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Background Anti-cancer drugs can cause cardiovascular complications. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are usually used to identify clinical and subclinical cardiotoxicity. Purpose The aim of our study was to assess the addictional role of left atrial reservoir strain (LAS-S) and left atrial stiffness (LASI – the ratio of E/e' to LAS-S) in identifying patients at higher risk of cardiotoxicity. Methods 102 breast cancer patients (median age 53±9.5 years), without cardiovascular diseases, were enrolled before starting chemotherapy. Electrocardiogram and transthoracic echocardiogram (conventional measurements based on EACVI recommendations; GLS, LAS-S and LASI measurement) were performed in all patients before starting chemotherapy (T0) and 3 (T1) and 6 months (T2) after chemotherapy. Results No patient developed clinical cardiotoxicity. Moreover we did not find at all times a significant reduction in LVEF compared to baseline. At T1 and T2, we found a significant reduction in GLS (−21.1% IQR −21.9, −20.2% at T0 vs −18.8% IQR −9.5, −18.1% at T1 vs −18.0% IQR −19.8, −17.8% at T2; p value &amp;lt;0.01) and LAS-S (34.4% IQR 31.4–37.4% at T0 vs 28.5% IQR 26.2–30.8% at T1 vs 30.8% IQR 27.6–34% at T2; p&amp;lt;0.001), a significant increase of LASI (0.21%-1 IQR 0.10–0.20%-1 at T0 vs 0.28%-1 IQR 0.20–0.31%-1 at T1 vs 0.35%-1 IQR 0.23–0.41%-1 at T2, p&amp;lt;0.001). In addiction patients were divided into 2 groups based on the presence at T2 and not at T1 (A group) or absence (B group) of a subclinical cardiac dysfunction (identified by a reduction in GLS ≥15% compared to baseline). In A group (47% of population) LASI increased significantly already at T1 and remained significantly increased at T2 (0.21±0.07 at T0 vs 0.3±0.12 at T1, p value &amp;lt;0.0001; 0.33±0.16 at T2, p value &amp;lt;0.0001); LAS-S was significantly reduced at T1 and T2 (35±5 at T0 vs 30±8 at T1, p value 0.0005; 29±9 at T2, p value 0.0001). In patients without subclinical cardiac dysfunction during follow-up (B group, 53% of population), a significant reduction in LAS-S was already evident at T1 and not only at T2 (p value &amp;lt;0.0001 at T1-T2); we found a significant increase in LASI at T1 and T2 (p value &amp;lt;0.0001). Conclusion LAS-S and LASI are able to identify subclinical cardiac dysfunction during chemotherapy, they appear to be even more precious markers of cardio-toxicity than GLS. Further study are needed to verify the prognostic implications of atrial strain impairment during chemotherapeutic treatment. Funding Acknowledgement Type of funding sources: None.

Left atrial strain and left atrial stiffness for early detection of cardiotoxicity in cancer patients