{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T13:21:46Z","timestamp":1771939306332,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014677","name":"\u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology from Targu Mures, Romania","doi-asserted-by":"publisher","award":["511\/5\/17.01.2022"],"award-info":[{"award-number":["511\/5\/17.01.2022"]}],"id":[{"id":"10.13039\/501100014677","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Dilated cardiomyopathy (DCM) in children is rare, but carries a high risk of progression to advanced heart failure (HF) and heart transplant (HTx). Improved short-term risk stratification is essential; however, robust pediatric prognostic tools remain limited. We aimed to evaluate the 1-year prognostic value of multichamber speckle-tracking echocardiography (STE) and biomarkers, including age-adjusted N-terminal pro-B-type natriuretic peptide (NT-proBNP) and vitamin D, in children with DCM. In this single-centre prospective cohort study, 29 children with idiopathic DCM and 27 age- and sex-matched healthy controls underwent standardised clinical, laboratory, and echocardiographic assessment. The primary endpoint was a 12-month composite of implantation of an implantable cardioverter-defibrillator (ICD), left-ventricular assist device (LVAD), HTx, or all-cause mortality. During a 1-year follow-up, 9\/29 (31%) DCM patients experienced major events. Compared with event-free patients and controls, children with events had more impaired LVGLS (\u22125.99 \u00b1 2.45% vs. \u221213.44 \u00b1 6.88% and \u221219.98 \u00b1 3.25%), lower LASr (10.97 \u00b1 7.67% vs. 25.36 \u00b1 10.28% and 44.0 \u00b1 11.43%), and reduced RVFWSL (\u221215.32 \u00b1 5.24% vs. \u221223.13 \u00b1 8.55% and \u221224.78 \u00b1 4.45%; all p &lt; 0.01). Zlog NT-proBNP was markedly higher in the event group (5.37 [5.00\u20136.08] vs. 2.28 [0.71\u20133.68] and 0.14 [\u22120.02\u20130.88]). LVGLS, Zlog NT-proBNP, and LASr showed excellent discrimination for 1-year events (AUC 0.91, 0.91, and 0.87, respectively), with clinically applicable cut-offs (LVGLS \u2265 \u22128%, Zlog NT-proBNP \u2265 4.6, LASr \u2264 21%). In conclusion, multichamber strain imaging combined with age-adjusted NT-proBNP provides clinically relevant, exploratory markers for short-term risk stratification in pediatric DCM, supporting earlier intensification of follow-up and timely referral for advanced heart failure therapies. These findings warrant validation in larger multicenter cohorts.<\/jats:p>","DOI":"10.3390\/life16030369","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T12:19:23Z","timestamp":1771935563000},"page":"369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multichamber Strain Imaging and Biomarker Profiling for 1-Year Risk Stratification in Pediatric Dilated Cardiomyopathy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9930-018X","authenticated-orcid":false,"given":"Iolanda","family":"Muntean","sequence":"first","affiliation":[{"name":"Department of Paediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Clinic of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mure\u0219, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1521-3503","authenticated-orcid":false,"given":"Asmaa-Carla","family":"Hagau","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Pediatric Clinical Hospital, 550106 Sibiu, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana-Ramona","family":"Iurian","sequence":"additional","affiliation":[{"name":"Clinic of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mure\u0219, 540139 Targu Mures, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrix Julia","family":"Hack","sequence":"additional","affiliation":[{"name":"Clinic of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mure\u0219, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Muntean","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horatiu","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Clinic of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mure\u0219, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1056\/NEJMoa021715","article-title":"The Incidence of Pediatric Cardiomyopathy in Two Regions of the United States","volume":"348","author":"Lipshultz","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1056\/NEJMoa021737","article-title":"The Epidemiology of Childhood Cardiomyopathy in Australia","volume":"348","author":"Nugent","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1161\/CIRCRESAHA.116.309386","article-title":"Pediatric Cardiomyopathies","volume":"121","author":"Lee","year":"2017","journal-title":"Circ. Res."},{"key":"ref_4","first-page":"1535","article-title":"Presentation diagnosis medical management of heart failure in children: Canadian Cardiovascular Society guidelines","volume":"29","author":"Kantor","year":"2013","journal-title":"Can. