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 (−5.99 ± 2.45% vs. −13.44 ± 6.88% and −19.98 ± 3.25%), lower LASr (10.97 ± 7.67% vs. 25.36 ± 10.28% and 44.0 ± 11.43%), and reduced RVFWSL (−15.32 ± 5.24% vs. −23.13 ± 8.55% and −24.78 ± 4.45%; all p < 0.01). Zlog NT-proBNP was markedly higher in the event group (5.37 [5.00–6.08] vs. 2.28 [0.71–3.68] and 0.14 [−0.02–0.88]). 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 ≥ −8%, Zlog NT-proBNP ≥ 4.6, LASr ≤ 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.

We sought to investigate the inter- and intra-country variation in paediatric heart transplantation (HTx) and mechanical circulatory support (MCS) availability and practice in Europe. Data was obtained through a survey circulated to paediatric transplant cardiologists identified through the Association of European Paediatric and Congenital Cardiology between November 2022 and March 2023. Twenty-eight respondents from twenty-eight European countries completed the survey. Twenty-four (86

Background: Borderline left ventricle represents a heterogeneous spectrum of congenital heart disease for which accurate prediction of suitability for biventricular versus univentricular circulation is often difficult. Serial fetal echocardiography may provide dynamic information to support postnatal decision-making. Case Presentation: We report the case of a fetus diagnosed at 32 weeks’ gestation with a borderline left ventricle, ventricular disproportion, hypoplastic left-sided structures, ductal-dependent systemic circulation, and a non-restrictive ostium secundum atrial septal defect. Serial fetal echocardiographic evaluations demonstrated stable left ventricular dimensions, preserved systolic function, impaired diastolic relaxation, and absence of endomyocardial fibroelastosis. Postnatal echocardiography confirmed hypoplastic aortic arch and coarctation. Following multidisciplinary evaluation, a biventricular repair strategy was selected. At 14 days of life, the patient underwent aortic arch reconstruction and partial atrial septal defect closure with preservation of a small therapeutic interatrial communication. Postoperative evolution was favorable, with progressive left ventricular growth and preserved function. At 2-year follow-up, echocardiography showed normalized mitral and aortic valve z-scores, good left ventricular systolic performance, and no evidence of myocardial fibrosis. Conclusions: This case highlights the value of serial fetal echocardiography in guiding individualized management of borderline left ventricle. Careful assessment of ventricular function and atrial septal physiology may support selection of a biventricular strategy in selected patients and contribute to favorable mid-term outcomes.

BackgroundTransposition of the great arteries (TGA) is characterized by parallel circulation dependent on intercirculatory mixing. The impact of perinatal hemodynamic changes on myocardial mechanics remains poorly understood. The main objective of the study was to evaluate perinatal changes in ventricular strain in TGA.MethodsThe current prospective longitudinal study included 79 fetuses, of whom 72 were included after applying predefined exclusion criteria (19 with simple TGA and 53 healthy controls). Speckle-tracking echocardiography was used to assess segmental and global ventricular strain. Differences in temporal changes between groups were analyzed using linear regression models with robust standard errors clustered at the subject level. Estimated marginal means (EMMS) with 95% confidence intervals (CI) were derived to compare groups at each timepoint (T0: fetal evaluation; T1:neonatal evaluation).ResultsFetal myocardial deformation parameters did not differ significantly between the TGA and control groups (p > 0.05, corrected p > 0.05). Between-group differences at the neonatal assessment are nominally significant for the basal, medial, and apical interventricular septal segments and for right ventricle (RV) peak longitudinal strain from 4 chamber view (p < 0.05). After Benjamini-Hochberg correction, however, only the medial interventricular septal strain remained statistically significant (p-corrected = 0.0242). Additionally, RV end-systolic volume measured at neonatal time point was significantly increased in neonates with TGA compared to healthy controls [EMMS: 2.50 mL (95% CI: 2.25–2.76) vs. 1.30 mL (95% CI: 1.19–1.41)] reflecting altered loading conditions. Although RV peak longitudinal strain from 4 chamber view significantly differed between neonates requiring balloon atrial septostomy and those who did not (p = 0.007), no significant discriminatory ability was observed (AUC = 0.73, 95% CI: 0.46–1). As secondary outcomes, these parameters were not subject to correction for multiple testing.ConclusionsIn this cohort of prenatally diagnosed simple TGA, fetal myocardial deformation parameters did not differ significantly from those of healthy controls, whereas load-sensitive regional differences in interventricular septal and RV deformation identified as nominal associations, though not all retained significance after correction for multiple testing, became apparent after birth. These findings suggest that postnatal changes in loading conditions may reveal regional mechanical differences that are not evident during fetal life.

