Critical analysis of the 2023 ESC guidelines on cardiomyopathy management

The first European Society of Cardiology (ESC) guidelines on the management of cardiomyopathies (CMPs), published 1 year ago, remain highly relevant. These guidelines provide a comprehensive framework to manage the complexity of CMPs, consolidating previous approaches. All CMPs are now addressed systematically in one document. The ESC recommends a ‘CMP-oriented’ approach, emphasizing thorough clinical assessments and phenotype-first categorization into hypertrophic, dilated, arrhythmogenic, restrictive, and non-dilated left ventricular CMP. Despite the utility of this method, certain classifications, such as arrhythmogenic right ventricular CMP and the novel non-dilated left ventricular CMP, raise controversies. Key advances in the guidelines include the use of genetic testing and cardiac magnetic resonance imaging to refine diagnoses and inform treatment, especially for high-risk genotypes. These guidelines advocate for personalized, multidisciplinary care. Overall, they represent a significant step forward but highlight the evolving nature of CMP management as scientific understanding progresses.