**6. Therapeutic Strategy for DCM**

Usually HF restricts the definition to the manifestation of clinical symptoms. Before clinical symptoms manifest, DCM progresses. Most of the DMD patients are asymptomatic for most of their life, so identifying precursors of the HF is crucial to manage this group. Demonstration of the ventricular dysfunction based on the assessment of ejection fraction help to guide therapy. DMD DCM really comprises a wide range of patients, from those with normal LVEF (typically considered as ≥50%) to those with reduced LVEF. Patients with an LVEF in the range of 40–49% represent a "grey area," considered as a mid-range of DCM. In the following section, we evaluate all cardiovascular drug therapies according to LVEF [49] (Figure 2).

**Figure 2.** Progression of DMD-DCM. According to clinical stage of the DMD-DCM, different strategy might be considered. ACE: Angiotensin Converting Enzyme; CRT: Cardiac Resyncronization Therapy; ICD: IntraCardiac Defibrillator; VAD: Ventricular Assist Device.