Dilated cardiomyopathy (DCM) is a significant contributor to heart failure (HF) in the pediatric population despite its lower incidence compared to adults. Method: We present a case-control study that investigates serum levels of Vitamin D, measured as 25-hydroxyvitamin D (25-OHD), in children diagnosed with DCM and explores the relationship between Vitamin D levels and left ventricular (LV) dimensions and systolic function. Results: Thirty patients (mean age: 10.61 ± 6.54 years) with DCM were included, with a control group of thirty-one matched healthy children. We found a high prevalence of 25-OHD deficiency (67%) in the DCM group, which was statistically significant compared to the control group (p < 0.05). Notably, a significant negative correlation was observed between 25-OHD levels and both LV end-diastolic diameter (LVEDD; r = −0.43, p < 0.01) and end-systolic diameter (LVESD; r = −0.46, p < 0.01). However, no significant correlation was found between Vitamin D levels and LV ejection fraction or shortening fraction. Conclusion: These findings emphasise the importance of assessing Vitamin D status in pediatric DCM patients and may suggest that Vitamin D supplementation can be beneficial in managing this condition through its potential effects on cardiac remodelling and function. Further research is warranted to clarify the underlying mechanisms and therapeutic implications.

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication of SARS-CoV-2, often with cardiac involvement. Myocardial strain imaging may detect dysfunction missed by conventional echocardiography. The objectives of this study are to characterize cardiac manifestations of MIS-C and assess the value of strain imaging in children with preserved and reduced left ventricular ejection fraction (LV-EF). Methods: We retrospectively analyzed 22 MIS-C patients admitted between September 2020 and January 2024, all with cardiac involvement. Clinical, laboratory, and echocardiographic data—including 2D and speckle-tracking strain—were collected at the day of worst dysfunction (DWD) and discharge (DD) and compared with 22 matched controls. Results: Median age was 4.65 years; 59% male; 45% overweight/obese. LV systolic dysfunction (LV-EF < 50%) occurred in 54.5%, coronary abnormalities in 36.4%, and pericardial effusion in 95.5%. LV global longitudinal strain (LVGLS) was significantly lower than controls at the DWD (−15.45 ± 4.76%, p < 0.0001) and DD (−20.63 ± 4.66%, p = 0.014). Strain abnormalities persisted despite LV-EF recovery, and even patients with preserved LV-EF showed significant segmental strain reduction. LVGLS and apical infero-septal strain were strongest predictors of reduced LV-EF. Conclusions: MIS-C often causes systolic dysfunction and coronary changes, but strain imaging reveals persistent subclinical myocardial injury. Long-term cardiac monitoring is warranted.

Background: Left atrial strain (LAS) derived from speckle-tracking echocardiography (STE) provides a sensitive, load-dependent measure of atrial function and ventricular filling pressures. Data on LAS in paediatric cardiomyopathies are still scarce; therefore, this study aimed to assess LA phasic function in dilated (DCM) and hypertrophic (HCM) cardiomyopathy and to determine its relationship with clinical and echocardiographic indices of disease severity. Methods: We conducted a cross-sectional case-control study that included 84 children (DCM n = 29, HCM n = 29, control n = 26) who underwent comprehensive clinical and echocardiography evaluation, including LAS parameters (reservoir-LASr; conduit-LAScd; and contractile-LASct). Group comparisons were performed using ANOVA or Kruskal-Wallis tests with post hoc adjustments, and correlations were analysed using Pearson's or Spearman's coefficients. Multivariable linear and logistic regression models were adjusted for age, body surface area (BSA), heart rate (HR), and blood pressure (BP) percentiles. Results: LASr and LAScd were significantly reduced in both cardiomyopathy groups compared with controls (p < 0.001), following a graded pattern (DCM < HCM < control). In DCM, lower LASr was independently associated with higher left atrial volume index (LAVi) and elevated E/E' ratio, whereas in HCM, septal hypertrophy (IVSd Z-score) and log NT-proBNP were dominant determinants of impaired LASr. In logistic regression, LASr (OR = 0.93, p = 0.016) and LAScd (OR = 1.21, p = 0.001) independently predicted severe NYHA/Ross functional class after covariate adjustment, while LASct showed no significant association. Conclusions: These findings demonstrate that LA reservoir and conduit strain are markedly impaired in paediatric cardiomyopathy and are strongly linked to structural remodelling and functional limitation, underscoring their value as sensitive non-invasive markers of disease severity.

