Alterations in Left Atrial Strain in Breast Cancer Patients Immediately Post Anthracycline Exposure

Peter Emerson; Luke Stefani; Anita Boyd; David Richards; Rina Hui; Mikhail Altman; Liza Thomas

doi:10.1016/j.hlc.2023.06.864

Alterations in Left Atrial Strain in Breast Cancer Patients Immediately Post Anthracycline Exposure

Heart Lung Circ. 2023 Oct 6:S1443-9506(23)04291-9. doi: 10.1016/j.hlc.2023.06.864. Online ahead of print.

Authors

Peter Emerson¹, Luke Stefani², Anita Boyd³, David Richards³, Rina Hui⁴, Mikhail Altman¹, Liza Thomas⁵

Affiliations

¹ Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.
² Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
³ Westmead Private Cardiology, Westmead, Sydney, NSW, Australia.
⁴ Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia; The Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia.
⁵ Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia. Electronic address: liza.thomas@sydney.edu.au.

PMID: 37806911
DOI: 10.1016/j.hlc.2023.06.864

Abstract

Aims: With improved diagnosis and treatments, a greater percentage of breast cancer patients are achieving long-term survival. Consequently, long-term cardiotoxicity secondary to chemotherapy has become more prevalent, warranting improved cardiac surveillance. We evaluated changes in left atrial (LA) strain in breast cancer patients immediately post anthracycline (AC) therapy to assess its utility as a marker of diastolic dysfunction.

Methods: This was a prospective cohort study of 128 consecutive human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients who underwent transthoracic echocardiography prior to and immediately post AC treatment. Traditional left ventricular (LV) systolic and diastolic parameters and LA volumes were evaluated; additionally, LV global longitudinal strain (LV GLS) and LA phasic strain were measured.

Results: All patients had normal LV ejection fraction (>53%) post AC, though LV GLS was significantly reduced. Peak E and é velocities were reduced post AC, with no change in LA volumes. LA reservoir strain (LAS_RES 34.8% vs 31.5%, p<0.001) and conduit strain (LAS_CD 17.2% vs 14.4%, p<0.001) were significantly lower post AC and correlated modestly with LV diastolic parameters. Reduction in LA strain post AC was evident even in patients with preserved LV systolic and diastolic function. More patients demonstrated alteration in diastolic function (≥15% reduction in LAS_RES from baseline) (32%) compared to alteration in systolic function (≥15% reduction in LV GLS) (23%).

Conclusions: LA strain is a promising marker of early diastolic dysfunction. We demonstrate its potential utility in surveillance of breast cancer patients treated with AC.

Keywords: Anthracycline; Breast cancer; Cardiotoxicity; Left atrial strain.

Copyright © 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.