Challenges in diagnosis and prognosis of Dilated cardiomyopathy with cardiac MRI

Anastasia Perdika, Georgios Delimpasis, Anastasios Gyftopoulos


Dilated Cardiomyopathy (DCM) is the final response of the myocardium to several conditions, in most cases related to genetic or inflammatory factors, which lead to progressive left ventricular wall thinning and dilation, myocardial fibrosis, and cardiac dysfunction.

DCM is the third most common cause of heart failure (after ischemia and valvular heart disease) and the most common cardiomyopathy (other types: hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathies). It is end-stage cardiomyopathy, predominantly involving the left ventricle.

Evaluation of the etiology by excluding other causes of LV dilation and dysfunction, may lead to the appropriate therapeutic protocol and contribute to prognosis.

Detection of pre-DCM phenotype may reduce morbidity and mortality.

The aim of surveillance and therapy in each stage of DCM is to prevent remodeling, assess reverse remodeling, and avoid adverse events, especially sudden cardiac death.

Cardiac MRI (CMR) has a major role in diagnosis, prognosis, and selection of therapeutic schema. It is the gold-standard technique to measure chamber dimensions, to assess morphological features, systolic function, and valve disease. Also, tissue characterization may exclude ischemia as well as detect myocardial fibrosis which leads to arrhythmias and heart failure.

In this article, we discuss the predictive value of Cardiac Magnetic Resonance (CMR) for the evaluation of etiology, detection of pre-clinical DCM, assessment of left ventricular dysfunction, cardiac remodeling, and myocardial fibrosis, aspects that give a prognosis of sudden cardiac death and also guidance in the decision for device therapy.


Dilated Cardiomyopathy , Cardiac MRI, Cardiomyopathies, Heart failure

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