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. Methods: 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. Results: 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−1 vs. −1.12 ± 0.16 s−1; p < 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 (p < 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; p = 0.005); adding systolic blood pressure (p = 0.798) or heart rate (p = 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; p = 0.009), LVSF (OR 1.19 per 1% decrease; 95% CI 1.04–1.36; p = 0.011), and NT-proBNP (≈OR 1.11 per 100 units; p = 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). Conclusions: 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.

Hypertrophic cardiomyopathy (HCM) is a myocardial disease characterized by abnormal thickening of the ventricular myocardium. It is most commonly inherited as an autosomal dominant disorder caused by mutations in sarcomere or sarcomere-associated protein genes. We report the case of a 15-year-old female with HCM and a strong family history (mother, sister, and maternal grandfather). Despite this background, her diagnosis was made incidentally following the onset of cardiac symptoms. Genetic testing confirmed a pathogenic MYH7 mutation. Based on elevated risk scores (HCM-Risk Kids = 8.6%, Primacy Risk Score = 13.09), she was considered at high risk for sudden cardiac death and underwent implantation of an implantable cardioverter-defibrillator (ICD) for primary prophylaxis. This case highlights the importance of a comprehensive approach to pediatric and adolescent HCM, including family history, genetic testing of at-risk relatives, early diagnosis, and multidisciplinary management. It also emphasizes the urgent need for systematic family screening of first-degree relatives using echocardiography and electrocardiography. Although genetic testing confirmed the diagnosis in our patient, it could not be extended to relatives due to financial limitations. Expanding access to genetic screening at a national level should be a priority. Future research should focus on optimizing genetic testing protocols and improving quality-of-life interventions for young patients with HCM and ICDs.

Arrhythmogenic cardiomyopathies (ACM) are rare inherited cardiac disorders, with an incidence below 1% in adults and an undetermined prevalence in pediatric populations. Formerly recognized primarily as arrhythmogenic right ventricular cardiomyopathy (ARVC), affecting exclusively the right ventricle (RV), recent diagnostic advancements have shed light on the involvement of the myocardium in ACM, revealing fibrous infiltration in both ventricles. In 2023, the European Society of Cardiology introduced updated phenotypic classifications of cardiomyopathy, highlighting the coexistence of multiple types within families and the potential transition from one cardiomyopathy to another. We present a case series comprising four pediatric cases of ARVC with diverse presentations and outcomes. Subsequent evaluations unveiled both left ventricle (LV) and RV dysfunction, culminating in a diagnosis of ARVC based on the 2020 diagnostic criteria. Additionally, genetic testing uncovered mutations in genes associated with cardiomyopathies. Cardiac magnetic resonance imaging (MRI) corroborated the biventricular involvement, aligning with a diagnosis of ACM per the 2020 Padua criteria. In conclusion, recent updates in diagnostic criteria have refined the classification of ACM, underscoring the importance of cardiac MRI and morphological features for precise diagnosis. Genetic testing has identified novel mutations linked to cardiomyopathy, emphasizing the significance of personalized treatment strategies and genetic counselling for affected individuals and their families.

Background: Right-ventricular (RV) involvement is starting to gain recognition in pediatric dilated cardiomyopathy (DCM), but its deformation characteristics and its relationship to functional status remain insufficiently defined. Methods: Twenty-nine children with primary DCM were compared with age- and sex-matched healthy controls. Conventional echocardiography and two-dimensional speckle-tracking echocardiography (2D-STE) were performed. Segmental deformation (basal, mid-ventricular and apical levels) was analyzed using a linear mixed-effects model. Associations between strain indices and advanced functional limitation (NYHA/Ross Class III-IV) were evaluated using exploratory logistic regression and ROC analysis. Results: Children with DCM showed significant impairment in both ventricles. Conventional parameters (TAPSE, tricuspid E/A ratio, RV E' velocity, and LV ejection fraction) were reduced. Right ventricular strain was significantly lower in DCM compared with controls (p < 0.05). Segmental analysis demonstrated a basal-predominant reduction in RV strain. Right-ventricular free-wall longitudinal strain correlated with RV S' (r = -0.49), RV E' (r = -0.46), LVGLS (r = 0.79) and LV ejection fraction (r = -0.63, all p < 0.05). In univariable analysis, RVFWSL predicted advanced functional class (OR 1.13 per 1% decrease, p = 0.026), while LVGLS remained the independent predictor in the multivariable model. A combined model incorporating RVFWSL and LVGLS demonstrated excellent discriminative accuracy (AUC 0.95). Conclusions: Pediatric DCM is characterized by RV involvement with a distinct basal-dominant deformation pattern. Biventricular strain assessment improves the identification of children with advanced functional class and may enhance functional stratification beyond conventional indices.

