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It has progressively transitioned from one predominantly based on clinical evaluation and conventional imaging towards an integrated and multidimensional approach that incorporates advanced imaging techniques, tissue characterization, and comprehensive genetic testing. In this perspective, the current classification of cardiomyopathies, from the European Society of Cardiology, has introduced the new entity of non-dilated left ventricular cardiomyopathy (NDLVC) that encompasses a spectrum of diseases from hypokinetic non-dilated forms [formerly called dilated cardiomyopathies (DCMs)] to non-hypokinetic non-dilated forms, characterized by left ventricular scar (previously called arrhythmogenic cardiomyopathies). However, the pivotal principle of the new classification is that the phenotype should be considered the starting point of a dynamic diagnostic pathway rather than its ultimate definition. Contemporary evaluation of patients with DCM and NDLVC requires a longitudinal and integrative perspective in which clinical features, imaging markers, and molecular data converge to refine disease characterization. Stated that, several aspects warrant further refinement. Arrhythmic risk stratification of DCM and NDLVC remains incompletely delineated, reflecting the complex and heterogeneous nature of the underlying arrhythmogenic substrate and its variable expression across different stages of the diseases. In addition, a proportion of patients remain genetically elusive despite extensive testing, underscoring the need for deeper molecular insights. At the same time, the expanding recognition of genotype-positive\/phenotype-negative individuals introduces clinical scenarios that are not yet fully delineated, particularly with regard to surveillance strategies and preventive decision-making.<\/jats:p>\n                  <jats:p>This review paper aims to provide a structured and evidence-informed framework to guide personalized management of DCM and NDLVC, starting from the phenotype towards precision medicine.<\/jats:p>","DOI":"10.1093\/ejhf\/xuag224","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:01:11Z","timestamp":1785585671000},"source":"Crossref","is-referenced-by-count":0,"title":["Integrating genetics and phenotyping in clinical management of dilated and non-dilated left ventricular cardiomyopathy"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4775-9140","authenticated-orcid":false,"given":"Rudolf A","family":"de Boer","sequence":"first","affiliation":[{"name":"Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Chaloupka","sequence":"additional","affiliation":[{"name":"1st Department of Internal Medicine\u2014Cardiology, St Anne\u2019s University Hospital and Medical Faculty Masaryk University , Brno ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Cowley","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Brompton & Harefield Hospitals, Part of Guy\u2019s & St Thomas\u2019 NHS Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Madrid , Madrid ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3360-3548","authenticated-orcid":false,"given":"Piero","family":"Gentile","sequence":"additional","affiliation":[{"name":"De Gasperis Cardio Center, Transplant Center, Niguarda Hospital , Milano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P","family":"Halliday","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Royal Brompton and Harefield Hospitals , London ,","place":["UK"]},{"name":"National Heart and Lung Institute, Imperial College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9477-7803","authenticated-orcid":false,"given":"Stephane","family":"Heymans","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht ,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruxandra O","family":"Jurcut","sequence":"additional","affiliation":[{"name":"Expert Center for Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases \u201cProf. Dr. C.C. 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