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.

Bicuspid aortic valve (BAV) is the most commonly encountered congenital malformation in the pediatric population, associated with aortic leaflet degeneration and aortopathy. However, studies on BAV and its complications in children are limited. We present the case of a 16-year-old with type 1B BAV with a raphe with fusion between the right and non-coronary cusps who exhibited severe aortic stenosis, regurgitation, and progressive dilatation of the ascending aorta. Surgical intervention, including aortic valve and aortic root replacement, was performed due to the patient’s deteriorating condition. Histopathological examination revealed degenerative changes and calcifications in the aortic valve and mucoid fibrosis in the ascending aorta. The results are consistent with BAV patients being predisposed to aortic stenosis and regurgitation due to increased mechanical stress and hemodynamic abnormalities. Although more common in adults and a rare complication in pediatric patients, calcification was previously observed concurrently with rapid valve degeneration in our daily practice. Further studies are needed to improve our understanding of the mechanisms underlying BAV-related complications and refine treatment strategies for pediatric patients.

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.

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: 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.

Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy in children. Heart transplantation is considered standard therapy in dilated cardiomyopathy with end-stage heart failure. We present a case of a 15-year-old patient diagnosed with DCM in the neonatal period, who underwent heart transplantation for end-stage heart failure. Despite the use of induction therapy, the endomyocardial biopsy performed at two weeks post-transplant revealed mixed moderate cellular (2R) and humoral (pAMR2) allograft rejection. Aggressive rejection treatment was initiated with good outcome. Besides endomyocardial biopsy, advanced echocardiography can also be a valuable noninvasive tool for rejection assessment.