[Diagnostic and prognostic value of the resting ECG in structural heart disease]

The 12-lead resting electrocardiogram (ECG) remains a central tool in the diagnosis and risk stratification of structural heart disease despite significant advances in cardiac imaging. This review highlights the role of the resting ECG in ischemic cardiomyopathy, hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), including its differentiation from cardiac sarcoidosis, as well as in genetically determined forms of dilated cardiomyopathy (DCM) and nondilated left ventricular cardiomyopathy (NDLVC). Characteristic electrocardiographic patterns not only facilitate identification of the underlying myocardial substrate but also provide prognostically relevant information regarding arrhythmic events and sudden cardiac death. Particularly in genetic cardiomyopathies, electrical abnormalities may precede overt structural manifestations, thereby enabling early phenotypic characterization. Despite the limited sensitivity of individual parameters, the resting ECG remains a widely available, cost-effective, and clinically highly relevant instrument that constitutes an integral component of contemporary guideline recommendations.