LAUSR

Dilated cardiomyopathy (DCM) is characterised by dilatation and systolic dysfunction of the ventricles in the absence of significant abnormalities in loading conditions or coronary artery disease.1 DCM affects approximately one in 2500–3000 people, with the predominance of male sex, and represents an important cause of advanced heart failure, as well as the leading indication for heart transplantation, especially in the young and middle-aged adults.2 Owing to the progress in the management of heart failure over the last three decades, the overall survival of patients with DCM has considerably improved with appropriate treatment.2,3 Hence, a timely diagnosis and in-depth aetiological assessment may influence the choice and response to treatment, and long-term prognosis. Although the assessment of DCM often involves a range of diagnostic procedures (e.g. echocardiography, cardiac magnetic resonance imaging, endomyocardial biopsy, genetic testing, etc.), the 12-lead electrocardiogram (ECG) represents the common starting point, and an integral part of diagnostic and follow-up evaluation of all patients. Of note, ECG is rarely normal in DCM, and despite low specificity of ECG abnormalities, a knowledgeable ECG interpretation can provide a myriad of clues useful to guide further assessment and risk stratification.4 This important topic is analysed in the current issue of the Journal by Finocchiaro et al.5 who provide an overview of ECG abnormalities pertinent to practical evaluation of DCM patients. Firstly, this comprehensive review deals with how to systematically read an ECG in search of ‘red flags’ that should raise a suspicion of DCM in patients presenting without prior history of a cardiomyopathy. It has been indicated that certain ECG ‘red flags’ deserve deeper analysis according to the clinical context. The most common ‘red flags’