The Universal Definition of Heart Failure, risk prediction in cardiogenic shock, artificial intelligence in cardiac allograft rejection, and the genetics of dilated cardiomyopathy

For the podcast associated with this article, please visit https://academic.oup.com/eurheartj/pages/Podcasts. This Focus Issue on heart failure (HF) and cardiomyopathies contains a Special Article entitled ‘The struggle towards a Universal Definition of Heart Failure: how to proceed?’.1 In a first part, Johann Bauersachs from the Hannover Medical School in Germany provides an introduction to the topic overall. He notes that definitions and classifications are crucial in medicine and provide the basis for a proper and timely diagnosis to enable prompt, precise, and efficient therapies. The diagnosis of HF currently relies on signs (pulmonary crackles and peripheral oedema) and symptoms (dyspnoea on exertion and fatigue) that are not always objective, and neither sensitive nor specific.2–4 Subsequently, Professor John Cleland from the University of Glasgow in the UK, and colleagues, take the stance that a universal definition of HF is needed. The concept of a universal definition of HF proposed by Cleland et al., comprising cardiac dysfunction (identified by imaging) and congestion (identified by natriuretic peptide measurement) (Figure 1), provides an excellent basis for the current efforts of different heart HF societies and associations, including the HFA of the ESC, to develop a universal definition of HF that is accepted worldwide with the goal of improving diagnosis and treatment of HF globally. In their counterstatement, Pfeffer and Teerlink from Harvard Medical School in Boston, MA, USA point out several important caveats precluding the simple introduction of natriuretic peptide elevation for HF diagnosis.