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Determining aetiology in dilated cardiomyopathy - does the 'cardiomyopathy blood panel' ameliorate clinical
Robin Ap Weir1, Claire Millarvie1, Catherine Smith1
1NHS Lanarkshire, University Hospital Hairmyres, Glasgow, Scotland.
Insights
A blood panel helps identify causes of dilated cardiomyopathy (DCM) in heart failure patients. However, many DCM cases remain idiopathic even with extensive testing.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Dilated cardiomyopathy (DCM) can stem from various medical conditions.
- Etiological investigation for DCM varies among clinicians and is often incomplete.
- Assessing the utility of a standardized blood panel for identifying DCM causes is crucial.
Purpose of the Study:
- To evaluate the effectiveness of a pre-specified blood panel in diagnosing underlying causes of dilated cardiomyopathy (DCM).
- To determine the diagnostic yield of a comprehensive blood test in patients with non-ischaemic DCM and heart failure with reduced ejection fraction (HFrEF).
Main Methods:
- A cohort of 55 patients with non-ischaemic DCM and HFrEF was identified from a regional heart failure clinic.
- Patients underwent clinical assessment and a specific blood panel targeting potential DCM etiologies.
- Etiologies were documented post-clinical assessment and revised after blood panel review.
Main Results:
- In 55 patients, 52.7% of DCM cases were initially classified as idiopathic after clinical assessment.
- The most frequent specific causes identified were toxin-mediated (14.5%), genetic (12.7%), and inflammatory (10.9%).
- The blood panel led to reclassification of etiology in 5.4% of patients and identified unrelated conditions in 3.6%.
Conclusions:
- Dilated cardiomyopathy (DCM) frequently remains idiopathic, even after thorough clinical evaluation.
- An extensive blood panel can identify specific etiologies in a limited number of DCM cases.
- Further research may be needed to optimize etiological diagnosis in DCM.
Background:
An increasing number of medical conditions are recognised as causative factors in dilated cardiomyopathy (DCM). Investigating aetiology in DCM is variable in extent among cardiologists and often not performed. We assessed the usefulness of a pre-specified blood panel in identifying an underlying cause in a population of DCM patients.
Methods:
Non-ischaemic DCM patients were identified from sequential new patients with heart failure-reduced ejection fraction (HFrEF) at a regional HF clinic over a 2 year period. Each patient underwent clinical assessment and a blood panel related to causes of DCM. The likely aetiology was documented after initial assessment, and reclassified where relevant when the blood panel results were reviewed.
Results:
55 non-ischaemic DCM patients (mean age 63.4 [9.2]yr, 54.5% male) were identified from 259 HFrEF patients. Mean LVEF was 31.3 (4.3)%. After clinical assessment 29 (52.7%) were classified as idiopathic. The commonest specific aetiologies were toxin-mediated (n = 8, 14.5%), genetic (n = 7, 12.7%) and inflammatory (n = 6, 10.9%). Review of blood panels resulted in reclassification in 3 (5.4%) and detection of unrelated medical conditions in 2 (3.6%).
Conclusions:
Despite thorough clinical assessment, DCM remains idiopathic in at least half of cases. Adding an extensive blood panel identifies a specific aetiology in a small proportion of cases.
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