In pediatric dilated cardiomyopathy, left ventricular systolic dysfunction, pronounced dilation, functional mitral regurgitation, and elevated natriuretic peptides consistently determine the risk of death or heart transplantation.
A multi-layered approach integrating serial imaging, biomarkers, and genomic testing enables trajectory-based risk stratification and personalized therapeutic decision-making in pediatric dilated cardiomyopathy.
Pediatric dilated cardiomyopathy (DCM) is one of the rare causes of heart failure in children that can be fatal without early diagnosis and treatment. The dis-ease has highly variable outcomes: some patients may require HTx, some may die early without timely treatment, whereas a smaller subset of children may recover partially. This narrative review integrates up-to-date prognostic evidence from clini-cal presentation, echocardiography and advanced imaging, circulating biomarkers, and genetic findings, while also recognizing that resource context and access to ad-vanced therapies may influence the endpoints observed. In all cohorts and imaging syntheses, three echocardiographic features are the main factors that consistently determine the risk: left ventricular systolic dysfunction, pronounced left ventricu-lar dilation (LVEDD z-score), and intensive functional mitral regurgitation. Prog-nosis changes over time; early trajectories, improvement vs. persistence or pro-gression of dysfunction and dilation, often provide greater refinement of risk than baseline severity. Out of various laboratory measurements, natriuretic peptides (NT-proBNP/BNP) remain the most widely confirmed prognostic biomarkers, especially if they are measured serially as quantifiable markers of hemodynamic stress and treatment response. Inflammatory indices derived from CBC (e.g., NLR/SII) along with routine chemistry abnormalities might offer additional low-cost information but need to be validated in larger, multicenter studies. Genomic testing is progressively unveiling previously”idiopathic” diseases and has the potential to alter risk, notably in arrhythmia- or conduction-prone genotypes, hence it advocates detection and family screening on the basis of the genotype. Integrating these areas, we identify a multi-layered, down-to-earth approach for risk assessment at diagnosis, with regular updating during early follow-up through serial imaging and biomarkers, thus allowing for timely escalation of treatment in high-risk children and personalized monitoring for those who show reverse remodeling.
Ali et al. (Mon,) conducted a review in Pediatric dilated cardiomyopathy. Prognostic factors (clinical, imaging, biomarkers, genetics) was evaluated. In pediatric dilated cardiomyopathy, left ventricular systolic dysfunction, pronounced dilation, functional mitral regurgitation, and elevated natriuretic peptides consistently determine the risk of death or heart transplantation.