Fulminant myocarditis is a peculiar condition characterized by sudden-onset diffuse myocardial inflammation leading to hemodynamic compromise. We report the case of a 15-year-old male adolescent, without any cardiovascular history, who presented sudden-onset severe biventricular systolo-diastolic dysfunction leading to cardiogenic shock, 2 weeks after an episode of respiratory tract infection. A comprehensive treatment regimen was initiated including heart failure treatment, inotropic and vasoactive support, antibiotics, antiviral treatment, intravenous immunoglobulin, and glucocorticoids, but with poor evolution. Bridge-to-transplantation therapy was taken into consideration for hemodynamic stabilization. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated, first peripherally, via femoral artery and femoral vein access, but secondary to left ventricle (LV) distension, the patient developed pulmonary edema. To decompress the LV, an echocardiography-guided atrial septostomy was performed, and after 2 days, central cannulation (right atrium - ascending aorta) with another cannula for left atrial venting was done, and the patient remained with open sternum. Five days from the initiation of VA-ECMO the patient underwent an orthotopic heart transplantation by bicaval technique with favorable evolution in the follow-up period. Early initiation of VA-ECMO is a salvage intervention in pediatric patients with fulminant myocarditis, but with multiple possible complications. This paper highlights strategies for the optimization of VA-ECMO.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare and potentially life-threatening condition affecting infants that requires immediate corrective surgery to restore blood flow to the myocardium. We present a case of an infant with ALCAPA and severe heart failure. What sets this case apart is the utilization of speckle-tracking echocardiography as a non-invasive method for assessing global and regional myocardial function before and after surgical intervention. Our preoperative analysis revealed compromised contraction in specific areas of the left ventricle (LV), in the regions that were supplied by both the left coronary artery (LCA) and the right coronary artery (RCA). Interestingly, despite an increase in ejection fraction (EF) measured by conventional echocardiography, the postoperative speckle-tracking analysis revealed persistent impairment in the anterior territories supplied by LCA, highlighting the potential of this technique in identifying myocardial abnormalities during postoperative follow-up. In conclusion, speckle-tracking echocardiography may be a valuable tool for identifying subtle myocardial changes in ALCAPA patients with a higher sensitivity in detecting regional left ventricular (LV) dysfunction compared to conventional echocardiography.

Background Lymphatic disorders such as protein‐losing enteropathy, plastic bronchitis, and chylothorax are important complications of the Fontan circulation and ultimately result in an increased risk of early death. Several European centers are now performing lymphatic procedures. The aim of this study is to map the extent of these lymphatic disorders and treatments provided across European pediatric cardiology centers. Methods and Results A survey was circulated to 49 European pediatric cardiology centers consisting of 37 questions including a mix of binary, categorical, and continuous variables. Thirty‐one centers (63%) participated in the study, performing a median of 250 (interquartile range, 178 ‐ 313) cardiopulmonary bypass procedures per year. Chylothorax emerged as the most prevalent lymphatic disorder followed by protein‐losing enteropathy and plastic bronchitis. The most common diagnostic investigation method was noncontrast magnetic resonance lymphangiography (52%). Eleven centers (35%) conducted lymphatic interventions with a median of 3 (interquartile range, 1 ‐ 4) procedures per year and 12 (interquartile range, 5 ‐ 15) interventions in total per center. Conclusions This study confirms the rarity of and variation in treatment approaches for lymphatic disorders across Europe. With at least 11 centers offering lymphatic interventions, the adoption of these procedures is on the rise in Europe. To improve the quality of care and treatment outcomes for these complex patients, it is crucial to consider evidence‐based lymphatic diagnostics, interventional lymphatic procedures, and the centralization of services in Europe.

BACKGROUND:There is limited data on the organisation of paediatric echocardiography laboratories in Europe. METHODS:A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs. RESULTS:Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%). CONCLUSION:Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.

