Muntean Iolanda, Hack Beatrix-Jullia, Hagau Asmaa Carla
Department of Paediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540136 Targu Mures, Romania.
Clinic of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mureș, 540139 Targu Mures, Romania.
J Cardiovasc Dev Dis. 2025 Sep 12;12(9):351. doi: 10.3390/jcdd12090351.
Pediatric dilated cardiomyopathy (DCM) is a rare but important cause of heart failure (HF) and a major indication for cardiac transplantation. Early detection of subclinical myocardial dysfunction is essential for risk stratification and management. This study aimed to evaluate left ventricular (LV) systolic function in children with DCM using conventional echocardiographic parameters and speckle-tracking echocardiography (STE) and to explore the relationship between deformation indices, clinical severity and biomarkers. We conducted a case-control study including 29 children diagnosed with DCM and 27 healthy controls matched by age and sex. All participants underwent clinical evaluation, NT-proBNP measurement, and transthoracic echocardiography. LV systolic function was assessed using conventional echocardiographic parameters, while STE was used to measure LV global longitudinal strain (GLS) and strain rate (SR) from all apical views. GLS and SR were significantly reduced in the DCM group across all apical views (Global GLS: -11.13 ± 6.79% vs. -19.98 ± 3.25%, Global SR: -0.74 ± 0.39 s vs. -1.12 ± 0.16 s; < 0.01). GLS strongly correlated with functional indices (LV ejection fraction, shortening fraction, S' lateral wave), LV end-diastolic diameter Z-score and NT-proBNP ( < 0.05), but not with MAPSE. In the primary model, GLS was associated with NYHA/Ross III-IV (OR 1.54 per 1% increase; 95% CI 1.14-2.07; = 0.005); adding systolic blood pressure ( = 0.798) or heart rate ( = 0.973) did not materially change the GLS estimate (Δ ≤ 2%). In separate collinearity-avoiding models, LVEF (OR 1.12 per 1% decrease; 95% CI 1.03-1.22; = 0.009), LVSF (OR 1.19 per 1% decrease; 95% CI 1.04-1.36; = 0.011), and NT-proBNP (≈OR 1.11 per 100 units; = 0.013) were also associated with advanced class. ROC analysis showed excellent discrimination for NT-proBNP (AUC 0.948) and GLS (AUC 0.906), and good-excellent performance for LVEF (AUC 0.869) and LVSF (AUC 0.875). Speckle-tracking derived parameters such as GLS and SR are sensitive and clinically relevant markers of LV dysfunction in pediatric DCM. Global longitudinal strain demonstrated a strong association with both clinical and biochemical markers of disease severity, after accounting for heart rate and blood pressure, supporting its integration into routine evaluation and risk stratification in pediatric DCM.
小儿扩张型心肌病（DCM）是心力衰竭（HF）的一个罕见但重要的病因，也是心脏移植的主要指征。亚临床心肌功能障碍的早期检测对于风险分层和管理至关重要。本研究旨在使用传统超声心动图参数和斑点追踪超声心动图（STE）评估DCM患儿的左心室（LV）收缩功能，并探讨变形指数、临床严重程度和生物标志物之间的关系。我们进行了一项病例对照研究，包括29例诊断为DCM的儿童和27例年龄和性别匹配的健康对照。所有参与者均接受临床评估、NT-proBNP测量和经胸超声心动图检查。使用传统超声心动图参数评估LV收缩功能，而STE用于从所有心尖视图测量LV整体纵向应变（GLS）和应变率（SR）。在所有心尖视图中，DCM组的GLS和SR均显著降低（整体GLS：-11.13±6.79%对-19.98±3.25%，整体SR：-0.74±0.39 s对-1.12±0.16 s；P<0.01）。GLS与功能指标（LV射血分数、缩短分数、S'侧壁波）、LV舒张末期直径Z评分和NT-proBNP密切相关（P<0.05），但与MAPSE无关。在主要模型中，GLS与NYHA/Ross III-IV相关（每增加1%，OR为1.54；95%CI为1.14-2.07；P=0.005）；添加收缩压（P=0.798）或心率（P=0.973）并未实质性改变GLS估计值（Δ≤2%）。在单独的避免共线性模型中，LVEF（每降低1%，OR为1.12；95%CI为1.03-1.22；P=0.009）、LVSF（每降低1%，OR为1.19；95%CI为1.04-1.36；P=0.011）和NT-proBNP（每100单位约为OR 1.11；P=0.013）也与高级别相关。ROC分析显示NT-proBNP（AUC 0.948）和GLS（AUC 0.906）具有出色的鉴别能力，LVEF（AUC 0.869）和LVSF（AUC 0.875）具有良好至出色的性能。斑点追踪得出的参数如GLS和SR是小儿DCM中LV功能障碍的敏感且临床相关的标志物。在考虑心率和血压后，整体纵向应变与疾病严重程度的临床和生化标志物均显示出强烈关联，支持将其纳入小儿DCM的常规评估和风险分层。
