Key result
Anthracycline exposure is linked to ~14% higher left atrial contraction strain in pediatric leukemia survivors.
Why the study?
Anthracycline cardiotoxicity reduces left ventricular strain, but left atrial structural and functional changes evaluated by CMR remain underexplored.
Does anthracycline chemotherapy alter left atrial strain and left atrioventricular coupling in pediatric leukemia patients compared to healthy controls?
Cross-Sectional (n=149)
No
Does anthracycline chemotherapy alter left atrial strain and left atrioventricular coupling in pediatric leukemia patients compared to healthy controls?
Absolute Event Rate: 24% vs 21%
p-value: p=0.025
Anthracycline chemotherapy disrupts left atrial-left ventricular coordination in pediatric leukemia patients in a dose-dependent manner, highlighting the utility of CMR-derived strain parameters for early cardiotoxicity monitoring.
May signal early anthracycline cardiotoxicity via LA-LV dyssynchrony in children; leaves open whether CMR strain monitoring should enter guidelines.
Background The 2022 European Society of Cardiology on cardio-oncology guidelines emphasized anthracycline chemotherapy's dose-dependent cardiotoxicity, identifying reduced left ventricular (LV) strain as a sensitive biomarker for early myocardial injury. However, left atrial (LA) structural/functional changes assessed via cardiac magnetic resonance (CMR) remain underexplored. Methods This cross-sectional cohort study included 109 pediatric leukemia patients (2015–2021) and 40 age-matched controls. Leukemia patients were stratified into low-/high-dose anthracycline groups. CMR parameters (LA ejection fraction [LAEF], LV strain [LVS], LA strain [LAS], and left atrioventricular coupling index [LACI]) were analyzed. Linear regression evaluated strain-LACI relationships; Spearman's correlation assessed LAS-LVS associations. Results Leukemia patients exhibited higher LA contraction strain (Ɛa: 24% vs. 21%, p = 0.025) but lower total/passive LAEF [73 ± 8 vs. 78 ± 7; 50 [40,56] vs. 59 [53,65]] and higher LV ejection fraction (64.5 ± 5.5 vs. 62.4 ± 5.7) than that in controls. LAS-LVS correlations were stronger in controls (r = 0.32–0.52) than leukemia (r = 0–0.27). Among leukemia patients, low-dose patients had higher active LAEF (48 ± 14 vs. 39 ± 16) and weaker LAS-LVS correlations than high-dose group(r = 0–0.28 vs. r = 0–0.42), while high-dose group showed elevated LACI ( β =9.68, p = 0.018) correlating with the cumulative anthracycline dose. Conclusions Anthracyclines disrupt LA-LV coordination in pediatric leukemia, with higher doses exacerbating atrial strain impairment. These findings highlight CMR-derived strain parameters as critical for monitoring anthracycline-induced cardiac impairment.
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Liao et al. (2026) conducted a cross-sectional in Pediatric leukemia (n=149). Anthracycline chemotherapy vs. Healthy age-matched controls was evaluated on Left atrial contraction strain (Ɛa) (p=0.025). Anthracycline exposure in pediatric leukemia patients was associated with higher left atrial contraction strain (24% vs. 21%) and lower total left atrial emptying fraction compared to healthy controls.
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