Diastolic function assessment with left atrial strain in long-term survivors of childhood acute leukemia

Introduction and objectives: Survivors of childhood cancer might be at increased risk of diastolic dysfunction at follow-up due to exposure to cardiotoxic treatment. Although assessment of diastolic function is challenging in this relatively young population, left atrial strain might provide a novel insight in this evaluation. Our aim was to examine diastolic function in a cohort of long-term survivors of childhood acute lymphoblastic leukemia by using left atrial strain and conventional echocardiographic parameters. Methods: Long-term survivors who were diagnosed at a single center between 1985 and 2015 and a control group of healthy siblings were recruited. Conventional diastolic function parameters and atrial strain were compared, and the latter was measured during the 3 atrial phases: reservoir (PALS), conduit (LACS) and contraction (PACS). Inverse probability of treatment weighting was used to account for differences between the groups. Results: We analyzed 90 survivors (age, 24.6 +/- 9.7 years, time since diagnosis 18 [11-26] years) and 58 controls. PALS and LACS were significantly reduced compared with the control group: 46.4 +/- 11.2 vs 52.1 +/- 11.7; P=.003 and 32.5 +/- 8.8 vs 38.2 +/- 9.3; P=.003, respectively. Conventional diastolic parameters and PACS were similar between the groups. The reductions in PALS and LACS were associated with exposure to cardiotoxic treatment in age- and sex-adjusted analysis (>= moderate risk, low risk, controls): 45.4 +/- 10.5, 49.5 +/- 12.9, 52.1 +/- 11.7; P-adj=.003, and 31.7 +/- 9.0, 35.2 +/- 7.5, 38.2 +/- 9.3; P-adj=.001, respectively. Conclusions: Long-term childhood leukemia survivors showed a subtle impairment of diastolic function that was detected with atrial strain but not with conventional measurements. This impairment was more pronounced in those with higher exposure to cardiotoxic treatment.