Autoimmunity and idiopathic dilated cardiomyopathy: where we stand?

Idiopathic dilated cardiomyopathy (DCM) with its heterogeneous phenotype and genotype remains one of the leading causes of severe heart failure particularly in the younger. Even in the elderly, it appears around 15% of heart failure is due to DCM. Despite great improvements in heart failure therapy, prognoses remains poor. One of the most important reasons is that the present heart failure management is aimed mostly at restoration of neurohormonal balance, rather than targeting primary causes of the disease. As a matter of fact, a substantial subgroup of DCM and chronic heart failure is accompanied by autoimmune mechanism, in particular a wide spectrum of autoantibodies. For almost two decades, the autoimmune hypothesis has been considered a "fairy tale". Today, we have better understanding of autoimmune mechanism in DCM. This focused issue is aimed to summarize what has happened in the last two decades in the context of basic understanding of underlying mechanisms and clinical relevance.