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Childhood cancer survivors (CCSs) are at increased risk of cancer therapy-related cardiac dysfunction following anthracycline chemotherapy. Although left atrial (LA) strain assessed by speckle-tracking echocardiography has emerged as a sensitive marker of diastolic dysfunction, it remains unclear when during survivorship LA dysfunction becomes detectable in CCSs treated with anthracyclines.In this retrospective observational case-control study, 92 CCSs (aged 4-32 years) and 96 age-matched healthy controls underwent echocardiography. Participants were stratified into three age groups (4-12, 13-18, and 19-32 years). LA reservoir, conduit, and pump strains were measured using two-dimensional speckle-tracking echocardiography from the apical four-chamber view. Conventional echocardiographic parameters, including mitral inflow velocities (E and A waves), E/A ratio, and tissue Doppler-derived e' and E/e', as well as left ventricular longitudinal strain (LVLS), were assessed.Conventional diastolic parameters did not significantly differ between CCSs and controls within corresponding age groups. However, in young adult CCSs (19-32 years), all three components of LA phasic strain (reservoir, conduit, and pump strains) were significantly reduced compared with age-matched controls. LVLS was also significantly lower in this group, whereas younger CCSs showed no significant differences in LA strain.LA phasic dysfunction was most evident in young adult CCSs despite preserved conventional diastolic indices, suggesting that age-stratified LA strain assessment may help identify survivorship stages at which atrial dysfunction becomes detectable.