Abstract: Primary cardiomyopathies were previously defined as primary myocardial disorders of unknown causes, in which the secondary effect of ischemia, hypertension, diabetes, and hyperthyroidism, etc. was excluded. The clinical diagnostic pathway was limited to describing the structural and functional abnormalities, such as dilatation, hypertrophy, restrictive cardiomyopathies, and systolic or diastolic heart failure. With the progression of diagnostic techniques, especially of high-resolution imaging and molecular precision medicine, the previous definition and pathway cannot satisfy clinical demands. Accordingly, large medical centers with sufficient equipment should adopt a new clinical diagnostic pathway including high-resolution imaging and genetic analysis in the new era, which would supply more precise information of cardiac images and particular genetic abnormalities. This new pathway will greatly help the radiomics analysis, gene therapy, the development of targeted drugs, and genetic counseling for patients with cardiomyopathies.