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August 1, 2026International Heart JournalOpen Access

Age-Related Impairment of Left Atrial Phasic Strain in Childhood Cancer Survivors Treated with Anthracyclines

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Why the study?

It remains unclear when during survivorship left atrial dysfunction becomes detectable in childhood cancer survivors treated with anthracyclines.

Does prior anthracycline chemotherapy impair left atrial phasic strain in childhood cancer survivors compared to healthy controls?

Population

92 childhood cancer survivors aged 4-32 years and 96 age-matched healthy controls

Comparison

Childhood cancer survivors treated with anthracyclines vs age-matched healthy controls across age groups

Design

Retrospective observational case-control study

Key result

Anthracycline chemotherapy exposure in childhood cancer survivors was associated with significantly reduced left atrial reservoir, conduit, and pump strains in young adulthood compared to controls.

Authors

HSHiroyuki SatoKTKen TakahashiYHYu Hosono

Discussion

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Overview

Strain assessment may detect subclinical dysfunction in young adult survivors; leaves open prospective outcome validation before routine use.

Key Points

  • To determine the timing of detectable left atrial dysfunction in childhood cancer survivors treated with anthracyclines.
  • Retrospective observational case-control study
  • Evaluated 92 childhood cancer survivors and 96 age-matched healthy controls using echocardiography
  • Measured left atrial phasic strains and conventional diastolic indices across three age groups.
  • In young adult survivors aged 19–32 years, left atrial reservoir, conduit, and pump strains were significantly reduced compared to controls (exact rates not provided).
  • Left ventricular longitudinal strain was also significantly lower in the same age group.
  • No significant differences in left atrial strain were observed in younger survivors (4–18 years) despite preserved conventional diastolic indices.

Study Design

Type

Case-Control (n=188)

Blinding

Observers blinded to clinical data

Multicenter

Yes

Structured PICO

Does prior anthracycline chemotherapy impair left atrial phasic strain in childhood cancer survivors compared to healthy controls?

P
Population
188 participants, comprising 92 childhood cancer survivors treated with anthracyclines and 96 age-matched healthy controls aged 4 to 32 years, evaluated for left atrial phasic strain.
E
Exposure
Prior anthracycline chemotherapy exposure
C
Comparator
Age-matched healthy controls (no anthracycline exposure)
O
Outcome
Left atrial (LA) phasic strain (reservoir, conduit, and pump strains) measured by two-dimensional speckle-tracking echocardiographysurrogate

Main Result

p-value: p=<0.01

Age-stratified left atrial strain assessment can detect subclinical cardiac dysfunction in young adult childhood cancer survivors treated with anthracyclines, even when conventional diastolic indices remain preserved.

Limitations

  • Retrospective observational design without longitudinal echocardiographic follow-up
  • Lack of multimodal objective assessments such as cardiac magnetic resonance imaging
  • Inability to statistically adjust for duration since chemotherapy completion due to collinearity with age
  • Single-center study at a tertiary pediatric oncology referral center, limiting generalizability
  • Use of P-wave onset as the zero reference for LA strain may limit comparability with studies using end-diastolic referencing

Cite This Study

Sato et al. (2026) conducted a case-control in Childhood cancer survivors treated with anthracyclines (n=188). Anthracycline chemotherapy vs. Age-matched healthy controls was evaluated on Left atrial phasic strain (reservoir, conduit, and pump strains) (p=<0.01). Anthracycline chemotherapy exposure in childhood cancer survivors was associated with significantly reduced left atrial reservoir, conduit, and pump strains in young adulthood compared to controls.

synapsesocial.com/papers/6a6dab3fe258b358b3c6ca17https://doi.org/10.1536/ihj.26-140
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer2019 · 47 citations
  2. 2Left Ventricular Strain Analysis During Submaximal Semisupine Bicycle Exercise Stress Echocardiography in Childhood Cancer Survivors2022 · 8 citations
  3. 3Cardiac Function After Cardiotoxic Treatments for Childhood Cancer—Left Ventricular Longitudinal Strain in Screening2021 · 16 citations
  4. 4Left ventricular dyssynchrony in long-term childhood cancer survivors treated with anthracyclines: a retrospective cross-sectional study2021 · 3 citations
  5. 5Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography2019 · 31 citations