Small left atrium volume : a simple parameter to predict the subclinical LV dysfunction in survivors of childhood, adolescent and young adult cancer

Echocardiographic assessment of the left atrium (LA) is an integral part of the follow-up assessment of patients treated for cancer. Some authors have found that LA reservoir function évaluated by LA strain and the Global Longitudinal Strain (GLS) of the left ventricule (LV) deteriorate before the onset of a decrease in LVEF with a better sensitivity and specificity of LA reservoir function reduction to predict LV dysfunction than LV GLS.

To investigate the relationship between LA volume which is a simple parameter assessed by echocardiography and LV GLS decline in cancer longterm survivors.

The study included patients aged 18 years and older, asymptomatic cardiovascular survivors of childhood, adolescent and young adult cancer treated with anthracyclines with or without mediastinal radiotherapy. Anthropometric characteristics, cardiovascular risk factors and cancer treatment-related characteristics were collected. GLS was assessed and expressed as an absolute value. A GLS equal to 17.3% was retained as the threshold value after calculation in a referent group matched to patients according to age and gender. The volume of the LA was measured in four-chamber apical incidence according to the Area length (AL) method. Cardiac biomarkers GDF 15, ultra-sensitive troponin I and NT-proBNP levels were measured in addition to fasting blood glucose and lipid profiles. Multivariate analysis using linear regression was performed to identify associations between these different parameters.

A total of 104 cancer survivors from childhood, adolescence and young adulthood were included. The sex ratio was 1.3. The mean age of the patients was 25 years, the mean time since completion of cancer treatment was 10.6 years, the mean cumulative doses of anthracyclines and mediastinal radiotherapy were successively 245.75 ± 75.14 mg/m2 and 34.6 ± 6.19 Gy. Mean GLS was 18.5 ± 2.83%, mean LVEF 60.6 ± 5.69%. None of the patients had any known diabetes or treatment to lower blood glucose or triglyceride levels. No patient had a history of cardiovascular disease. We found that 6.7% had a fasting blood glucose ≥ 110 mg/dl, 8.7% had an obesity and 11% a dyslipidemia. The mean LA volume was 20.62 ± 6.06 ml/m2 and the mean level of troponins 5.79 ± 3.18 pg/ml. In the multivariate study, the factors associated with lower GLS were dyslipidemia (p = 0.04), obesity (p = 0.01), troponins level (p = 0.05) and small LA volume (p = 0.01).

Our results suggest that the detection of a small volume of LA , which is an easy and quick parameter to assess in echocardiography, could help identify cancer survivors from childhood, adolescence and young adulthood who would be at risk of subclinical cardiac dysfunction. Prospective studies with larger numbers are needed to confirm these findings.