Right Ventricular Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: From the CTOXALL Study

SIMPLE SUMMARY: Childhood cancer survivors have an increased lifetime risk of cardiac problems due to the cardiotoxic effects of cancer treatments. While most research has focused on the left side of the heart, little is known about the effects of these treatments on the right-side chambers. We used cardiac ultrasound to examine the right ventricle in 90 long-term survivors of childhood leukemia and a control group of 58 healthy siblings. Our findings showed that a noticeable number of survivors had subtle alterations in the pump function of the right ventricle, especially when measured using a novel parameter called a free-wall strain. Alterations in free-wall strain were more common in the survivors who were obese or smoked. This study underscores the importance of incorporating right ventricular strain assessment into routine cardiac surveillance and promoting healthy lifestyle habits among survivors. ABSTRACT: 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.