Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non-obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision-making. In addition, new aetiology-specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies.

2nd Department of Cardiology Heart Failure and Preventive Cardiology Section Henry Dunant Hospital Athens Greece

2nd Department of Medicine Department of Cardiovascular Medicine General University Hospital Charles University Prague Prague Czech Republic

Berlin Brandenburg Center for Regenerative Therapies Berlin Germany

Berlin Brandenburg Center for Regenerative Therapies Deutsches Zentrum für Herz Kreislauf Forschung Berlin Department of Cardiology Campus Virchow Klinikum Charite Universitaetsmedizin Berlin Berlin Germany

BIOMED Biomedical Research Institute Faculty of Medicine and Life Sciences Hasselt University Diepenbeek Belgium

Cardiology Department Centro Hospitalar São João Porto Portugal

Cardiology Department of Experimental Diagnostic and Specialty Medicine Alma Mater Studiorum University of Bologna Bologna Italy

Cardiology Department of Medical and Surgical Specialties Radiological Sciences and Public Health University of Brescia Brescia Italy

Cardiomyopathy Clinic and Heart Failure Institute Leviev Heart Center Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel

Cardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MA USA

Cardiovascular Research Institute Basel and Department of Cardiology University Hospital Basel University of Basel Basel Switzerland

Centre for Inherited Cardiovascular Diseases IRCCS Foundation University Hospital Policlinico San Matteo Pavia Italy

Centre for Radiology and Magnetic Resonance Imaging Clinical Centre of Serbia Belgrade Serbia

Clinic for Endocrinology Diabetes and Metabolic Disorders Clinical Center Serbia and Faculty of Medicine University of Belgrade Belgrade Serbia

Clinic of Cardiac and Vascular Diseases Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania

Department of Cardiology and Angiology Medical School Hannover Hannover Germany

Department of Cardiology Clinical Center of Serbia Belgrade Serbia

Department of Cardiology Hacettepe University Faculty of Medicine Ankara Turkey

Department of Cardiology IRCCS San Raffaele Pisana Rome Italy

Department of Cardiology Rabin Medical Center Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Department of Cardiology University Heart Center Zürich Switzerland

Department of Cardiology University Medical Center Groningen University of Groningen Groningen The Netherlands

Department of Cardiology Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Sciences Università della Campania 'Luigi VanvitellI' Monaldi Hospital AORN Colli Centro di Ricerca Cardiovascolare Ospedale Monaldi AORN Colli Naples Italy and UCL Institute of Cardiovascular Science London UK

Department of Cardiovascular Diseases University Hospital Center Zagreb University of Zagreb Zagreb Croatia

Department of Cardiovascular Surgery Dokuz Eylül University Faculty of Medicine İzmir Turkey

Department of Internal Medicine B University Medicine Greifswald Greifswald Germany

Department of Medical Sciences IRCCS San Raffaele Rome Italy and Cardiology Clinical Academic Group St George's Hospitals NHS Trust University of London London UK

Department of Medicine Karolinska Institutet and Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden

Department of Molecular Cardiology and Epigenetics University of Heidelberg Heidelberg Germany

Department of Social and Welfare Studies Faculty of Health Science Linköping University Linköping Sweden

Division of Cardiology and Metabolism Department of Cardiology Charité Berlin Germany

Division of Cardiology Department of Cardiological Thoracic and Vascular Sciences University of Padua Padua Italy

DZHK partner site Berlin Charité Berlin Germany

DZHK partner site Heidelberg Mannheim Heidelberg Germany

Emergency Institute for Cardiovascular Diseases 'Prof C C Iliescu' Bucharest Romania

Heart Failure Unit Cardiology G da Saliceto Hospital Piacenza Italy

Medizinische Klinik Kardiologie and Internistische Intensivmedizin Klinikum Würzburg Mitte Würzburg Germany

Mid German Heart Center Department of Internal Medicine 3 Division of Cardiology Angiology and Intensive Medical Care University Hospital Halle Martin Luther University Halle Halle Germany

Monash University Australia and University of Warwick Coventry UK

National Heart and Lung Institute Imperial College London and Royal Brompton Hospital London UK

Pacemaker Center Clinical Center of Serbia Belgrade Serbia

Pharmacology Centre of Clinical and Experimental Medicine IRCCS San Raffaele Pisana Rome Italy and St George's University of London London UK

School of Nursing and Midwifery Queen's University Belfast Belfast UK

Serbian Academy of Sciences and Arts Belgrade Serbia

State Research Institute Centre for Innovative Medicine Vilnius Lithuania

University of Belgrade Faculty of Medicine Belgrade Serbia

University of Cyprus Medical School Nicosia Cyprus; Heart Failure Unit Department of Cardiology Athens University Hospital Attikon National and Kapodistrian University of Athens Athens Greece

University of Medicine Carol Davila Bucharest Romania

Volgograd State Medical University Regional Cardiology Centre Volgograd Volgograd Russia

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