Modern Aspects of Diagnosis and Treatment of Dilated Cardiomyopathy With Remodeling of the Right Heart

Dilated cardiomyopathy (DCM) is the second most common cause of chronic heart failure, and a leading indication for heart transplantation. In the early stages of the disease, many patients are asymptomatic, but they have a high risk of developing life-threatening ventricular arrhythmias (VA) and sudden cardiac death (SCD). Modern methods of DCM diagnosis, such as MRI of the heart, speckle tracking and 3D echocardiography, have convincingly proved the development of structural and functional changes of the right heart (RH) in patients with DCM, their prognostic and therapeutic significance. By MRI of the heart, myocardial fibrosis (MF) is diagnosed, which occurs in the early stages of DCM. Progressive fibrosis is observed in one fifth of patients and is associated with a more than a 3-fold increase in the risk of death and complications of chronic heart failure (CHF). With adequate pharmacological and hardware treatment, reverse heart remodeling occurs in some patients. However, optimal and long-term drug therapy does not lead to MF regression even in individuals with improved left ventricular (LV) function. Remodeling of the RH, regardless of LV ejection fraction (EF), is a predictor of SCD, indicates the progression of the disease, foreshadowing an unfavorable outcome. The prevalence of RH remodeling has not been reliably determined; however, systolic dysfunction of the right ventricle was registered in 34-65% of patients with DCM. The annual and subsequent mortality of patients with DCM remains high.MRI of the heart with contrast enhancement has become the gold standard for the diagnosis of DCM and crucial for the stratification of risk and prognosis of the disease. The treatment of patients with DCM is a complex process. Adequate drug and instrumental therapy in 40% of cases leads to reverse remodeling of the heart, which may be unstable.