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Arrhythmic genotypes in dilated cardiomyopathy and risk of advanced heart failure

Nerea Mora-Ayestarán1,2,3, Juan Pablo Ochoa4, Cristina Gómez-González2,3,5,6,7

  • 1Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Manuel de Falla 1, Majadahonda, 28222 Madrid, Spain.

European Heart Journal
|August 29, 2025
PubMed

Insights

Patients with high-risk dilated cardiomyopathy (DCM) genotypes face increased advanced heart failure (AHF) events. This finding suggests tailored therapies for DCM patients beyond preventing sudden cardiac death.

Area of Science:

  • Cardiology
  • Genetics
  • Heart Failure Research

Background:

  • Dilated cardiomyopathy (DCM) has genetic subtypes with varying risks.
  • The association between high-risk arrhythmic genotypes and advanced heart failure (AHF) complications in DCM is not well understood.

Purpose of the Study:

  • To investigate if DCM patients with high-risk arrhythmic genotypes experience more AHF events.
  • To analyze the relationship between DCM genotype and AHF complications.

Main Methods:

  • A cohort of 1203 genotyped DCM patients was analyzed.
  • Patients were categorized into high-risk arrhythmic genotypes, TTN variants, other gene variants, and genotype-negative groups.
  • Primary endpoint: composite of AHF events (device implantation, transplant, mortality); Secondary endpoint: malignant ventricular arrhythmias (MVA).

Main Results:

  • 15.4% of patients had high-risk arrhythmic genotypes.
  • High-risk genotype patients showed a significantly higher incidence of AHF events (24.3%) compared to other groups (10.1-18.7%).
  • High-risk arrhythmic genotype was an independent predictor of AHF and MVA.

Conclusions:

  • DCM patients with high-risk arrhythmic genotypes experience a greater burden of AHF events.
  • These findings support the need for distinct therapeutic strategies for this patient subgroup, extending beyond arrhythmia management.
Abstract

Keywords:
Dilated cardiomyopathyGenesHeart failurePrognosisSudden cardiac death

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