Dilated Cardiomyopathy Medical Slides

Present a systematic algorithm: (1) exclude ischemic cause with coronary evaluation, (2) assess for reversible causes (thyroid, tachycardia-mediated, alcohol >80g/day, cocaine), (3) CMR with LGE for myocarditis, sarcoidosis, and iron overload patterns, (4) genetic testing if ≥2 family members affected or red flags (conduction disease, skeletal myopathy), (5) consider endomyocardial biopsy if giant cell myocarditis or eosinophilic myocarditis suspected.

LMNA mutations cause 6-8% of familial DCM but carry disproportionate risk of sudden death, malignant arrhythmias, and progressive conduction disease. Emphasize that ICD implantation is recommended at lower thresholds (LVEF <45% with NSVT or other risk factors) compared to other DCM etiologies. The 2022 ESC guidelines provide a specific LMNA risk calculator to guide ICD decisions, making genotype directly actionable.

Emphasize that 30-40% of recent-onset non-ischemic DCM shows significant LVEF improvement with GDMT over 6-12 months, termed "reverse remodeling." The TRED-HF trial showed that withdrawing GDMT after apparent recovery led to relapse in 44% of patients within 6 months, supporting lifelong therapy. Peripartum cardiomyopathy has the highest recovery rate (50-80%) and should be highlighted as a distinct entity.