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Cardiac MRI was used to evaluate late gadolinium enhancement, native T1 mapping, extracellular volume, and T2* for estimation of iron load. Cardiac function and myocardial performance index (MPI, evaluated by tissue Doppler echocardiography) and serum galectin-3 were\u00a0compared to controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age of the included patients was 13.3\u2009\u00b1\u20093.2\u00a0years. Myocardial iron load by T2* was normal. The mean level of extracellular volume (35.41\u2009\u00b1\u20095.02%) was significantly associated with the frequency of vaso-occlusive crises (<jats:italic>P<\/jats:italic>\u2009=\u20090.017) and negatively correlated with hemoglobin levels (<jats:italic>P<\/jats:italic>\u2009=\u20090.005). Galectin-3 levels were significantly higher among cases than controls (<jats:italic>P<\/jats:italic>\u2009=\u2009<jats:italic>0.00)<\/jats:italic>, at a cutoff value on the receiver operating characteristic curve of 6.5\u00a0ng\/ml, sensitivity of 82.5% and specificity of 72.8%. The extracellular volume was significantly higher in cases, with a MPI\u2009&gt;\u20090.4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Diffuse interstitial myocardial fibrosis can be detected early\u00a0in children with sickle cell disease using T1 mapping and is associated with a high frequency of vaso-occlusive crisis. MPI of the left ventricle and serum galectin-3 are recommended screening tools for subclinical cardiac abnormalities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Graphical abstract<\/jats:title><\/jats:sec>","DOI":"10.1007\/s00247-023-05750-2","type":"journal-article","created":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T06:02:08Z","timestamp":1694844128000},"page":"2515-2527","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of cardiac fibrosis and subclinical cardiac changes in children with sickle cell disease using magnetic resonance imaging, echocardiography, and serum galectin-3"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0738-9306","authenticated-orcid":false,"given":"Reham","family":"Wagdy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Fathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-9107","authenticated-orcid":false,"given":"Abdelaziz","family":"Elnekidy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0063-5405","authenticated-orcid":false,"given":"Geylan","family":"Salaheldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanan","family":"Nazir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Fahmy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagar","family":"Elkafrawy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6258-9576","authenticated-orcid":false,"given":"Fatma","family":"Elkafrawy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,16]]},"reference":[{"key":"5750_CR1","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.tcm.2020.02.002","volume":"31","author":"V Sachdev","year":"2021","unstructured":"Sachdev V, Rosing DR, Thein SL (2021) Cardiovascular complications of sickle cell disease. 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