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.cardfail.2016.11.006","article-title":"Fibrosis and fibrotic gene expression in pediatric and adult patients with idiopathic dilated cardiomyopathy","volume":"23","author":"Woulfe","year":"2017","journal-title":"J. Card. Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.jcmg.2015.10.008","article-title":"Longitudinal Strain as Risk Factor for Outcome in Pediatric Dilated Cardiomyopathy","volume":"9","author":"Klitsie","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1002\/ehf2.13233","article-title":"Predicting outcome in children with dilated cardiomyopathy: The use of repeated measurements of risk factors for outcome","volume":"8","author":"Blom","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1007\/s00246-024-03489-7","article-title":"NT-proBNP for Predicting All-Cause Death and Heart Transplant in Children and Adults with Heart Failure","volume":"46","author":"Schmitt","year":"2025","journal-title":"Pediatr. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/aje\/kwu059","article-title":"Vitamin D deficiency and cardiovascular events in patients with coronary heart disease: Data from the Heart and Soul Study","volume":"179","author":"Welles","year":"2014","journal-title":"Am. J. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1093\/eurjhf\/hfr175","article-title":"Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome","volume":"14","author":"Gotsman","year":"2012","journal-title":"Eur. J. Heart Fail."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hagau, A.C., Matacuta-Bogdan, I.O., Chiperi, L.E., Hack, B.J., and Muntean, I. (2025). The Relationship Between Vitamin D Levels and Cardiac Remodelling in a Pediatric Dilated Cardiomyopathy Population: A Case-Control Study. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12030082"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1016\/j.jcmg.2018.07.016","article-title":"Prognostic Value of Global Longitudinal Strain in Hypertrophic Cardiomyopathy: A Systematic Review of Existing Literature","volume":"12","author":"Mohananey","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1111\/jce.12222","article-title":"Mutation-positive arrhythmogenic right ventricular dysplasia\/cardiomyopathy: The triangle of dysplasia displaced","volume":"24","author":"James","year":"2013","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s43055-023-01033-w","article-title":"Apical but not basal RV strain reflects right ventricular dysfunction in patients with dilated cardiomyopathy","volume":"54","author":"Ali","year":"2023","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1007\/s00246-017-1588-7","article-title":"Forgotten Right Ventricle in Pediatric Dilated Cardiomyopathy","volume":"38","author":"Agha","year":"2017","journal-title":"Pediatr. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"21059","DOI":"10.1038\/s41598-024-72175-8","article-title":"Abnormal left atrial strain and left atrial stiffness index are associated with adverse outcomes in children with cardiomyopathies: A pilot study","volume":"14","author":"Wozniak","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Muntean, I., Hack, B.J., and Hagau, A.C. (2025). Global Longitudinal Strain as a SensitiveMarker of Left Ventricular Dysfunction in Pediatric Dilated Cardiomyopathy: A Case\u2013Control Study. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12090351"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Muntean, I., Hack, B.J., Iurian, D.R., Benedek, T., Muntean, D., Matacuta-Bogdan, I.O., and Hagau, A.C. (2025). Left Atrial Deformation in Paediatric Dilated and Hypertrophic Cardiomyopathy: Insights from Two-Dimensional Speckle-Tracking Echocardiography. J. Clin. Med., 14.","DOI":"10.3390\/jcm14248622"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Muntean, I., Iurian, D.R., Hagau, A.C., and Hack, B.J. (2026). Basal-Predominant Right-Ventricular Dysfunction in Pediatric Dilated Cardiomyopathy: An Integrated Biventricular Strain Analysis. Biomedicines, 14.","DOI":"10.3390\/biomedicines14010038"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"ESCScientific Document Group 2023 ESCGuidelines for the management of cardiomyopathies","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_21","unstructured":"(2025, August 10). Centers for Disease Control Prevention National Center for Health Statistics CDC Growth Charts: United States Hyattsville MD, U.S. Department of Health and Human Services, Available online: https:\/\/www.cdc.gov\/growthcharts."