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Unless contraindicated due to renal insufficiency (estimated glomerular filtration rate Right-sided heart catheterisation was performed using a Swan-Ganz pulmonary artery thermodilution catheter (Baxter Health Care Corp, Santa Ana, California, USA).Intracardiac pressures were recorded, and cardiac output was measured by the thermodilution technique.We did not exclude patients with well-controlled diabetes mellitus or well-controlled hypertension in the absence of concentric left ventricular hypertrophy.

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Endomyocardial specimens obtained for light microscopy were fixed with formalin, embedded in paraffin, sliced into 5 μm sections, and stained with H&E as well as haematoxylin phloxine saffron and Congo stains for light microscopic examination.The value of employing each of these modalities in patients with initially unexplained dilated cardiomyopathy, and in particular the value of a comprehensive, multimodality work-up, has not been systematically investigated.We aimed to evaluate the diagnostic yield and therapeutic consequences of a multimodality diagnostic investigation, beyond physical examination, echocardiography, coronary angiography and blood tests, in a contemporary cohort of patients with ‘idiopathic’ dilated cardiomyopathy.In 10 patients (10%), a possibly disease-causing mutation was detected.2 patients were found to have non-compaction cardiomyopathy based on MRI findings; 2 patients had systemic inflammatory disease with cardiac involvement; and in 1 patient, cardiac amyloidosis was diagnosed by endomyocardial biopsy.Endomyocardial biopsies were obtained from the right ventricular side of the myocardial septum for viral genome detection, and conventional and electron microscopy.Total nucleic acid was extracted from endomyocardial biopsies.We aimed to assess the value of diagnostic testing beyond careful physical examination, blood tests, echocardiography and coronary angiography.Methods From October 2008 to November 2012, we prospectively recruited 102 patients referred to our tertiary care hospital with a diagnosis of ‘idiopathic’ DCM based on patient history, physical examination, routine blood tests, echocardiography and coronary angiography.Ischaemic, hypertensive and primary valvular heart disease were excluded by patient history, physical examination, angiography and echocardiography prior to inclusion.Patients with a known or suspected cause of cardiomyopathy, including acute or prior myocarditis; an implantable cardiac device; or severe concomitant disease were excluded.

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