Diagnostic Challenges and Evaluation of Dilated Cardiomyopathy in Elderly Patients: A Comprehensive Review

Abstract

Dilated cardiomyopathy (DCM) represents a significant cardiovascular challenge in the elderly population, characterized by left ventricular dilatation and systolic dysfunction. The clinical presentation in elderly patients differs substantially from younger cohorts, featuring atypical symptoms, delayed diagnosis, and complex interplay with age-related cardiac changes and multiple comorbidities. Elderly patients frequently present with nonspecific symptoms such as fatigue, cognitive decline, and falls rather than classic dyspnea, complicating early recognition. Diagnostic evaluation requires careful interpretation of electrocardiography, echocardiography, cardiac biomarkers, and advanced imaging modalities, considering age-specific reference ranges and confounding factors. Differential diagnosis must exclude ischemic cardiomyopathy, cardiac amyloidosis, hypertensive heart disease, and valvular abnormalities – conditions that frequently coexist with or mimic DCM in the elderly. Diagnostic red flags requiring specific evaluation include low-voltage electrocardiography with ventricular hypertrophy, unexplained conduction disease, recent chemotherapy exposure, and multisystem symptoms suggesting infiltrative disease. Prognostic assessment incorporates frailty, comorbidity burden, and competing mortality risks alongside traditional cardiac risk factors. Understanding these distinctive features is essential for optimizing diagnostic accuracy and clinical outcomes in elderly DCM patients. This review synthesizes current evidence on epidemiology, pathophysiology, clinical manifestations, diagnostic criteria, imaging approaches, and differential diagnosis of DCM specific to elderly patients (≥65 years), providing a practical framework for clinicians navigating the diagnostic complexities inherent to this population.