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Research Progress of the Pediatric Cardiology: 3rd Edition
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Research Progress of the Pediatric Cardiology: 3rd Edition

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Cardiology".

Deadline for manuscript submissions: 1 October 2025 | Viewed by 6538

Special Issue Editor

Dr. Massimo Mapelli

E-Mail Website
Guest Editor
1. Cardiology Center Monzino, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20138 Milano, Italy
2. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
Interests: heart failure; exercise testing; HFrEF; cardiomyo-pathies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Considering the success and popularity of the two previous Special Issues published in the journal Children (https://www.mdpi.com/journal/children/special_issues/Research_Progress_Pediatric_Cardiology; https://www.mdpi.com/journal/children/special_issues/Y40A16K8JG), we are now releasing another issue aiming to gather original research papers and review articles focused on pediatric cardiology. I am honored to have been asked to serve as the Guest Editor for this valuable project again.

The world of cardiology has undergone a heavy and favorable revolution in recent years. Heart disease that previously seemed incurable can now be addressed with far better diagnostic and therapeutic ability than in the past. Opportunities for the percutaneous or surgical treatment of structural heart disease now permit much less invasive but effective interventions. In parallel, multimodal imaging techniques (advanced echocardiogram, magnetic resonance imaging, cardiac CT) allow for the visualization of the cardiovascular system as has never been possible before, helping our understanding of cardiomyopathies and structural alterations that underlie many diseases of the heart.

The aim of this Special Issue is to produce a rich collection of research, articles and opinions for clinicians, academics and policy makers in the field of pediatric cardiology. Contributions related to all aspects of this topic and, in particular, the understanding, management and improvement of cardiovascular diseases in children, are welcome.

Our work will be based on an interdisciplinary approach to disseminate advanced knowledge and evidence with the aim of improving pediatric cardiovascular care. High-quality papers in all areas of pediatric cardiology will be handled through a fair and rigorous peer review process.

Innovative papers on new cardiovascular treatments, prognostic indicators and imaging techniques, as well as studies focused on the impact of disruptive events (i.e., the COVID-19 pandemic), are particularly welcome.

I look forward to receiving your contributions.

Dr. Massimo Mapelli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric cardiology
  • congenital heart disease
  • heart failure
  • myocarditis
  • COVID-19 and cardiovascular system
  • heart transplantation
  • cardiac imaging in children
  • pediatric cardiology in low-income countries
  • rheumatic heart disease
  • child/children
  • adolescent

