PD Dr. Amr Abdin, Saarland University Hospital, Homburg, Germany
Prof Hadi Skouri, Balamand University, Beirut, Lebanon
What is the reason for and aim of the publication?
Recent-onset cardiomyopathy (ROCM) is a dynamic and potentially reversible clinical condition that is not adequately addressed by traditional phenotype-based cardiomyopathy classifications. Clinicians often face uncertainty regarding prognosis, timing of device therapy, and identification of patients likely to recover versus those at risk for sudden cardiac death (SCD). This consensus statement was developed to provide a practical framework for the early evaluation, risk stratification, and management of patients with newly diagnosed non-ischaemic cardiomyopathy.
What are the most important take-home messages?
- ROCM is a time-sensitive and potentially reversible condition.
Early identification of reversible causes and rapid initiation of guideline-directed medical therapy (GDMT) can substantially alter the disease trajectory and improve outcomes.
- Management should be guided by two axes: LVRR potential and SCD risk.
Therapeutic decisions should not rely solely on LVEF but integrate clinical characteristics, imaging, biomarkers, genetics, and arrhythmia burden.
- Multimodality risk stratification is essential.
Echocardiography, CMR (especially LGE), ECG/Holter monitoring, biomarkers, genetic testing, and selected use of endomyocardial biopsy provide complementary information regarding recovery potential and arrhythmic risk.
- Reassessment is critical.
Patients should be systematically reassessed after initiation of therapy, particularly at 3 and 6 months, before making definitive decisions regarding ICD implantation or advanced heart failure therapies.
- Recovery of LVEF does not necessarily eliminate SCD risk.
Patients with fibrosis, high-risk genetic variants (e.g., LMNA, FLNC, DSP, RBM20), or persistent arrhythmias may remain at significant arrhythmic risk despite LVEF improvement.
What are challenges in practical implementation – and possible solutions?
The main challenge is the heterogeneity of ROCM and the difficulty of predicting which patients will recover and which will remain at risk of sudden cardiac death. In addition, access to advanced diagnostics such as CMR, genetic testing, and endomyocardial biopsy is not universally available. These challenges can be addressed through a structured multimodal evaluation, early initiation and optimization of GDMT, and systematic reassessment at 3 and 6 months to guide individualized decisions regarding device therapy and advanced heart failure interventions.
Which issues still need to be tackled, that are not yet addressed by the paper?
- Optimal timing and selection for ICD implantation in ROCM remain uncertain, particularly in patients with improving LVEF.
- How to integrate fibrosis, genetics, and biomarkers into a validated risk score for predicting SCD and recovery is still unresolved.
- Prospective ROCM-specific registries and randomized studies are lacking. Most current evidence is extrapolated from broader heart failure populations.
- Long-term relapse risk after apparent recovery or remission and the optimal duration of GDMT remain incompletely understood.
- The residual arrhythmic risk after reverse remodelling requires better characterization.
What further developments on the topic are emerging?
- AI-based personalized risk prediction models integrating clinical, imaging, genetic, biomarker, and rhythm-monitoring data.
- Integration of serial multi-marker panels with CMR, echocardiographic strain, EMB findings, and continuous rhythm monitoring for dynamic risk assessment.
- Ongoing ICD stratification trials such as BRITISH CMR, GUIDE-DCM, CMR-ICD, SPANISH-1, and PROFID, which aim to refine primary prevention strategies in the era of contemporary GDMT.
- More individualized management approaches, moving beyond LVEF alone toward precision medicine based on genotype, fibrosis burden, and treatment response.
Evaluation and management of recent-onset cardiomyopathy in the current era of heart failure therapeutics
H Skouri, A Abdin, et al. 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, ESC Heart Failure, Volume 13, Issue 3, June 2026, xvag115, https://doi.org/10.1093/eschf/xvag115
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