Combined prediction of anthracycline-induced cardiotoxicity in patients with breast cancer using neutrophil-to-lymphocyte ratio and left atrial reservoir strain: A prospective observational study.

ObjectiveAnthracycline-related cardiotoxicity may involve systemic inflammatory responses, and the neutrophil-to-lymphocyte ratio may change during chemotherapy as a marker for inflammatory and immune status. Considering this, we designed the present study to assess the predictive value of neutrophil-to-lymphocyte ratio combined with left atrial reservoir longitudinal strain for subclinical cancer therapy-related cardiac dysfunction during anthracycline chemotherapy in patients with breast cancer.MethodsThis prospective observational study enrolled 85 patients with breast cancer undergoing anthracycline chemotherapy. Neutrophil-to-lymphocyte ratio and left atrial reservoir longitudinal strain were measured before chemotherapy (T0), after the second cycle (T2), and after the fourth cycle (T4). Subclinical cancer therapy-related cardiac dysfunction was defined as a normal left ventricular ejection fraction with a ≥15% decrease in left ventricular global longitudinal strain compared with that at baseline. The predictive efficacy of the relative decrease in left atrial reservoir longitudinal strain, T2 neutrophil-to-lymphocyte ratio, and their combined model for subclinical cancer therapy-related cardiac dysfunction at T4 was evaluated using receiver operating characteristic curves.ResultsWe found that 29.41% of the patients developed subclinical cancer therapy-related cardiac dysfunction. Multivariate analysis showed that both T2 neutrophil-to-lymphocyte ratio (odds ratio = 1.611, p = 0.002) and relative decrease in left atrial reservoir longitudinal strain (odds ratio = 1.426, p < 0.001) were independent predictors. Receiver operating characteristic analysis revealed an area under the curve of 0.896 for the combined model.ConclusionsThis study provides preliminary evidence for an association of T2 neutrophil-to-lymphocyte ratio and relative decrease in left atrial reservoir longitudinal strain with subclinical cancer therapy-related cardiac dysfunction during anthracycline chemotherapy in patients with breast cancer. In this cohort, their combined use suggested good predictive value.