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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10 pages, 215 KiB  
Article
Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope
by Wenrui Xu, Chunyu Zhang, Junbao Du, Hongfang Jin and Ying Liao
Children 2025, 12(5), 636; https://doi.org/10.3390/children12050636 - 15 May 2025
Viewed by 133
Abstract
Background: This study aimed to identify the risk factors associated with malignant vasovagal syncope (VVS), a rare yet clinically significant subtype of VVS. Methods: This single-center case–control study enrolled children diagnosed with malignant VVS, and the malignant VVS patients were matched in a [...] Read more.
Background: This study aimed to identify the risk factors associated with malignant vasovagal syncope (VVS), a rare yet clinically significant subtype of VVS. Methods: This single-center case–control study enrolled children diagnosed with malignant VVS, and the malignant VVS patients were matched in a 1:4 ratio with non-asystolic VVS children as a control group through age and sex stratification. Clinical characteristics and heart rate variability (HRV) parameters were analyzed. Binary logistic regression analyses were used to identify the risk factors significantly associated with malignant VVS. Results: A total of 10 patients in the malignant group and 40 children in the control group were included. The malignant group exhibited earlier symptom onset (7.0 ± 2.7 vs. 9.7 ± 2.7 years, p < 0.05) than the control group, and children in the malignant group had a higher prevalence of central triggers (60.0% vs. 17.5%, p < 0.05) and convulsive/incontinence episodes (80.0% vs. 17.5%, p < 0.05) than the control group. Additionally, the malignant group demonstrated significantly elevated HRV parameters, including very low frequency (VLF), low frequency (LF), and high frequency (HF), indicating substantial autonomic dysregulation characterized by parasympathetic predominance. Central triggers (OR = 7.16, 95%CI 1.10–46.73) and convulsive/incontinence manifestations (OR = 19.02, 95%CI 2.81–128.64) were independent risk factors of malignant VVS. Conclusions: The age at syncope onset was significantly earlier in children with malignant VVS, and children with malignant VVS exhibited profound autonomic dysregulation characterized by significant parasympathetic predominance. Finally, children with episodes induced by central triggers and accompanied by incontinence or convulsions were at a higher risk of asystole. Full article
(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)
15 pages, 1487 KiB  
Article
Analysis of Factors Relevant to the Severity of Symptoms in Children and Adolescents with Postural Orthostatic Tachycardia Syndrome
by Yali Cao, Ping Liu, Bo Li, Yingqian Zhang, Junbao Du, Hongfang Jin and Ying Liao
Children 2025, 12(4), 474; https://doi.org/10.3390/children12040474 - 7 Apr 2025
Viewed by 356
Abstract
Objectives: The current study aims to investigate the factors associated with the severity of conditions for pediatric cases with postural orthostatic tachycardia syndrome (POTS). Methods: Patients hospitalized and first diagnosed with POTS were retrospectively included and reviewed. The severity of symptoms was evaluated [...] Read more.
Objectives: The current study aims to investigate the factors associated with the severity of conditions for pediatric cases with postural orthostatic tachycardia syndrome (POTS). Methods: Patients hospitalized and first diagnosed with POTS were retrospectively included and reviewed. The severity of symptoms was evaluated by symptom scores (SSs). Multiple Spearman correlation analyses and multiple linear regression analyses were used to determine factors independently associated with SS. Patients were divided into the mild (SS ≤ P25) and severe (SS ≥ P75) groups to test the distinguishing efficiency of the candidate factors. The efficiency of each independently correlated factor in indicating the condition of children with POTS was assessed by the receiver operating characteristic (ROC) curve. Results: A series of 296 pediatric patients aged 5–17 years suffering from POTS were included. Multiple Spearman correlation analyses and multiple linear regression analyses showed that corrected QT interval dispersion (QTcd) was independently correlated with SS (p < 0.05). QTcd can be used to suggest the severity of POTS symptoms, and the area under the curve (AUC) was 0.986 (95% CI 0.976–0.997). At a threshold of QTcd = 45 ms, the sensitivity and specificity were, respectively, 94.0% and 91.8% for symptom severity indication. Conclusions: In pediatric cases with POTS, QTcd was positively correlated with their symptom severity and exhibited a strong indicative value. A QTcd of 45 ms was a valid cut-off value for indicating symptom severity. Full article
(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)
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13 pages, 1388 KiB  
