Not Only the Left Ventricle: The Impact of Potentially Cardiotoxic Oncological Treatment on the Left Atrium and Right Ventricle.

BACKGROUND

Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) remain recommended for cardiotoxicity surveillance during cancer therapy, yet it changes late and overlooks injury to the other cardiac chambers.

PURPOSE: We systematically reviewed echocardiographic and cardiac magnetic resonance (CMR) studies that assessed left atrial (LA), right atrial (RA), and right ventricular (RV) function in patients exposed to potentially cardiotoxic oncological treatment.

METHODS

PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for English-language studies published between January 2020 and March 2026, following the PRISMA recommendations. Across tumor types-lymphoma, acute lymphoblastic leukemia, breast, gastrointestinal, and melanoma-and across anthracycline-, trastuzumab-, fluoropyrimidine-, and immune checkpoint inhibitor-based regimens, strain imaging detected subclinical dysfunction that conventional measures missed.

RESULTS

LA reservoir strain declined early and frequently preceded any fall in LVEF, outperforming volumetric LA indices for the detection and prediction of cancer therapy-related cardiac dysfunction (CTRCD). RV deformation parameters, particularly free-wall longitudinal strain and three-dimensional RV ejection fraction, identified RV involvement that was sometimes independent of LV cardiotoxicity and was associated with adverse cardiac events. Data on the RA remain sparse but point in the same direction.

CONCLUSION

Multichamber strain assessment adds sensitivity to LVEF and GLS-based monitoring; standardization of acquisition, reference values, and reporting is needed before it can enter routine cardio-oncology surveillance.