Journal of Pediatric Cardiology and Cardiac Surgery

Heart failure is conventionally defined as a dynamic clinical syndrome where the cardiovascular system fails to meet the metabolic demand of the peripheral tissues or can only do so at the expense of increased ventricular filling pressure. Emerging new findings in biomedical research have enabled us to recognize the early preclinical myocardial changes at the cellular and molecular levels before ventricular dysfunction becomes visible. These preclinical changes have also become recognizable by advanced medical technology. Here, we introduce two relatively common clinical entities that present with an asymptomatic preclinical stage in pediatrics, cardiomyopathies in Duchenne muscular dystrophy and anthracycline-induced cardiotoxicity. We will discuss underlying pathobiology, early diagnosis by noninvasive imaging studies, and cardioprotective treatment of the preclinical stage of progressive myocardial disease. The early recognition and treatment of the preclinical stage of heart failure may provide us with new perspectives in understanding this devastating disease.