{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T13:14:44Z","timestamp":1788527684775,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004166","name":"Medical University of Warsaw","doi-asserted-by":"publisher","award":["2M6\/1\/M\/MB\/N\/25\/26"],"award-info":[{"award-number":["2M6\/1\/M\/MB\/N\/25\/26"]}],"id":[{"id":"10.13039\/501100004166","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2M6\/1\/M\/MB\/N\/25\/26"],"award-info":[{"award-number":["2M6\/1\/M\/MB\/N\/25\/26"]}],"id":[{"id":"https:\/\/ror.org\/04p2y4s44","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Acute lymphoblastic leukemia (ALL) treatment is effective but involves the use of cardiotoxic anthracyclines. Data on three-dimensional (3D) strain echocardiography utility in the monitoring of acute and early-onset cardiotoxicity in children with ALL are scarce. The aim was to assess the left ventricular function in 3D strain echocardiography in children with ALL treated with anthracyclines in reference to a healthy cohort and to assess risk factors of possible subclinical cardiotoxicity. Methods: For this study, medical records from between May 2023 and December 2024 were retrospectively analyzed, and the echocardiographic data were reassessed. The study group consisted of children diagnosed and treated for ALL for at least 6 months with the use of daunorubicin and doxorubicin (or only with daunorubicin) who underwent routine cardiological evaluation with 3D echocardiography in &gt;6 months and &lt;2 years from the beginning of treatment. The echocardiographic records were reassessed offline to analyze the left ventricle 3D global longitudinal (GLS 3D), circumferential (GCS 3D) and radial (GRS 3D) strain. The results were compared with the results of 24 apparently healthy peers matched by sex and age. A set of models was developed to test literature-based subclinical cardiotoxicity determinants in relation to the obtained 3D strain values. Results: The study group consisted of 42 children (22 males and 20 females) aged 2\u201317 years (mean 7.7 \u00b1 4.1 years) treated for ALL. The median time from the first anthracycline dose was 0.59 (IQR1 = 0.5; IQR3 = 0.96) years with a cumulative equivalent anthracycline dose of 158.2 \u00b1 78.0 (min. 48.0\u2013max. 451.8) mg\/m2. Statistically significant differences between study and control groups were observed in terms of LVEF 3D (53.9 \u00b1 4.4% vs. 59.1 \u00b1 5.8%, p &lt; 0.001), GLS 3D (\u221221.8 \u00b1 4.2% vs. \u221225.2 \u00b1 3.6%, p &lt; 0.001), GCS 3D (\u221222.3 \u00b1 3.8% vs. \u221227.3 \u00b1 4.7%, p &lt; 0.001) and GRS 3D (37.1 \u00b1 5.0% vs. 44.6 \u00b1 5.7%, p &lt; 0.001). None of the previously described cardiotoxicity risk factors\u2014age at the diagnosis, sex, age at treatment initiation, body surface area (BSA) at treatment initiation, time since treatment initiation, ALL subtype, total anthracycline dose and doxorubicin treatment\u2014were statistically significant in the GLS or GCS models. Conclusions: GLS 3D, GCS 3D and GRS 3D of the left ventricle may be sensitive indicators of myocardial dysfunction in children with ALL treated with anthracyclines. The relation of the previously described cardiotoxicity risk factors to the 3D strain values and myocardial dysfunction is inconclusive; further studies are warranted.<\/jats:p>","DOI":"10.3390\/cancers18172867","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:20:19Z","timestamp":1788524419000},"page":"2867","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three-Dimensional Left Ventricle Strain Echocardiography in the Detection of Anthracycline Cardiotoxicity in Children with Acute Lymphoblastic Leukemia\u2014Retrospective Case-Control Analysis and Relation to the Cardiotoxicity Risk Factors Assessment"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6078-9037","authenticated-orcid":false,"given":"Julia","family":"Haponiuk-Skwarli\u0144ska","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2838-7011","authenticated-orcid":false,"given":"Halszka","family":"Kami\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2009-2200","authenticated-orcid":false,"given":"Jakub S.","family":"G\u0105sior","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-6484","authenticated-orcid":false,"given":"Katarzyna","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oncology, Hematology and Transplantology, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3656-5236","authenticated-orcid":false,"given":"Pawe\u0142","family":"\u0141aguna","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oncology, Hematology and Transplantology, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6416-4106","authenticated-orcid":false,"given":"Bo\u017cena","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1038\/s41375-022-01620-2","article-title":"The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms","volume":"36","author":"Alaggio","year":"2022","journal-title":"Leukemia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101966","DOI":"10.1016\/j.eclinm.2023.101966","article-title":"Evidence of clinical benefit of WHO essential anticancer medicines for children, 2011-2021","volume":"59","author":"Bai","year":"2023","journal-title":"eClinicalMedicine"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Childhood Acute Lymphoblastic Leukaemia Collaborative Group (2009). 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