Left atrial function: early target of chemotherapy related cardiac damage

The improvement of antineoplastic treatment regimens as well as the advances achieved in surgical strategies have enormously increased the average survival of cancer patients, indirectly encouraging the clinical manifestation of collateral effects of chemotherapeutic agents in an increasing number of patients. Moreover, most of patients affected by cancer also have multiple cardiovascular (CV) risk factors, that make even more likely that cancer and CV disease may both be diagnosed in the same patient. Cardioncology deals with all the possible damages directly or indirectly induced by chemotherapy with the aim to prevent irreversible CV detrimental effects of chemotherapeutic agents, without reducing their therapeutic efficacy. Serial noninvasive assessment of cardiotoxicity in patients receiving anthacyclines (ANTs) has centered for decades on the echocardiographic assessment of LV systolic function using ejection-phase indices, namely, fractional shortening and ejection fraction. However, changes in these indices are most commonly late clinical findings and often lack in the early identification of subclinical myocardial dysfunction. It is well known that LV systolic function could be impaired in patients treated by ANTs, but the effects on left atrial (LA) function are still poorly investigated. In our study we sought to evaluate the effect of chemotherapy on LA function assessed by 2 dimensional Speckle Tracking longitudinal strain in 58 women affected by breast cancer and treated with ANTs-based chemotherapy regimen. After 3 months of treatment an early impairment of LA longitudinal strain during reservoir phase together with a reduction of LV global longitudinal strain was detected. Our results encourage the research of an early subclinical cardiac damage targeted on LA longitudinal function in patients treated with potentially cardiotoxic drugs.