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Controversies in Heart Failure

Is the 2006 American Heart Association classification of cardiomyopathies the gold standard?

The 2006 American Heart Association Classification of Cardiomyopathies Is the Gold Standard

Barry J. Maron, MD

From the Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn.

Correspondence to Barry J. Maron, MD, Hypertrophic Cardiomyopathy Center, 920 E 28th St, Suite 620, Minneapolis, MN 55407. E-mail hcm.maron@mhif.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The cardiomyopathies are an important and complex group of heart muscle diseases with multiple etiologies and heterogeneous phenotypic expression.¹ Awareness and knowledge of these diseases in both the public and medical communities have historically been impaired by periodic confusion surrounding definitions and nomenclature. Therefore, formal and systematic classifications have traditionally been viewed as useful exercises promoting greater understanding of the heart muscle diseases.^1–10 Indeed, a multitude of such cardiomyopathy classifications have been advanced over the years by individual investigators and consensus panels sanctioned by medically related organizations such as the World Health Organization (WHO).^2,4 These classification schemes have evolved in concert with the level of scientific understanding.

Response by Elliott p 76

	Historical Context to the Debate

 
Remarkably, it was not until 50 years ago (1957) that the term cardiomyopathy was used for the first time.¹ Over the next 25 years, a number of definitions for cardiomyopathies were advanced. Indeed, in the original 1980 WHO classification,⁴ cardiomyopathies were defined only as "heart muscle diseases of unknown cause," reflecting a general lack of available information about basic disease mechanisms. In 1968, the WHO defined cardiomyopathies as "diseases of different and often unknown etiology in which the dominant feature is cardiomegaly and heart failure."^1,3 The final WHO classification published in 1995² proposed "diseases of myocardium associated with cardiac dysfunction" and included for the first time arrhythmogenic right ventricular cardiomyopathy/dysplasia, as well as primary restrictive cardiomyopathy.

Therefore, why was it necessary to offer yet another classification scheme for cardiomyopathies in 2006 under the auspices of the American Heart . . . [Full Text of this Article]