Dilated cardiomyopathy (DCM) in children is associated with a substantial risk of progression to advanced heart failure (HF) and heart transplant (HTx), underscoring the need for reliable short-term prognostic markers. A prospective single-centre cohort study, published in Life, examined whether multichamber speckle-tracking echocardiography (STE) parameters and circulating biomarkers could identify children at higher risk of adverse outcomes within one year.
The study enrolled 29 children with idiopathic DCM and 27 matched healthy controls, all of whom underwent uniform clinical, laboratory, and echocardiographic evaluation.
The composite primary endpoint included implantable cardioverter-defibrillator (ICD) implantation, left-ventricular assist device (LVAD) implantation, HTx, or death within 12 months. Over the follow-up period, 9 children (31%) met this endpoint.
Children who experienced events had markedly worse myocardial deformation indices. Left ventricular global longitudinal strain (LVGLS) values were less negative compared with event-free patients and controls. Left atrial reservoir strain (LASr) was substantially reduced, and right ventricular free-wall longitudinal strain (RVFWSL) also showed impairment across the event group, with all comparisons reaching statistical significance (p < 0.01).
Biomarker analysis showed higher Zlog N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in those with events compared with both event-free patients and controls. Discriminatory performance for identifying 1-year events was strong for LVGLS and NT-proBNP, with area under the curve (AUC) values of 0.91, while LASr demonstrated an AUC of 0.87. Thresholds with clinical applicability included LVGLS ≥ −8%, Zlog NT-proBNP ≥ 4.6, and LASr ≤ 21%.
These findings indicate that combining strain-based imaging with biomarker assessment may help refine short-term risk stratification in pediatric DCM. The results support closer surveillance and earlier consideration of advanced HF therapies, while requiring confirmation in larger multicentre cohorts.
