From the Guidelines
Dilated cardiomyopathy (DCM) is characterized by reduced left ventricular (LV) systolic function and ventricular dilation.
Key Characteristics
- Definition: DCM is defined by the presence of left ventricular (LV) or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions (hypertension and valve disease) or coronary artery disease sufficient to cause global systolic impairment 1.
- Prevalence: DCM has an estimated prevalence of one case in 2500 individuals and is a major cause of heart failure (HF) with reduced ejection fraction (EF) 1.
- Causes: DCM encompasses a broad range of underlying causes, including genetic and acquired disorders, such as infiltrative cardiomyopathies, nutritional deficiencies, stress-induced cardiomyopathy, systemic autoimmune diseases, and peripartum cardiomyopathy 1.
Diagnostic Considerations
- Imaging: Multimodality imaging plays a crucial role in the diagnosis, risk stratification, and management of patients with DCM 1.
- Diagnostic Workup: A dedicated diagnostic workup is essential to identify the underlying cause of DCM, which will guide an aetiology-oriented approach to therapy 1.
Treatment Strategies
- Individualized Treatment: Treatment should be individualized and target the underlying cause, in addition to standard systolic HF therapies 1.
- Reversal of Cardiac Dysfunction: In certain cases, elimination of the cause and appropriate treatment can lead to reversal of myocardial remodeling and recovery of cardiac dysfunction 1.
From the Research
Definition and Characteristics of Dilated Cardiomyopathy
- Dilated cardiomyopathy (DCM) is characterized by reduced left ventricular (LV) systolic function and ventricular dilation 2, 3, 4.
- It is defined as the presence of left ventricular or biventricular dilatation or systolic dysfunction in the absence of abnormal loading conditions or significant coronary artery disease sufficient to cause ventricular remodelling 2.
- DCM can be caused by genetic or acquired factors, including infections, toxins, cancer treatment, endocrinopathies, pregnancy, tachyarrhythmias, and immune-mediated diseases 2, 3.
Clinical Features and Diagnosis
- DCM is characterized by left ventricular dilation and reduced systolic function, which can lead to heart failure and arrhythmias 3, 4.
- Echocardiography is central to the diagnosis of DCM, and is characterized by left ventricular systolic dysfunction with progressive chamber dilation and variable enlargements of the left atrium and right-sided chambers 5.
- Diagnostic tests and therapeutic approaches should consider both genetic and acquired factors 2.
Comparison with Other Cardiomyopathies
- The dilated phase of hypertrophic cardiomyopathy (D-HCM) has been reported to have a poor prognosis compared to DCM, with a higher prevalence of atrial fibrillation and larger left atrial diameter 6.
- Patients with D-HCM are more symptomatic at diagnosis, and have a worse prognosis than patients with DCM despite similar or more intensive treatment for heart failure 6.