Moya-Ayestarán, NereaOchoa, Juan PabloGómez-González, CristinaNavarro-Peñalver, MarinaGallego-Delgado, MaríaLarrañaga Moreira, José MaríaRobles-Mezcua, AinhoaBasurte-Elorz, M. TeresaRodríguez-Palomares, José FernandoCliment-Payá, VicenteJiménez-Jáimez, JuanMogollón-Jiménez, María VictoriaGarcía-Granja, Pablo ElpidioGarcía-Álvarez, AnaPeña-Peña, María LuisaÁlvarez Barredo, MaríaRipoll-Vera, TomásPalomino-Doza, JuliánBayes-Genis, A.Tirón, ColomaFernández, Ana I.Sabater Molina, MaríaToranzo, InésCrespo-Leiro, María GenerosaDoncel-Abad, VictoriaLacuey-Lecumberri, GemmaLimeres-Freire, JavierGarcía-Álvarez, María I.Cabrera, EvaKounka-Ait El Maalem, ZinebVilches, SilviaGonzález-López, EstherVillacorta, EduardoGarcía-Pinilla, José ManuelBarriales-Villa, RobertoGimeno-Blanes, Juan RamónGarcía-Pavía, PabloDomínguez, Fernando2026-01-292026-01-292025-08-29Mora-Ayestarán N, Ochoa JP, Gómez-González C, Navarro-Peñalver M, Gallego-Delgado M, Larrañaga-Moreira JM, Robles-Mezcua A, Basurte-Elorz MT, Rodriguez-Palomares JF, Climent-Paya V, Jiménez-Jaímez J, Mogollón-Jiménez MV, García-Granja PE, García-Álvarez A, Peña-Peña ML, Alvarez Barredo M, Ripoll-Vera T, Palomino-Doza J, Bayes-Genis A, Tirón C, Fernández AI, Sabater-Molina M, Toranzo I, Crespo-Leiro MG, Doncel-Abad V, Lacuey-Lecumberri G, Limeres-Freire J, García-Álvarez MI, Cabrera-Borrego E, Kounka-Ait El Maalem Z, Vilches S, González-López E, Villacorta E, García-Pinilla JM, Barriales-Villa R, Gimeno-Blanes JR, Garcia-Pavia P, Domínguez F. Arrhythmic genotypes in dilated cardiomyopathy and risk of advanced heart failure. Eur Heart J. 2025 Dec 22;46(48):5222-5233.0195-668Xhttps://hdl.handle.net/2183/47144Multicenter study[Abstract] Background and aims: Certain genetic forms of dilated cardiomyopathy (DCM) entail a higher arrhythmic risk. It is unknown whether DCM patients with high-risk arrhythmic genotypes also develop more advanced heart failure (AHF) complications. AHF events were studied according to DCM genotype. Methods: Clinical data from 1203 genotyped DCM patients were collected from 19 Spanish centres. Patients were classified into high-risk arrhythmic genotypes (LMNA, FLNC, desmosomal genes, PLN, TMEM43, RBM20), TTN, other genes, and genotype negative (Gen-). The primary endpoint was a composite of AHF events (ventricular assist device implantation, heart transplant, and AHF-related mortality). The secondary endpoint was a combination of malignant ventricular arrhythmias (MVA). Results: A DCM-causing variant was identified in a high-risk arrhythmic gene in 185 patients (15.4%), 193 (16.0%) had variants in TTN, 134 (11.1%) in other genes, and 691 (57.4%) were Gen-. After a median follow-up of 5.7 years (interquartile range 2.9-9.1 years), AHF events occurred in 45 (24.3%) patients in the high-risk arrhythmic group, while in 25 (18.7%), 25 (13.0%), and 70 (10.1%) patients with other genotypes, TTN, and Gen-, respectively (hazard ratio 1.85, 95% confidence interval 1.31-2.61 for high-risk arrhythmic genes compared with other groups). MVA occurred in 55 patients (29.7%) (hazard ratio 2.52, 95% confidence interval 1.81-3.51 for high-risk genotypes vs other groups). High-risk arrhythmic genotype was the main independent predictor of AHF in multivariate analysis. High-risk arrhythmic genotype and late gadolinium enhancement were independent predictors of MVA. Conclusions: Patients with high-risk arrhythmic genotypes also experience more AHF events, supporting a differential therapeutic approach in this group of patients beyond sudden death prevention.engAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/Dilated cardiomyopathyGenesHeart failurePrognosisSudden cardiac deathjournal articleopen access10.1093/eurheartj/ehaf605