Article
Nomogram Based on HRV for Predicting the Therapeutic Effects of Orthostatic Training in Children with Vasovagal Syncope
by Xiaojuan Du, Ping Liu, Dandan Xiang, Chunyu Zhang, Junbao Du, Hongfang Jin and Ying Liao
Children 2024, 11(12), 1467; https://doi.org/10.3390/children11121467 - 30 Nov 2024
Cited by 1 | Viewed by 716
Abstract
Background: This study intended to find out whether the parameters of heart rate variability (HRV) can predict the treatment efficacy of orthostatic training among pediatric cases of vasovagal syncope (VVS). Methods: Patients with VVS who underwent orthostatic training were retrospectively enrolled. Lasso and [...] Read more.
Background: This study intended to find out whether the parameters of heart rate variability (HRV) can predict the treatment efficacy of orthostatic training among pediatric cases of vasovagal syncope (VVS). Methods: Patients with VVS who underwent orthostatic training were retrospectively enrolled. Lasso and logistic regression were used to sift through variables and build the model, which is visualized using a nomogram. The model’s performance was evaluated through calibration plots, a receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) for both datasets. Results: In total, 119 participants were included in the analysis, and 73 and 46 were assigned to the training and validation datasets, respectively. Five factors with nonzero coefficients were chosen based on lasso regression: age, the root means square of successive differences between normal sinus beats (rMSSD), standard deviation of the averages normal-to-normal intervals in all 5-min segments, minimum heart rate, and high frequency. Drawing from the logistic regression analysis results, the visual predictive model incorporated two variables, namely age and rMSSD. For the training dataset, the sensitivity was 0.686 and the specificity was 0.868 with an area under the curve (AUC) of 0.81 (95% CI, 0.71–0.91) for the ROC curve. For the validation dataset, the AUC of the ROC was 0.80 (95% CI, 0.66–0.93), while sensitivity and specificity were recorded at 0.625 and 0.909, respectively. In the calibration plots for both datasets, the predicted probabilities correlated well with the actual probabilities. According to the DCA, the visual predictive model gained a significant net benefit across a wide threshold range. Conclusions: Pediatric patients with VVS can benefit from orthostatic training using a visual predictive model comprising age and rMSSD. Full article
(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)
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11 pages, 741 KiB  
Article
Management of Paediatric Cardiac Arrest due to Shockable Rhythm—A Simulation-Based Study at Children’s Hospitals in a German Federal State
by Nadine Mand, Marieke Hoffmann, Anja Schwalb, Andreas Leonhardt, Martin Sassen, Tina Stibane, Rolf Felix Maier and Carolin Donath
Children 2024, 11(7), 776; https://doi.org/10.3390/children11070776 - 27 Jun 2024
Cited by 1 | Viewed by 1653
Abstract
(1) Background: To improve the quality of emergency care for children, the Hessian Ministry for Social Affairs and Integration offered paediatric simulation-based training (SBT) for all children’s hospitals in Hesse. We investigated the quality of paediatric life support (PLS) in simulated paediatric resuscitations [...] Read more.
(1) Background: To improve the quality of emergency care for children, the Hessian Ministry for Social Affairs and Integration offered paediatric simulation-based training (SBT) for all children’s hospitals in Hesse. We investigated the quality of paediatric life support (PLS) in simulated paediatric resuscitations before and after SBT. (2) Methods: In 2017, a standardised, high-fidelity, two-day in-house SBT was conducted in 11 children’s hospitals. Before and after SBT, interprofessional teams participated in two study scenarios (PRE and POST) that followed the same clinical course of apnoea and cardiac arrest with a shockable rhythm. The quality of PLS was assessed using a performance evaluation checklist. (3) Results: 179 nurses and physicians participated, forming 47 PRE and 46 POST interprofessional teams. Ventilation was always initiated. Before SBT, chest compressions (CC) were initiated by 87%, and defibrillation by 60% of teams. After SBT, all teams initiated CC (p = 0.012), and 80% defibrillated the patient (p = 0.028). The time to initiate CC decreased significantly (PRE 123 ± 11 s, POST 76 ± 85 s, p = 0.030). (4) Conclusions: The quality of PLS in simulated paediatric cardiac arrests with shockable rhythm was poor in Hessian children’s hospitals and improved significantly after SBT. To improve children’s outcomes, SBT should be mandatory for paediatric staff and concentrate on the management of shockable rhythms. Full article
(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)
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Review

