Evaluation and management of recent onset cardiomyopathy in the current era of heart failure therapeutics. A clinical consensus statement of the Heart Failure Association of the ESC.

Abstract

Recent-onset cardiomyopathy represents a clinically dynamic and potentially reversible clinical framework of non-ischemic cardiomyopathy, characterized by high variability in left ventricular (LV) function and arrhythmic risk. This clinical consensus statement provides a structured diagnostic and therapeutic approach based on two prognostic axes: the potential for left ventricular reverse remodeling (LVRR) and the risk of sudden cardiac death (SCD). We operationalize four trajectories in the LV evolution, ranging from recovered LV ejection fraction (LVEF) to persistently reduced LVEF. Multimodal stratification including echocardiography, cardiac magnetic resonance (CMR), genetic profiling, biomarkers, and early treatment response allows tailored decision-making on pharmacological and device-based therapies. We propose a unified management algorithm emphasizing early initiation of guideline-directed medical therapy, structured reassessment at 3 and 6 months, and individualized consideration of defibrillators, resynchronization therapy, arrhythmia ablation, transcatheter valve leaflet edge to edge repair, and advanced HF assessment. This document aims to support clinicians in risk stratification and timely management or referrals.