Highlights from the 2024 Annual Meeting of the ESC Working Group on Myocardial and Pericardial Diseases in Athens

The annual meeting of the European Society of Cardiology Working Group (WG) on Myocardial and Pericardial Diseases took place in Athens, Greece, on 3–4 October 2024.1 The event was organized by Carsten Tschöpe (Berlin, Germany), Chairperson of the WG; Massimo Imazio (Udine, Italy), past Chairperson of the WG; Andrea Frustaci (Rome, Italy), Chairperson-elect; and George Lazaros (Athens, Greece), local host and Programme Director. This 2-day conference, held in the heart of the city, featured 20 sessions, three tribute lectures, two joint sessions (one with the Heart Failure Association and one with the European Heart Rhythm Association), and two satellite symposia (Figure 1). (A) Precongress nucleus meeting; (B) full attendance during the meeting sessions; (C) Young Investigator Award Session; (D) a visit of the nucleus members to the Acropolis Museum with a view of Parthenon, a symbol of excellence Over 90 original research and clinical case abstracts with innovative concepts were presented in the dedicated poster session. The top-scoring abstracts were presented orally in a Young Investigator Award Session. The ∼200 attendees lauded the conference for its diverse and up-to-date programme, the high quality of its presentations, as well as its expert discussions and networking opportunities. The WG celebrated six new nucleus members: cardiomyopathy—Teresa Castiello (UK); Alexandros Kasiakogias (Greece); Marco Merlo (Italy); myocarditis—Domingo Pascual Figal (Spain); and pericardial disease—Sibel Catirli Enar (Turkey); Claire Peet (UK). Five non-voting members were named: Wilhelm Haverkamp (Germany); Ahmed Elsanhoury (Germany); Rabea Asleh (Israel); Valentino Collini (Italy); and Emilia Lazarou (Greece). The meeting kicked off with a strong start by Michael Papadakis (London) who discussed the current approach to left ventricular noncompaction, a phenotypic trait that may be observed in various pathologies such as cardiomyopathies, neuromuscular diseases, and congenital defects, as well as in normal conditions such as athletic adaptation and pregnancy. Antonis Pantazis (London), who previously served as Chairperson of the WG, discussed the current view of arrhythmogenic cardiomyopathy. He highlighted that it is important to identify an arrhythmic phenotype originating from causative gene variants and presenting variably in ventricular involvement. Juan Pablo Kaski (London) elaborated on paediatric cardiomyopathies, pointing out that the most common aetiologies are similar to the ones found in adults. There is now evidence about the benefits of family screening—even for young children—because paediatric disease represents an early, mild form of the adult version of the disease. Perry Elliott (London) provided a state-of-the art lecture dedicated to the late Prof. Claudio Rapezzi, focusing on the first European Guidelines for the Management of Cardiomyopathies. Prof. Elliott discussed the guideline structure and elaborated on how the proposed patient pathway reflects the very essence of a clinical treatment approach. The advent of myosin inhibitors with increasingly positive results from randomized clinical trials, as well as the current role of invasive septal reduction therapies, was among the main points discussed in an educational session on hypertrophic cardiomyopathy. Mavacamten, a first-in-class myosin inhibitor which has a good safety profile, was highly recommended for management of outflow tract obstruction in the latest guidelines. Ongoing studies are investigating the role of myosin inhibitors in other patient populations such as nonobstructive hypertrophic cardiomyopathy. Several other sessions drew the interest of attendees, particularly those on cardiomyopathies and pregnancy, cardiac pathology, treatment of metabolic and infiltrative diseases, and sports cardiology. Current evidence on gene-specific dilated and nondilated left ventricular cardiomyopathy was reviewed in a session dedicated to the genetic and clinical profile of titin, LMNA, filamin C, and desmoplakin variants. Although certain genetic changes are associated with a high-risk clinical phenotype, further study data are needed to clarify the optimal approach to arrhythmic risk stratification while gene-specific risk scores are being used to help with decision-making. In the field of amyloid cardiomyopathy, Charalambos Vlachopoulos (Athens) and Mary Sheppard (London) emphasized the need for multidisciplinary care of patients with transthyretin amyloidosis and the role of myocardial biopsy for diagnostic purposes. It was noted that recently published trial data for new medications, including the short half-life myosin inhibitor, aficamten, and the transthyretin