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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 Not the Gold Standard

Perry Elliott, MBBS, MD, FRCP

From The Heart Hospital, University College London, London, UK.

Correspondence to Dr Perry Elliott, The Heart Hospital, 16-18 Westmoreland St, London W1G 8PH, UK. E-mail pelliott@doctors.org.uk

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

	Introduction

 

The truth is rarely pure and never simple.

Oscar Wilde, The Importance of Being Earnest, Act I, 1895

Even a cursory examination of the medical literature from the past 100 years reveals that many proposed disease classifications were never adopted because they were too complex or irrelevant to everyday clinical practice; others fell victim to the onward march of medical knowledge. The term cardiomyopathy was first used more than 40 years ago to describe myocardial disorders that could not be explained by hemodynamic disturbances (such as valve disease and hypertension) or multisystem diseases; heart muscle disorders with an identifiable etiology were initially termed specific heart muscle diseases but were later renamed specific cardiomyopathies.¹ Remarkably, this method of describing disorders of heart muscle has survived to the present day with only minor changes and remains a cornerstone of clinical practice and scientific research. Recently, expert committees of the American Heart Association (AHA) and the European Society of Cardiology (ESC) Working Group on Myocardial and Pericardial Diseases have proposed updated versions of the cardiomyopathy classification system.^2,3 The aims of both groups were to resolve a number of ambiguities in the existing classification and to incorporate knowledge gleaned from recent advances in molecular genetics. Unfortunately, an unintended consequence of these independent initiatives is that attention will, for a time, be diverted toward debates on taxonomy rather than the advancement of knowledge. In this brief commentary, I have tried to avoid a polemic on the merits of one or the other classification . . . [Full Text of this Article]