title: [Dilated cardiomyopathy: a dynamic disease - clinical course, reverse remodeling and prognostic stratification].
abstract: Dilated cardiomyopathy (DCM) is a relatively rare primary heart muscle disease with genetic or post-inflammatory etiology. In the last decade, the incidence and prevalence of the disease have significantly increased as a consequence of an earlier diagnosis supported by extensive familial screening programs and by the improvement in diagnostic techniques. Moreover, current therapeutic strategies have deeply modified the prognosis of DCM with a dramatic reduction in mortality. A significant number of patients with DCM present an impressive response to pharmacological and non-pharmacological therapy in terms of left ventricular reverse remodeling (reduction in ventricular size with improvement of systolic function), which confers a more favorable prognosis in the long term. However, the identification of patients with an increased likelihood of improvement after therapeutic optimization remains a challenging issue; in particular the assessment of arrhythmic risk carries important implications. Finally, the long-term follow-up of patients showing a significant left ventricular functional recovery under optimal treatment is still poorly known. Hence, the aim of the present review is to provide an insight into the clinical evolution/long-term follow-up of DCM, which should be actually considered a dynamic process rather than a static and chronic disease. Left ventricular reverse remodeling should be considered a key therapeutic goal, mostly associated with a long-standing recovery, but cannot be considered the expression of permanent "healing", confirming the need for a systematic and careful follow-up over time in this setting.
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Marta
authors.initials: M
authors.lastname: Gigli
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Stefano
authors.initials: S
authors.lastname: Poli
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Davide
authors.initials: D
authors.lastname: Stolfo
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Francesca
authors.initials: F
authors.lastname: Brun
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Gerardina
authors.initials: G
authors.lastname: Lardieri
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pivetta
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Vitrella
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Dipartimento Cardiovascolare e Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, A.O.U. "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D042241:Early Diagnosis; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008403:Mass Screening; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020257:Ventricular Remodeling