There are limited data regarding right ventricle (RV) impairment in long-term survivors of childhood acute lymphoblastic leukemia (CLS). The aim of this study was to assess RV function in these patients using echocardiographic conventional measurements and automated RV strain. Echocardiographic recordings of 90 CLS and 58 healthy siblings from the CTOXALL cohort were analyzed. For group comparisons, inverse probability weighting was used to reduce confounding. The CLS group (24.6 ± 9.7 years, 37.8% women) underwent an echocardiographic evaluation 18 (11–26) years after the diagnosis. RV systolic dysfunction was found in 16.7% of CLS individuals using RV free-wall strain (RVFWS) compared to 2.2 to 4.4% with conventional measurements. RV systolic function measurements were lower in the CLS than in the control group: TAPSE (23.3 ± 4.0 vs. 25.2 ± 3.4,p= 0.004) and RVFWS (24.9 ± 4.6 vs. 26.8 ± 4.7,p= 0.032). Modifiable cardiovascular risk factors such as obesity (p= 0.022) and smoking (p= 0.028) were independently associated with reduced RVFWS. In conclusion, RV systolic function impairment was frequent in long-term survivors of childhood leukemia, underscoring the importance of RV assessment, including RVFWS, in the cardiac surveillance of these patients.
关于儿童急性淋巴细胞白血病长期幸存者右心室功能受损的研究数据有限。本研究旨在通过超声心动图常规测量及自动化右心室应变技术评估此类患者的右心室功能。研究分析了CTOXALL队列中90例白血病幸存者及58例健康同胞的超声心动图数据，并采用逆概率加权法进行组间比较以减少混杂因素影响。白血病幸存者组（平均年龄24.6±9.7岁，女性占37.8%）在确诊后18年（中位数，四分位距11-26年）接受超声心动图评估。采用右心室游离壁应变检测发现16.7%的幸存者存在右心室收缩功能障碍，而常规测量方法仅检出2.2%-4.4%。与对照组相比，幸存者组的右心室收缩功能指标显著降低：三尖瓣环收缩期位移（23.3±4.0 mm vs. 25.2±3.4 mm, p=0.004）和右心室游离壁应变（24.9±4.6% vs. 26.8±4.7%, p=0.032）。可调控的心血管危险因素如肥胖（p=0.022）和吸烟（p=0.028）与右心室游离壁应变降低独立相关。结论表明，儿童白血病长期幸存者普遍存在右心室收缩功能损伤，这凸显了在心脏监测中纳入右心室评估（包括右心室游离壁应变）的重要性。
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