Classification of cardiomyopathies: bringing order to complexity

Cardiomyopathy classification remains challenging due to their extraordinary clinical, morphological, and genetic heterogeneity. As diagnostic technologies evolve, so too must the frameworks by which we conceptualize and communicate these diseases. Since the 2008 ESC morphofunctional classification and the genotype–phenotype integrated MOGE(S) system proposed in 2013, substantial advances in imaging and genetics have prompted a revised 2023 ESC phenotype-first model. The five current phenotypes—dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and non-dilated left ventricular cardiomyopathy (NDLVC)—capture major morphological expressions but display extensive overlap, especially among DCM, ARVC, and NDLVC. This overlap underscores the need for dynamic, multiparametric diagnostic pathways and individualized interpretation.