Anthracycline-induced left atrioventricular dyssynchrony in children with leukemia: a cardiac magnetic resonance imaging study of functional and strain analysis.
In a cross-sectional CMR study of 109 pediatric leukemia patients and 40 age-matched controls, anthracycline exposure—particularly at higher cumulative doses—was associated with impaired left atrial function, altered atrial–ventricular strain relationships, and increased left atrioventricular coupling index.
Open original publication →What the AI sees
In a cross-sectional CMR study of 109 pediatric leukemia patients and 40 age-matched controls, anthracycline exposure—particularly at higher cumulative doses—was associated with impaired left atrial function, altered atrial–ventricular strain relationships, and increased left atrioventricular coupling index.
Research significance
The reported human imaging associations support CMR-derived atrial strain and left atrioventricular coupling as candidate markers of anthracycline-related cardiac impairment; it remains an inference, requiring longitudinal validation, that these markers could enable earlier cardioprotective intervention or chemotherapy-monitoring adjustments and thereby reduce toxicity.
Source abstract
BACKGROUND: The 2022 European Society of Cardiology on cardio-oncology guidelines emphasized anthracycline chemotherapy's dose-dependent cardiotoxicity, identifying reduced left ventricular (LV) strain as a sensitive biomarker for early myocardial injury. However, left atrial (LA) structural/functional changes assessed via cardiac magnetic resonance (CMR) remain underexplored. METHODS: This cross-sectional cohort study included 109 pediatric leukemia patients (2015-2021) and 40 age-matched controls. Leukemia patients were stratified into low-/high-dose anthracycline groups. CMR parameters (LA ejection fraction [LAEF], LV strain [LVS], LA strain [LAS], and left atrioventricular coupling index [LACI]) were analyzed. Linear regression evaluated strain-LACI relationships; Spearman's correlation assessed LAS-LVS associations. RESULTS: Leukemia patients exhibited higher LA contraction strain (Ɛa: 24% vs. 21%, p = 0.025) but lower total/passive LAEF [73 ± 8 vs. 78 ± 7; 50 [40,56] vs. 59 [53,65]] and higher LV ejection fraction (64.5 ± 5.5 vs. 62.4 ± 5.7) than that in controls. LAS-LVS correlations were stronger in controls (r = 0.32-0.52) than leukemia (r = 0-0.27). Among leukemia patients, low-dose patients had higher active LAEF (48 ± 14 vs. 39 ± 16) and weaker LAS-LVS correlations than high-dose group(r = 0-0.28 vs. r = 0-0.42), while high-dose group showed elevated LACI (β=9.68, p = 0.018) correlating with the cumulative anthracycline dose. CONCLUSIONS: Anthracyclines disrupt LA-LV coordination in pediatric leukemia, with higher doses exacerbating atrial strain impairment. These findings highlight CMR-derived strain parameters as critical for monitoring anthracycline-induced cardiac impairment.