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NDLVC Classification — EECC MCQ

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ModerateCardiomyopathyNDLVC ClassificationEECC

A 45-year-old man presents with new-onset HF. Echocardiography shows severe biventricular dilatation (LVEF 18%, RVEF 25%) with no regional wall motion abnormalities. Coronary angiography is normal. CMR shows diffuse fibrosis with elevated T1 and ECV but no focal LGE. The 2023 ESC Cardiomyopathy Guidelines use a new classification term. What replaces the old 'idiopathic DCM' label?

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Correct answer: E — Non-dilated left ventricular cardiomyopathy (NDLVC) is a new category for LV dysfunction without dilatation; however, this patient with biventricular dilatation and dysfunction would still be classified as DCM — the guidelines now use a genotype-phenotype approach rather than morphological labels alone

The 2023 ESC Cardiomyopathy Guidelines introduced a phenotype-first classification approach: (1) HCM phenotype (hypertrophied, non-dilated LV); (2) DCM (dilated LV with systolic dysfunction); (3) NDLVC (non-dilated left ventricular cardiomyopathy) — a NEW category for patients with LV systolic dysfunction or non-ischaemic LV scar but WITHOUT LV dilatation (encompasses some patients previously labelled 'idiopathic DCM' or early ARVC/ALVC); (4) ARVC; (5) RCM (restrictive). Each phenotype is then aetiologically characterised using genetics, CMR, and other tools. This patient has classic DCM (biventricular dilatation with systolic dysfunction). NDLVC specifically describes the phenotype where dysfunction or scar is present without dilatation.

Reference: ESC (2023): Guidelines on Cardiomyopathies