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Dilated cardiomyopathy

Abstract

Dilated cardiomyopathy (DCM) is a clinical diagnosis characterized by left ventricular or biventricular dilation and impaired contraction that is not explained by abnormal loading conditions (for example, hypertension and valvular heart disease) or coronary artery disease. Mutations in several genes can cause DCM, including genes encoding structural components of the sarcomere and desmosome. Nongenetic forms of DCM can result from different aetiologies, including inflammation of the myocardium due to an infection (mostly viral); exposure to drugs, toxins or allergens; and systemic endocrine or autoimmune diseases. The heterogeneous aetiology and clinical presentation of DCM make a correct and timely diagnosis challenging. Echocardiography and other imaging techniques are required to assess ventricular dysfunction and adverse myocardial remodelling, and immunological and histological analyses of an endomyocardial biopsy sample are indicated when inflammation or infection is suspected. As DCM eventually leads to impaired contractility, standard approaches to prevent or treat heart failure are the first-line treatment for patients with DCM. Cardiac resynchronization therapy and implantable cardioverter–defibrillators may be required to prevent life-threatening arrhythmias. In addition, identifying the probable cause of DCM helps tailor specific therapies to improve prognosis. An improved aetiology-driven personalized approach to clinical care will benefit patients with DCM, as will new diagnostic tools, such as serum biomarkers, that enable early diagnosis and treatment.

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Acknowledgements

This work was partly supported by NIH R01 HL111938, NIH R21 ES024414 and American Heart Association grant AHA 16GRNT30950007 to D.F., and by ERA-Net grant on Cardiovascular Diseases (ERA-CVD; JTC2016-40-158), and grants of the German Research Foundation (DFG), Transregional Collaborative Research Center (CRC TR19) to H.P.S and F.E.

Reviewer information

Nature Reviews Disease Primers thanks S. Morimoto, B. Pinamonti, Y. Sawa and the other anonymous reviewer(s), for their contribution to the peer review of this work.

Author information

Introduction (H.-P.S. and P.P.L.); Epidemiology (S.E.L. and D.F.); Mechanisms/pathophysiology (R.E.H., P.P.L., A.L.P.C. and D.F.); Diagnosis, screening and prevention (H.-P.S. and F.E.); Management (J.M., H.-P.S., A.Maz. and S.G.P.); Quality of life (H.-P.S. and F.E.); Outlook (A.Mat.); Overview of Primer (H.-P.S. and D.F.).

Competing interests

All authors declare no competing interests.

Correspondence to Heinz-Peter Schultheiss or DeLisa Fairweather.

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Fig. 1: Epidemiology of cardiomyopathy.
Fig. 2: Genetic causes of dilated cardiomyopathy.
Fig. 3: Echocardiography and endomyocardial biopsy in dilated cardiomyopathy.
Fig. 4: Cardiac MRI.
Fig. 5: Differential diagnosis of the underlying causes of dilated cardiomyopathy.
Fig. 6: Algorithm for the management of dilated cardiomyopathy.