AIM: To study the pathological features of the dilated cardiomyopathy and the mechanisms involved. METHODS: The left ventricular myocardium specimens were obtained from 8 patients with dilated cardiomyopathy by BATISTA. The morphological changes was examined macropathologically and histopathologically. RESULTS: The dilated cardiomyopathy from 8 patients can be classified into two types macropathology. One of them showed hypertrophy of left ventricular wall and the other showed fatty infiltration on myocardium of the left ventricular. In the first type, swelling of the endothelial cells as well as luminal stenosis even occlusive of small arteries and arterioles were observed in the study. Electronical microscopical examination showed that there were a lot of homogeneous secretory granules in the endothelial cells. CONCLUSION: These results suggested that the secretory granules might be from the damaged myocardial cells and entered into the adjacent endothelial cells. The pathological changes mentioned above could aggravate the ischemia of myocardium. At the same time, the vicious cycle make the pathological changes more serious. Further study should be made to confirm the nature of the secretory granules.