Comparison of Left Atrial Strain Parameters After Doxorubicin Therapy in Pediatric Patients With Leukemia and Healthy Children: A Cross-Sectional Case–Control Study

Abstract Objective: To compare left atrial strain parameters during reservoir, conduit, and contraction phases in pediatric patients with leukemia treated with doxorubicin and age- and sex-matched healthy controls, and to evaluate their potential role in detecting subclinical cardiotoxicity. Methods: This single-center, cross-sectional case–control study included 22 pediatric patients with acute lymphoblastic leukemia who received a cumulative doxorubicin dose of 240 mg/m² and 25 healthy controls. All participants underwent comprehensive echocardiographic evaluation, including two-dimensional speckle-tracking analysis. Left ventricular global longitudinal strain (GLS) and left atrial strain parameters were assessed. Intergroup comparisons and correlation analyses were performed using appropriate statistical methods. Results: The mean follow-up duration after completion of chemotherapy was 4.6 ± 2.6 years. Left atrial reservoir, conduit, and contraction strain values were numerically lower in the leukemia group but did not differ significantly from controls. Mean reservoir strain was 39.4 ± 7.8% in patients and 48.9 ± 6.5% in controls (p = 0.353). Conduit strain showed a trend toward significance (25.1 ± 6.3% vs. 32.4 ± 7.1%, p = 0.078). Contraction strain and GLS were comparable between groups. Left ventricular wall thickness and end-diastolic diameter were significantly lower in patients, while ejection fraction remained preserved. No significant correlations were observed between strain parameters and follow-up duration. Conclusion: At mid-term follow-up after moderate-dose doxorubicin therapy, left atrial strain parameters and GLS remained largely preserved in pediatric leukemia survivors. These findings suggest the absence of overt subclinical myocardial dysfunction at this dose level, emphasizing the importance of long-term strain-based surveillance in this population.