Structural and functional abnormalities of the left atrium (LA) predict adverse outcomes
such as heart failure and mortality in many patients with heart disease. However,
the effect of anthracyclines on LA structural and functional abnormalities remains
incompletely characterized. Further, atorvastatin prevented the anthracycline-associated
decline in the left ventricular ejection fraction; however, whether atorvastatin protects
against anthracycline-associated impairment of LA structure and function is currently
unknown.In the STOP-CA randomized clinical trial, participants with lymphoma treated
with anthracyclines were randomized to placebo (n=150) or atorvastatin (n=150) for
12 months. In post-hoc analyses, CMR-derived LA volumetric and functional measurements
(reservoir [GLS], conduit, and booster strain) were measured at baseline and 12 months
using feature tracking (FT). The primary endpoint was the difference in the proportion
of participants with a ≥1SD decrease in LA GLS between the atorvastatin and placebo
groups. The secondary endpoint was a ≥20% relative decrease in LA GLS. Other exploratory
endpoints included volume indices and emptying fractions.Of 300 participants, 158
(mean age 51±16 years, 48% female, 83 with atorvastatin) had paired CMR-derived LA
strain and volumetric data at baseline and follow-up. Both groups had similar baseline
characteristics and cancer treatment. All LA strain and volumetric measures were similar
between the two groups at baseline. Among the placebo group, LA GLS decreased from
baseline to follow-up (35.5±8.8 vs. 32.4±8.2%, p=0.007). A ≥1SD absolute decrease
in LA GLS (8.8% units) was observed among 24% with atorvastatin and 28% with placebo
(p=0.59). Similarly, a ≥20% relative decrease in GLS was observed in 25% vs. 31% (p=0.48).
Participants over 50 had an almost 10% (9.9%, 95% confidence interval: -18.75, -1.12)
greater relative decrease in LA GLS with anthracyclines. There were no differences
between cardiac hospitalization rates with a ≥1SD absolute decrease (5% vs. 8%, p=0.72)
in LA GLS at 24 months. Among other indices of LA structure and function, the LA total
emptying fraction also decreased from baseline to follow-up, with no differences between
groups at follow-up.Atorvastatin did not attenuate the decline in CMR-derived LA GLS
among lymphoma patients undergoing anthracycline-based chemotherapy.NCT02943590; https://clinicaltrials.gov/study/NCT02943590.
