Dilated cardiomyopathy: Usefulness of imaging in prognostic stratification and choice of treatment

Abstract

Prognosis of idiopathic dilated cardiomyopathy (DCM) was once considered ominous. However, in the last 30 years, advancements in knowledge regarding the pathophysiology of heart failure (HF), earlier diagnosis, systematic long-term follow-up, and—mostly—the use of effective pharmacological and nonpharmacologic treatments have contributed to substantially improved survival rates. Evaluating left ventricular (LV) dimensions, systolic and diastolic function, and contractile reserve with echocardiography and/or cardiac magnetic resonance (CMR) can help in prognostic stratification. In the near future, the possibility of genotyping all patients could have a prognostic importance, allowing identification of some malignant mutations with higher mortality risk. A critical and still unresolved issue is early stratification of risk of sudden death (SD) and indication to implantable device therapy. SD can also occur in some apparently stable DCM patients. In this sense, some technologies such as T-wave alternans analysis and QT dynamicity are emerging but require further evidence before being routinely applied in clinical practice.