Genetic testing in cardiomyopathies: updates and future perspectives

Cardiomyopathies are a heterogeneous group of cardiac disorders with significant morbidity and mortality that often manifest as heart failure or sudden cardiac death. Although these conditions can be influenced by environmental factors, genetic causes play a critical role, with both Mendelian and non-Mendelian inheritance patterns contributing to their development. Advances in genetic testing have transformed clinical practice, offering new opportunities for diagnostic and prognostic characterization of cardiomyopathies, and supporting personalized interventions based on genetic profiles. This review explores the diagnostic utility of genetic testing for some specific cardiomyopathies and the complex prognostic insights it provides, especially for assessing arrhythmic risk and guiding implantable cardioverter defibrillator (ICD) implantation in primary prevention. In addition, the review highlights the emerging potential of gene-targeted therapies, which aim to improve outcomes for patients with variants in specific genes. As inherited cardiomyopathies often exhibit familial patterns, genetic testing is also crucial in family screening and management, enabling tailored monitoring and care. Recognizing the challenges posed by phenotypic variability and the interplay of genetic, comorbid, and lifestyle factors, this review emphasizes the need for a deeper understanding of these complexities to optimize precision medicine approaches in the care of inherited cardiomyopathies.