomyopathies are more common than previously thought
✅Aetiology fundamental to the management. Morpho/Functional PHENOTYPE crucial 1st step
✅Multimodality Imaging
✅GENETIC testing: Dx/Prognosis/risk stratification/Tx/Counselling
🔴Key messages II
✅Cardiac myosin Inh should be considered HCM and LVOTO who remain symptomatic despite OMT
✅SCD risk DCM & NDLVC varies depending underlying cause & 🧬subtype (even if LVEF >35%)
✅DEFINE aetiology for Tx: ERT/chaperone (Fabry), tafamidis, silencers (ATTR)
✅Cardiac myosin Inh should be considered HCM and LVOTO who remain symptomatic despite OMT
✅SCD risk DCM & NDLVC varies depending underlying cause & 🧬subtype (even if LVEF >35%)
✅DEFINE aetiology for Tx: ERT/chaperone (Fabry), tafamidis, silencers (ATTR)
🔴Key messages III
✅All cardiomyopathy patients should have an individualized risk assessment for exercise prescription
✅A multidisciplinary approach to cardiomyopathies that has the patient and their family at its heart
🧵(End)🫀
✅All cardiomyopathy patients should have an individualized risk assessment for exercise prescription
✅A multidisciplinary approach to cardiomyopathies that has the patient and their family at its heart
🧵(End)🫀
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