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Myocardial disease
Clinical use of multimodality imaging in the assessment of dilated cardiomyopathy
  1. João Silva Marques,
  2. Fausto J Pinto
  1. Department of Cardiology, University Hospital Santa Maria, Lisbon Academic Medical Centre, CCUL, University of Lisbon, Lisbon, Portugal
  1. Correspondence to Professor Fausto J Pinto, Faculty of Medicine of Lisbon University, Cardiology Department, University Hospital Santa Maria/CHLN, Av Prof Egas Moniz, Lisbon 1649-028, Portugal; faustopin{at}gmail.com

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Scope of the problem and challenges to the clinician

Dilated cardiomyopathy (DCM) is a heart muscle disorder that frequently leads to heart failure. It is defined by the presence of left ventricular (LV) dilatation and LV systolic dysfunction in the absence of abnormal loading conditions or extensive coronary artery disease (CAD).1 In that regard, the accurate and reproducible assessment of cardiac dimensions and function is paramount, but there is also a need to fully characterise valve function and the presence and functional consequences of CAD. This is particularly important because coronary heart disease is considered the most frequent cause for finding a dilated, dysfunctional heart in clinical practice. Also, LV enlargement and dysfunction are late features of chronic volume or pressure overload that are seen in patients with severe valve disease. Therefore, multimodality cardiac imaging aims to correctly identify DCM from the wider pool of patients with reduced ejection fraction (EF).

The prevalence of DCM in the general population remains undefined but it is considered to be the most common cardiomyopathy worldwide,w1 with an estimated incidence of 4.5/100 000/year.w2 A broad spectrum of entities may cause DCM. Traditionally, familial and genetic causes were thought to account for a small percentage of cases but are now increasingly recognised.w3 The other aetiologies are grouped into non-familial DCM, that comprises idiopathic DCM when there is no identifiable cause, and acquired DCM, when ventricular dysfunction is a complication of other disorders that afflict the myocardium. Imaging modalities may contribute valuable information for reaching a probable diagnosis of acquired DCM.

The prognosis in patients with DCM and symptoms of heart failure is very poor.w4 However, the clinical course of the disease is not always predictable based on these variables. Indeed, EF is considered an important imaging measurement in DCM, not only because of its diagnostic and prognostic relevance but also …

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