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

Abstract

Objective Anthracycline-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. Methods This 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. Results We 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. Conclusions This 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.