Atrial Function and Volumetry in Cancer Therapy-Related Cardiotoxicity: Prognostic Insights and Emerging Imaging...

Cancer therapy-related cardiac dysfunction (CTRCD) represents a major cause of morbidity among cancer survivors, even in the absence of overt left ventricular (LV) systolic impairment. Current cardio-oncology surveillance strategies predominantly focus on LV ejection fraction and global longitudinal strain, potentially overlooking early alterations in diastolic function and atrial remodeling. The atria, particularly the left atrium, play a pivotal role in modulating ventricular filling pressures and serve as sensitive integrators of cumulative hemodynamic stress. Increasing evidence supports the prognostic value of left atrial volume index and left atrial strain for the early detection of subclinical cardiotoxicity, refinement of diastolic function assessment, and prediction of heart failure and atrial arrhythmias. Moreover, emerging data suggest that right atrial size and mechanics may provide additional insights into right heart involvement during immunotherapy and thoracic radiotherapy, although evidence remains limited. This narrative review summarizes current evidence on atrial volumetric and functional assessment in cardio-oncology, with a particular focus on strain imaging, diastolic function, and novel indices such as left atrial stiffness and mechanical dispersion. We highlight methodological challenges, gaps in standardization, and future directions, including artificial intelligence-assisted imaging and multimodal risk stratification. Integrating atrial imaging into routine cardio-oncology practice may improve early detection of CTRCD, enhance prognostic stratification, and support personalized surveillance strategies in cancer patients exposed to cardiotoxic therapies.