Key result
Sequential anthracycline and taxane chemotherapy significantly reduced left atrial reservoir strain from baseline to post-therapy in breast cancer patients (median 35.0% vs 31.5%; p<0.001).
Why the study?
Subclinical injury from chemotherapy often precedes left ventricular ejection fraction decline and involves the entire heart. Left atrial strain has emerged as a potentially sensitive marker for early myocardial remodelling, prompting assessment of sequential anthracycline and taxane therapy on atrial mechanics.
Does sequential anthracycline and taxane chemotherapy reduce 2D-STE-derived left atrial reservoir strain in women with invasive breast cancer?
Cohort (n=111)
Does sequential anthracycline and taxane chemotherapy reduce 2D-STE-derived left atrial reservoir strain in women with invasive breast cancer?
Sequential anthracycline and taxane chemotherapy in breast cancer patients leads to significant bi-atrial strain reduction and left atrial volumetric remodeling, highlighting 2D-STE atrial mechanics as sensitive markers for early subclinical cardiotoxicity.
Answers are grounded in this paper and cite their sources.
May support atrial strain monitoring for subclinical cardiotoxicity; hypothesis-generating and requires prospective validation before practice change.
Background Chemotherapy-induced cardiotoxicity is traditionally defined by a decline in left ventricular (LV) ejection fraction. However, subclinical injury often precedes LV dysfunction and involves the entire heart. Left atrial (LA) strain has emerged as a potentially sensitive marker for early myocardial remodelling. Purpose We aimed to assess the impact of sequential anthracycline and taxane therapy on atrial mechanics using two-dimensional speckle-tracking echocardiography (2D-STE). Methods We conducted a prospective, longitudinal study, including 111 women (mean age50.3 ±9.9 years) with invasive breast cancer receiving chemotherapy between September 2024 and December 2025. Patients with baseline structural heart disease, significant valvular disease, or LVEF < 40% were excluded. Echocardiography was performed at baseline (T0) and after chemotherapy completion (T1). The primary endpoint was the 2D-STE-derived LA reservoir strain. Results Following therapy, a significant reduction was observed in LA reservoir strain (median 35.0% vs. 31.5%; p < 0.001) and LA contractile strain (-16.0% vs. -14.0%; p < 0.001). This functional decline was accompanied by significant LA structural remodelling, with an increase in LA volume index (LAVi) from 24.1 to 30.9 mL/m² (p < 0.001). Atrial involvement was global, characterized by a significant decrease in right atrial reservoir strain (34.0% vs. 32.0%; p = 0.003). LA conduit strain did not show a significant change (-19.0% vs -17.0%; p = 0.103). Conclusion Sequential anthracycline and taxane chemotherapy is associated with early and global atrial involvement. The impairment of both left and right atrial reservoir strains, alongside volumetric remodelling, suggests that atrial mechanics are highly sensitive markers for the detection of subclinical cardiotoxicity.
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Allouche et al. (2026) conducted a cohort in Invasive breast cancer receiving sequential anthracycline and taxane chemotherapy (n=111). Sequential anthracycline and taxane chemotherapy vs. Baseline (pre-chemotherapy, T0) was evaluated on 2D speckle-tracking echocardiography-derived left atrial (LA) reservoir strain (p=<0.001). Sequential anthracycline and taxane chemotherapy significantly reduced left atrial reservoir strain from baseline to post-therapy in breast cancer patients (median 35.0% vs 31.5%; p<0.001).
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