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e20171904","DOI":"10.1542\/peds.2017-1904","article-title":"Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents","volume":"140","author":"Flynn","year":"2017","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1515\/cclm-2019-1185","article-title":"Continuous, complete and comparable NT-proBNP reference ranges in healthy children","volume":"58","author":"Palm","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_24","unstructured":"German Heart Center Munich (2020). Biomarkers in Children and Adolescents with Congenital Heart Defects\u2014NT-probnp Z-Score Calculator, German Heart Center. Available online: https:\/\/www.deutsches-herzzentrum-muenchen.de\/en\/research\/biomarkers-in-children-and-adolescents-with-congenital-heart-defects-working-group\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1210\/endrev\/bnae009","article-title":"Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows","volume":"45","author":"Giustina","year":"2024","journal-title":"Endocr. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"465\u2013495, quiz 576\u2013577","DOI":"10.1016\/j.echo.2010.03.019","article-title":"Recommendations for quantification methods during the performance of a pediatric echocardiogram: A report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council","volume":"23","author":"Lopez","year":"2010","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.echo.2013.10.001","article-title":"Echocardiographic nomograms for ventricular, valvular and arterial dimensions in caucasian children with a special focus on neonates, infants and toddlers","volume":"27","author":"Cantinotti","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ehjci\/jey042","article-title":"Industry representatives; Reviewers: This document was reviewed by members of the 2016\u20132018 EACVI Scientific Documents Committee. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: A consensus document of the EACVI\/ASE\/Industry Task Force to standardise deformation imaging","volume":"19","author":"Badano","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e024505","DOI":"10.1161\/JAHA.121.024505","article-title":"Global Longitudinal Strain is Incremental to Left Ventricular Ejection Fraction for the Prediction of Outcome in Optimally Treated Dilated Cardiomyopathy Patients","volume":"11","author":"Raafs","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5409\/wjcp.v11.i1.71","article-title":"Tissue Doppler, speckling tracking and four-dimensional echocardiographic assessment of right ventricular function in children with dilated cardiomyopathy","volume":"11","author":"Elrazaky","year":"2022","journal-title":"World J. Clin. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1017\/S104795111200114X","article-title":"The role of right ventricular function in paediatric idiopathic dilated cardiomyopathy","volume":"23","author":"Groner","year":"2013","journal-title":"Cardiol. Young"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1016\/j.amjcard.2013.07.007","article-title":"Clinical implications of serial serum N-terminal prohormone brain natriuretic peptide levels in the prediction of outcome in children with dilated cardiomyopathy","volume":"112","author":"Kim","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"73","DOI":"10.18087\/cardio.2024.2.n2331","article-title":"Evaluation of the Relationship Between Vitamin D Deficiency and Subclinical Cardiac Dysfunction Using 2D\/3D Strain Echocardiography in Healthy People","volume":"64","author":"Aydogan","year":"2024","journal-title":"Kardiologiia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s10554-015-0622-1","article-title":"Effect of vitamin D deficiency and supplementation on myocardial deformation parameters and epicardial fat thickness in patients free of cardiovascular risk","volume":"31","author":"Sunbul","year":"2015","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s00431-025-06250-1","article-title":"Correlation between vitamin D level and left ventricular myocardial function demonstrated by speckle tracking echocardiography among \u03b2-thalassemia major children","volume":"184","author":"Abdelrahman","year":"2025","journal-title":"Eur. J. Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/echo.15329","article-title":"Evaluation of the left ventricular systolic strain in hypocalcemic infants with two-dimensional speckle tracking echocardiography","volume":"39","author":"Aboelata","year":"2022","journal-title":"Echocardiography"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/j.echo.2015.06.011","article-title":"Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors: The EACVI\/ASE Inter-Vendor Comparison Study","volume":"28","author":"Farsalinos","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T12:43:23Z","timestamp":1771937003000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["life16030369"],"URL":"https:\/\/doi.org\/10.3390\/life16030369","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]}}}