Left atrial strain as a marker of early cardiotoxicity: evaluation in bone marrow transplant and breast cancer patients

Abstract

Aims:

With improved cancer diagnosis and treatments, there has been an increased prevalence of long-term cardiotoxicity in bone marrow transplant (BMT) and breast cancer patients treated with anthracyclines (AC), warranting improved cardiac surveillance. We sought to evaluate changes in left atrial (LA) volumes and function, including LA strain, in BMT and breast cancer patients with prior AC exposure.

Methods:

We evaluated 79 BMT patients with prior AC exposure compared with age-matched healthy volunteers as a control group, who underwent a comprehensive transthoracic echocardiogram (TTE). Left ventricular (LV) and LA parameters were evaluated between the two groups, including LV global longitudinal strain (GLS) and LA phasic strain.

We also performed a prospective cohort study of 128 breast cancer patients (HER-2 negative) who underwent TTE prior to and immediately post AC therapy. Similarly, LV and LA parameters (including strain) were evaluated at both time points.

Results:

LV systolic function was reduced in the BMT group compared to controls. LA reservoir strain (LASRES) and conduit strain (LASCD) were significantly reduced in the BMT group. These parameters correlated modestly with traditional diastolic parameters. Whilst 26/79 BMT patients had diastolic dysfunction using traditional guidelines, a further 35 patients were identified using LASRES.

All breast cancer patients had preserved LV ejection fraction and similar LA volumes post AC. There were significant reductions in LV GLS as well as LASRES and LASCD post AC. Changes in LASRES and LASCD were also present in those with preserved LV systolic and diastolic function. More patients demonstrated significant reductions (≥15% from baseline) using LASRES (32%) compared to LV GLS (23%).

Conclusions:

LA strain is a sensitive marker of diastolic dysfunction in BMT and breast cancer patients treated with prior AC. We demonstrate its potential utility in early detection of cardiotoxicity in these patient populations.