Dilated Cardiomyopathy: A Comprehensive Approach to Diagnosis and Risk Stratification

Dilated cardiomyopathy (DCM) represents one of the most common causes of non-ischemic heart failure, characterised by ventricular dilation alongside systolic dysfunction. Despite advances in therapy, DCM mortality rates remain high, and it is one of the leading causes of heart transplantation. It was recently recognised that many patients present minor structural cardiac abnormalities and express different arrhythmogenic phenotypes before overt heart-failure symptoms. This has raised several diagnostic and management challenges, including the differential diagnosis with other phenotypically similar conditions, the identification of patients at increased risk of malignant arrhythmias, and of those who will have a worse response to medical therapy. Recent developments in complementary diagnostic procedures, namely cardiac magnetic resonance and genetic testing, have shed new light on DCM understanding and management. The present review proposes a comprehensive and systematic approach to evaluating DCM, focusing on an improved diagnostic pathway and a structured stratification of arrhythmic risk that incorporates novel imaging modalities and genetic test results, which are critical for guiding clinical decision-making and improving outcomes.

Automated summary

Dilated cardiomyopathy (DCM) is a common cause of heart failure characterized by ventricular dilation and systolic dysfunction. Despite advances in therapy, DCM mortality rates remain high, making it a major indication for heart transplantation. Recent discoveries have highlighted the presence of minor structural cardiac abnormalities and different arrhythmogenic phenotypes in DCM patients before heart failure symptoms. This has raised diagnostic and management challenges, which can be addressed with the help of cardiac magnetic resonance and genetic testing.