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16 pages, 1107 KiB  
Review
Pediatric Cardio-Oncology: Screening, Risk Stratification, and Prevention of Cardiotoxicity Associated with Anthracyclines
by Xiaomeng Liu, Shuping Ge and Aijun Zhang
Children 2024, 11(7), 884; https://doi.org/10.3390/children11070884 - 22 Jul 2024
Viewed by 1910
Abstract
Anthracyclines have significantly improved the survival of children with malignant tumors, but the associated cardiotoxicity, an effect now under the purview of pediatric cardio-oncology, due to its cumulative and irreversible effects on the heart, limits their clinical application. A systematic screening and risk [...] Read more.
Anthracyclines have significantly improved the survival of children with malignant tumors, but the associated cardiotoxicity, an effect now under the purview of pediatric cardio-oncology, due to its cumulative and irreversible effects on the heart, limits their clinical application. A systematic screening and risk stratification approach provides the opportunity for early identification and intervention to mitigate, reverse, or prevent myocardial injury, remodeling, and dysfunction associated with anthracyclines. This review summarizes the risk factors, surveillance indexes, and preventive strategies of anthracycline-related cardiotoxicity to improve the safety and efficacy of anthracyclines. Full article
(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)
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Other

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17 pages, 3453 KiB  
Systematic Review
Echocardiographic Assessment of Biventricular Mechanics of Fetuses and Infants of Gestational Diabetic Mothers: A Systematic Review and Meta-Analysis
by Andrea Sonaglioni, Antonino Bruno, Gian Luigi Nicolosi, Stefano Bianchi, Michele Lombardo and Paola Muti
Children 2024, 11(12), 1451; https://doi.org/10.3390/children11121451 - 28 Nov 2024
Cited by 1 | Viewed by 1097
Abstract
Background: Gestational diabetes mellitus (GDM) is the most common complication in pregnancy, representing a serious risk for the mother and fetus. Identifying new biomarkers to ameliorate the screening and improving GDM diagnosis and treatment is crucial. During the last decade, a few studies [...] Read more.
Background: Gestational diabetes mellitus (GDM) is the most common complication in pregnancy, representing a serious risk for the mother and fetus. Identifying new biomarkers to ameliorate the screening and improving GDM diagnosis and treatment is crucial. During the last decade, a few studies have used speckle tracking echocardiography (STE) for assessing the myocardial deformation properties of fetuses (FGDM) and infants (IGDM) of GDM women, providing not univocal results. Accordingly, we performed a meta-analysis to examine the overall influence of GDM on left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) in both FGDM and IGDM. Methods: All echocardiographic studies assessing conventional echoDoppler parameters and biventricular strain indices in FGDM and IGDM vs. infants born to healthy pregnant women, selected from PubMed and EMBASE databases, were included. The studies performed on FGDM and IGDM were separately analyzed. The subtotal and overall standardized mean differences (SMDs) in LV-GLS and RV-GLS in FGDM and IGDM studies were calculated using the random-effect model. Results: The full texts of 18 studies with 1046 babies (72.5% fetuses) born to GDM women and 1573 babies of women with uncomplicated pregnancy (84.5% fetuses) were analyzed. Compared to controls, FGDM/IGDM were found with a significant reduction in both LV-GLS [average value −18.8% (range −11.6, −24.2%) vs. −21.5% (range −11.8, −28%), p < 0.05)] and RV-GLS [average value −19.7% (range −13.7, −26.6%) vs. −22.4% (range −15.5, −32.6%), p <0.05)]. Large SMDs were obtained for both LV-GLS and RV-GLS studies, with an overall SMD of −0.91 (95%CI −1.23, −0.60, p < 0.001) and −0.82 (95%CI −1.13, −0.51, p < 0.001), respectively. Substantial heterogeneity was detected for both LV-GLS and RV-GLS studies, with an overall I2 statistic value of 92.0% and 89.3%, respectively (both p < 0.001). Egger’s test gave a p-value of 0.10 for LV-GLS studies and 0.78 for RV-GLS studies, indicating no publication bias. In the meta-regression analysis, none of the moderators (gestational age, maternal age, maternal body mass index, maternal glycosylated hemoglobin, white ethnicity, GDM criteria, ultrasound system, frame rate, FGDM/IGDM heart rate, and anti-diabetic treatment) were significantly associated with effect modification in both groups of studies (all p > 0.05). The sensitivity analysis supported the robustness of the results. Conclusions: GDM is independently associated with biventricular strain impairment in fetuses and infants of gestational diabetic mothers. STE analysis may allow for the early detection of subclinical myocardial dysfunction in FGDM/IGDM. Full article
(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)
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