Dilated Cardiomyopathies: Comprehensive Overview and Clinical Experience from Our Cardiology Department

Background: Dilated cardiomyopathy (DCM) is a disease of the heart muscle characterized by dilatation of the left ventricle (LV) associated with systolic dysfunction, in the absence of a clear triggering factor. Study Objective: To determine the epidemiological, clinical, paraclinical and therapeutic aspects of patients with DCM. Patients and Methods: Our series is a retrospective, descriptive and analytical study based on records of patients with dilated cardiomyopathy hospitalized in the cardiology department of the MHA, over a 2-year period from January 1, 2021 to January 1, 2023. Results: Ninety-one patients were enrolled. The sex ratio M/F was 3.7. The mean age was 66 years. The majority of patients had more than 3 cardiovascular risk factors. The most common clinical manifestations were those of right heart failure. The electrocardiogram showed various non-specific abnormalities, dominated by rhythm disorders (90%), conduction disorders (56%) and electrical cavitary hypertrophy (90%). Chest radiography revealed cardiomegaly in all patients, with a mean cardiothoracic index of 0.62. On echocardiography, the mean left ventricular EDD was 65.2 mm, the ejection fraction had a mean value of 33%, valvular diseases was found in the majority of patients (78%), and global hypokinesia was present in 63 patients. Regarding the right ventricular function, the mean TAPSE and PAPs were 18.4 mm and 45.5 mm Hg respectively. The most frequent etiology in our series was ischemic heart disease with a rate of 48.4%, followed by rhythmic origin in 17.5%, then valvular disease in 12.08%. Other etiologies were systemic lupus erythematosus in 4 patients, mixed connectivitis in 2 patients, while Behçet's disease, hypocalcemia, radiotherapy, post partum, post covid, and celiac disease were found in only one patient. Treatment was based mainly on the management of heart failure. All patients were treated with dietetic measures, 97.8% with diuretics, 83.5% with ACE inhibitors, 75.8% with beta-blockers and 39.5% with ISGLT2. Treatment of the underlying etiology was initiated in conjunction with treatment of heart failure. The outcome was generally favorable in 59% of cases and unfavorable in 33%. Four deaths occurred, including two following a sustained ventricular tachycardia that did not recover despite CPR measures, and two due to refractory cardiogenic shock following acute decompensation of their heart failure. Conclusion: At the end of this study, we highlight the importance of early diagnosis of this pathology in improving the long-term prognosis of patients. The key issue is etiological diagnosis, based on biological and radiological tests, with MRI playing an important role in positive diagnosis and etiological orientation. Management is mainly based on the treatment of heart failure associated with the treatment of the etiology.