Abstract
BACKGROUND: The survival rate of pediatric leukemia patients has remarkably increased. Early identification of cardiotoxicity associated with chemotherapy and the detection of prognostic factors are essential for effective patient management. OBJECTIVE: To evaluate the prognostic value of parameters assessed by cardiac magnetic resonance imaging (MRI) in pediatric patients with acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: A total of 217 children diagnosed with ALL (study group) and 65 healthy (control group) were recruited for the study and underwent cardiac MRI. Follow-up was conducted after the cardiac MRI to monitor adverse clinical events and adverse cardiac events. Cox and Kaplan-Meier (K-M) analyses were used to investigate the predictive value of cardiac MRI parameters. RESULTS: All strain parameters including global radial strain, global circumferential strain, and global longitudinal strain were significantly lower in the study group compared to the control group. Global radial strain (hazard ratio (HR) = 0.89; 95% confidence interval (CI) 0.79-0.99) and global longitudinal strain (HR = 1.31; 95% CI 1.01-1.71) were indicators of adverse clinical outcomes (P < 0.05). Left ventricular remodeling index (LVRI, HR = 1.11; 95% CI 1.00-1.23) was the risk predictor for adverse cardiac events (P < 0.05). Patients with global longitudinal strain of < 18% had worse clinical outcomes (HR = 6.97, 95% CI 1.07-62.39, P = 0.04) and higher risk of adverse cardiac events (HR = 5.94, 95% CI 1.23-28.58, P = 0.03) compared with those with global longitudinal strain of ≥ 18%. CONCLUSION: Cardiac MRI-derived parameters, including global longitudinal strain, global radial strain, and LVRI, are effective prognostic tools for predicting adverse events in children diagnosed with ALL who underwent chemotherapy with anthracyclines.