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2 Ferroptosis and its link to DCM Ferroptosis is a form of programmed cell death driven by the excessive accumulation of iron ions within cells, triggering the Fenton reaction, activating oxidative stress, and disrupting lipid metabolism, ultimately leading to cellular demise ( Acyl-CoA synthetase long-chain family member 4 (ACSL4) is a key enzyme involved in the synthesis of polyunsaturated fatty acid phosphatidylethanolamine (PUFA-PE) ( In patients with DCM, the GSH-dependent antioxidant mechanism is suppressed, whereas ACSL4 activation promotes ferroptosis in myocardial cells ( In the development of DCM, sustained hyperglycemia acts as a key driver of ferroptosis