stabilizer, acoramidis, mark more exciting progress in the pharmacotherapy of cardiomyopathies. Various presentations conveyed the message that inflammation is central to multiple disease processes. Andrea Frustaci provided an expert review of the clinical management of myocarditis and underlined that autoreactive inflammation is a major immune-mediated mechanism, while endomyocardial biopsy may contribute to the identification of new or uncommon infectious agents and novel therapeutic strategies. In the joint session with the European Heart Failure Association, Carsten Tschöpe provided exciting evidence about the role of the microbiome in myocarditis and heart failure, highlighting how gut bacteria can influence inflammation, immune responses, and myocardial function. Multimodality imaging was emphasized as being crucial to the clinical approach for patients with myocardial and pericardial inflammation. For instance, techniques to assess for cardiac sarcoidosis—from cardiac magnetic resonance to positron emission tomography—were masterfully presented by Jeanette Schulz-Menger (Berlin). Leslie Cooper (Rochester, USA) offered a top-tier closing keynote lecture about the present and future of myocarditis, covering hot topics such as potential novel therapies including mTOR inhibitors for sarcoidosis, as well as current evidence for the genetic basis of the disease. Recent advancements regarding pericardial syndromes were presented by worldwide leaders in the field. In the Shabetai Spodick Lecture, Allan Klein (Cleveland, USA) highlighted the potential upgrade of interleukin (IL-1) blockers as a second step to replace glucocorticoids in the treatment of recurrent pericarditis. This class of medication represents a new paradigm shift in the diagnosis and treatment of recurrent pericarditis with an autoinflammatory phenotype. Based on current evidence, the role of IL-1 blockers will probably be upgraded, at least for some difficult-to-treat patients. It is, therefore, evident why the new 2025 ESC Guidelines on Pericardial Diseases are eagerly anticipated. George Lazaros discussed the management of patients with normal inflammatory markers who had large asymptomatic and chronic, idiopathic pericardial effusions. Traditionally, these patients have been regarded with particular concern for a possible unheralded progression to cardiac tamponade. Nevertheless, recent data from large series indicate that such progression is observed in ∼2.2% per year, significantly lower than previously described. On the other hand, recurrence-free survival and complication-free survival are better in patients treated without interventions. Thus, a non-invasive wait-and-see approach may be the best choice in oligo-asymptomatic cases. Antonio Brucato (Milan, Italy) highlighted the sex and age differences in pericarditis, noting the atypical presentation of acute pericarditis in older patients, which makes diagnosis based on the proposed clinical criteria challenging. Paul Cremer (Chicago, USA), Vartan Mardigyan (Montreal, Canada), and Arsen Ristic (Belgrade, Serbia) discussed the distinctive features of all pericardial constriction subtypes, as well the paramount contribution of multimodality imaging in this setting. They emphasized the need for medical treatment (transient constriction) or surgical treatment (permanent constriction), as well as optimal postsurgical care. Lastly, Massimo Imazio underscored the compelling need for personalized treatment for recurrent pericarditis and the emerging role of genetics in its management. Particular emphasis was placed on the subgroup of patients who had typical chest pain but normal inflammation markers, as well as the role of cardiac MRI in the differential diagnosis and treatment of this largely unexplored condition. As this yearly conference concludes, we proudly hand over the torch to organizers of next year’s event in Trieste, Italy. We eagerly anticipate seeing all of you there. Completed COI disclosure forms for each author have been included in the submission. Organizing committee of the 2024 Annual Meeting of the ESC Working Group on Myocardial and Pericardial Diseases: George Lazaros (First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 144, 115 27 Athens, Greece), Massimo Imazio (Cardiology and Cardiothoracic Department of Medicine, University of Udine, Italy; and Department of Medicine (DMED), University of Udine, Udine, Italy), Andrea Frustaci (Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy), and Carsten Tschöpe (Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Medicine at Campus Virchow (CVK), Germany; Berlin Institute of Health (BIH) at Charité—Center for Regenerative Therapies (BCRT), Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité University, Berlin, Germany).

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