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European task force reclassification of dilated and non-dilated cardiomyopathies identifies a high arrhythmic-risk

Francesca Bonanni1, Ignazio Alessio Gueli2, Irina Bellisario3

  • 1Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.

International Journal of Cardiology
|November 7, 2025
PubMed

Insights

The European Task Force Criteria identified an overlapping cardiomyopathy phenotype with higher arrhythmic risk. This highlights the importance of multiparametric approaches for improved risk stratification in patients with cardiomyopathies.

Area of Science:

  • Cardiology
  • Genetics
  • Medical Diagnostics

Background:

  • Classifying left ventricular cardiomyopathies is complex due to evolving definitions and overlapping phenotypes.
  • The European Task Force Criteria refine arrhythmogenic cardiomyopathy diagnosis using structural, functional, arrhythmic, and genetic data.
  • This study aimed to characterize genotype-phenotype features in arrhythmogenic left ventricular/biventricular cardiomyopathy (ALVC/ABVC), dilated cardiomyopathy (DCM), and their overlap.

Purpose of the Study:

  • To reclassify patients with DCM or non-dilated left ventricular cardiomyopathy (NDLVC) using the European Task Force Criteria.
  • To identify and characterize an overlapping DCM-ALVC/ABVC phenotype.
  • To assess the genotype-phenotype correlation and clinical outcomes in these patient groups.

Main Methods:

  • Retrospective evaluation of 306 patients with DCM or NDLVC.
  • Reclassification into isolated DCM, isolated ALVC/ABVC, and DCM-ALVC/ABVC overlapping phenotypes based on European Task Force Criteria.
  • Exclusion of NDLVC not meeting criteria and isolated arrhythmogenic right ventricular cardiomyopathy; composite endpoint of cardiac death, VT, or VF.

Main Results:

  • 66 patients were categorized as DCM, 79 as ALVC/ABVC, and 76 as DCM-ALVC/ABVC.
  • Genetic variants were more frequent in ALVC/ABVC (50.6%) than DCM (28.8%) and DCM-ALVC/ABVC (27.6%).
  • DCM-ALVC/ABVC patients showed extensive LGE, higher NT-proBNP, increased arrhythmic burden, and significantly lower event-free survival.

Conclusions:

  • The European Task Force Criteria successfully identified an overlapping phenotype with increased arrhythmic risk.
  • Multiparametric diagnostic approaches are clinically valuable for improved risk stratification.
  • These findings support tailored therapeutic decisions for patients with cardiomyopathies.
Abstract

Keywords:
Arrhythmogenic cardiomyopathyCardiac magnetic resonanceDilated cardiomyopathyEuropean task force criteriaRisk stratification

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