Clinical and animal studies are also needed to find novel therapies with improved efficacy and safety for cases of EMB-proven virus-negative autoimmune DCM with or without serum cardiac-specific autoantibodies. The management of DCM aims at reducing symptoms of heart failure and improving cardiac function (Fig. 6). The pivotal randomized controlled clinical trials that provided the evidence for the guidelines on the treatment of heart failure with reduced ejection fraction included a large proportion of patients with a non-ischaemic aetiology (that is, individuals who probably developed heart failure as a result of DCM).

Worsening of LV function or an increased ventricular arrhythmic burden can be caused not only by DCM progression but also by the development of new co-pathologies. Thus, the possible presence of coronary artery disease, hypertensive heart disease, structural valve disease or acute myocarditis should be systematically ruled out during follow-up. However, clinical and echocardiographical parameters have limited ability to predict long-term prognosis, suggesting that other host–environmental factors are important in determining the outcome of DCM.


In patients with biopsy-proven myocarditis, global longitudinal strain (longitudinal shortening as a percentage), which provides an accurate assessment of regional contractility, is significantly impaired compared with patients without inflammation151. The wide spectrum of potential causes of DCM and the often-slow progression from initiation of cardiac damage to eventual signs and symptoms of heart failure make intervening in the disease process early enough to prevent irreversible damage particularly challenging. Palpitations, dizziness, and syncope are common complaints and are frequently caused by arrhythmias (eg, atrial fibrillation, flutter) and premature contractions. In the setting of acute alcohol use or intoxication, this is called holiday heart syndrome, because the incidence is increased following weekends and during holiday seasons. Echocardiography is perhaps the most useful initial diagnostic tool in the evaluation of patients with heart failure. Because of the ease and speed of the test and its noninvasive nature, it is the study of choice in the initial and follow-up evaluation of most forms of cardiomyopathy.

  • Thus, the possible presence of coronary artery disease, hypertensive heart disease, structural valve disease or acute myocarditis should be systematically ruled out during follow-up.
  • The aims of the present study were to define the long-term outcome of ACM, to compare the patient characteristics between the death and survival groups, and to determine prognostic markers.
  • Depressed LV function has been reported in 4–9% of individuals who used cocaine and had cardiac symptoms116,117.
  • Askanas et al[21] found a significant increase in the myocardial mass and of the pre-ejection periods in drinkers of over 12 oz of whisky (approximately 120 g of alcohol) compared to a control group of non-drinkers.

Endomyocardial biopsy is important to determine the underlying cause of dilated cardiomyopathy. A | Active myocarditis with immune cell infiltration and myocytolysis (arrows), histological azan staining. B | Giant cell myocarditis with massive immune cell infiltration around multinuclear giant cells (arrows), histological haematoxylin and eosin (H&E) staining. C | Eosinophilic myocarditis with immune cell infiltration and eosinophils (arrows), histological H&E staining. D | Immunohistochemical staining depicting CD3+ T cells (red-brown staining) in a focal pattern in borderline myocarditis.

A single-center cohort study

Sudden cardiac death in DCM can be caused by electromechanical dissociation (pulseless electrical activity) or ventricular arrhythmias. The development of new LV branch block during follow-up is a strong independent prognostic predictor of all-cause mortality, and atrial fibrillation is a sign of structural disease progression and negatively affects the prognosis. Patients with DCM and haemodynamically relevant mitral regurgitation may need invasive therapies, such as percutaneous or open repair of the mitral valve, mechanical circulatory support or even heart transplantation. Whereas right ventricular function frequently recovers under therapy (typically within 6 months), the development of right ventricular dysfunction during long-term follow-up indicates structural disease progression and portends a negative outcome. Strategies to detect pre-symptomatic DCM have a clear rationale because early treatment can retard adverse remodelling, prevent heart failure symptoms and increase life expectancy. In addition, patients with DCM should be regularly re-assessed, particularly in the presence of cardiovascular risk factors.

natural history and prognostic factors in alcoholic cardiomyopathy

As DCM eventually leads to impaired contractility, standard approaches to prevent or treat heart failure are the first-line treatment for patients with DCM. Cardiac resynchronization therapy and implantable cardioverter–defibrillators may be required to prevent life-threatening arrhythmias. In addition, identifying the probable cause of DCM helps tailor specific therapies to improve prognosis. An improved aetiology-driven personalized approach to clinical care will benefit patients with DCM, as will new diagnostic tools, such as serum biomarkers, that enable early diagnosis and treatment.

Quantity of Alcohol Intake in Cardiac Disease

In these studies, haemodynamic and echocardiographic parameters were measured in individuals starting an alcohol withdrawal program. The findings were analysed taking into account the amount and chronicity of intake alcoholic cardiomyopathy is especially dangerous because and they were compared with the same parameters measured in a control group of non-drinkers. For many decades, ACM has been considered one of the main causes of left ventricular dysfunction in developed countries.

natural history and prognostic factors in alcoholic cardiomyopathy