Diagnosis and management of dilated cardiomyopathy: a systematic review of clinical practice guidelines and recommendations

Abstract

Dilated cardiomyopathy (DCM) is extensively discussed in numerous expert consensus documents and international guidelines, with differing recommendations. To support clinicians in daily practice and decision-making, we conducted a systematic review of key guidelines and recommendations concerning the diagnosis and clinical management of DCM. Our research encompassed MEDLINE and EMBASE databases for relevant articles published, as well as the websites of relevant scientific societies. We identified two guidelines and one scientific statement that met stringent criteria, thereby qualifying them for detailed systematic analysis. Our review revealed consensus on several key aspects: the definition of DCM, the use of B-type natriuretic peptides and high-sensitivity troponin in laboratory testing, the essential role of multimodality cardiovascular imaging for initial diagnosis, genetic counselling, and the management of advanced disease. Nonetheless, notable areas of variation included the formation of multidisciplinary management teams, the role of cascade genetic testing, pathways for arrhythmic risk stratification, and the criteria for prophylactic defibrillator implantation. Significant evidence gaps persist, particularly regarding the clinical trajectory of genetic, non-genetic and gene-elusive forms of DCM, the use of cardiovascular magnetic resonance in phenotype-negative family members with genotype-positive probands, and the development of potential aetiology-oriented therapies. Addressing these gaps could enhance clinical outcomes and inform future research directions and guideline development.

Keywords: Cardiogenetics; Dilated cardiomyopathy; Guidelines recommendations; Multimodality cardiovascular imaging; Risk stratification.

Figure 1

Summary of guideline search and review process. AGREE II, Appraisal of Guidelines for Research and Evaluation II.

Figure 2

Summary of clinical practice guidelines and recommendations on dilated cardiomyopathy diagnosis and management. CMR, cardiovascular magnetic resonance; CT, computed tomography; DCM, dilated cardiomyopathy; G, genotype; HF, heart failure; ICD, implantable cardioverter defibrillator; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; MMI, multimodality imaging; P, phenotype; SCD, sudden cardiac death; VUS, variant of unknown significance.