INTRODUCTION:The aim of the study was to assess the predicting value of neuromarkers for psychomotor performances of congenital heart defect (CHD) patients before surgery, as until now the researchers only evaluated neuromarkers after the surgical treatment of the CHD. METHODS:This cross-sectional study included children with CHD who did not receive treatment (interventional or cardiac surgery). Psychomotor development was evaluated using the Denver II Screening Test. Blood samples were collected for neuromarkers analysis: neuron-specific enolase (NSE), protein S100 (pS100), brain-derived neurotrophic factor (BDNF), and glial fibrillary acidic protein (GFAP). RESULTS:We enrolled 77 children. Patients with CHD experienced more frequent developmental delays compared to healthy children (12-34% in the non-cyanotic group and 26-74% in the cyanotic group). The association between type of CHD and psychomotor impairment was statistically significant (p < 0.0001, RR = 2.604, CI = 2.07-3.26). Neuromarkers value was compared between cyanotic and non-cyanotic groups: NSE and BDNF values were higher in the cyanotic group, respectively, pS100 and GFAP had slightly higher values in the non-cyanotic group. A correlation coefficient of 0.35 (p = 0.023) was obtained between psychomotor development and BDNF level. An AUC of 0.72 was obtained for psychomotor development and BDNF in ROC analysis with the cut-off value of 5895 pg/ml. CONCLUSION:BDNF is showing moderate discriminative ability in predicting psychomotor development outcomes in pediatric patients with CHD.

The use of ventricular assist devices as bridge-to-transplantation therapy has a critical role in the management of end-stage heart failure in pediatric patients without available compatible organ donors. The HeartMate 3 is an intracorporeal centrifugal flow pump with a fully magnetically levitated motor currently approved for the management of advanced refractory left ventricular failure in pediatric patients, with positive early outcomes. We report the case of a 17-year-old adolescent girl with end-stage heart failure secondary to dilated cardiomyopathy of idiopathic etiology, with multiple failed attempts of weaning from inotropic support (PEDIMACS 3 profile), who successfully received a HeartMate 3 left ventricular assist device as bridge-to-transplantation therapy with no significant adverse events during the early follow-up period. This paper presents the first case of pediatric ventricular assist device implantation in Romania.

This study focuses on two of the most prevalent congenital heart defects: bicuspid aortic valve (BAV) and coarctation of the aorta (CoA). In severe forms, CoA is an emergency that can become life-threatening. Both diseases are linked to aortic vasculopathy, which represents a significant contributor to morbidity and mortality in young patients with congenital heart disease. The aim of this study was to investigate whether there are differences between patients with CoA and BAV, and patients with CoA and without BAV in terms of outcome and echocardiographic parameters, and to evaluate the efficacy of different echocardiographic parameters in predicting CoA.

Background: Several studies in recent years have shown the association between vitamin D levels and heart failure. Vitamin D deficiency is related to increased cardiovascular morbidity and mortality, with a higher risk of developing heart failure. In this systematic review, we aimed to assess recent studies that analyzed vitamin D deficiency and heart failure in adult and pediatric populations. (2) Methods: We conducted a systematic search for studies published in the following databases: PubMed and Scopus from January 2012 to October 2022. (3) Results: Most observational studies that were included found a significant association between hypovitaminosis D and heart failure. However, the beneficial role of vitamin D supplementation is still controversial due to the lack of randomized controlled trials. (4) Conclusions: Vitamin D may play an important role as a cardiovascular marker in heart failure patients. More well-designed studies are needed to investigate the relationship between vitamin D and heart failure and to determine if vitamin D supplementation could improve long-term outcomes.

Introduction: The objectives of this study were to assess the role of neuromarkers like glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF), protein S100 (pS100), and neuron-specific enolase (NSE) as diagnostic markers of acute brain injury and also as prognostic markers for short-term neurodevelopmental impairment. Methods: Pediatric patients with congenital heart defects (CHDs) undergoing elective cardiac surgery were included. Neurodevelopmental functioning was assessed preoperatively and 4–6 months postoperatively using the Denver Developmental Screening Test II. Blood samples were collected preoperatively and postoperatively. During surgery, regional cerebral tissue oxygen saturation was monitored using near-infrared spectroscopy (NIRS). Results: Forty-two patients were enrolled and dichotomized into cyanotic and non-cyanotic groups based on peripheric oxygen saturation. Nineteen patients (65.5%) had abnormal developmental scores in the non-cyanotic group and eleven (84.6%) in the cyanotic group. A good diagnostic model was observed between NIRS values and GFAP in the cyanotic CHD group (AUC = 0.7). A good predicting model was observed with GFAP and developmental scores in the cyanotic CHD group (AUC = 0.667). A correlation was found between NSE and developmental quotient scores (r = 0.09, p = 0.046). Conclusions: From all four neuromarkers studied, only GFAP was demonstrated to be a good diagnostic and prognostic factor in cyanotic CHD patients. NSE had only prognostic value.