Neutrophil-to-Lymphocyte Ratio Combined with Global Longitudinal Strain for Predicting Subclinical Cardiotoxicity in Breast Cancer Patients Receiving Anthracycline Chemotherapy

Background Cancer therapy–related cardiac dysfunction (CTRCD) is a frequent complication in breast cancer (BC) patients treated with anthracyclines, and early identification of high-risk individuals remains a clinical challenge. This study aimed to investigate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) combined with global longitudinal strain (GLS) for detecting subclinical CTRCD in BC patients undergoing anthracycline-based chemotherapy. Methods A total of 82 BC patients who received anthracycline-based chemotherapy at the First Affiliated Hospital of Jinzhou Medical University between January 2024 and July 2025 were prospectively enrolled. NLR and GLS were assessed at baseline prior to chemotherapy (T0), after the second cycle (T2), and after the fourth cycle (T4). Subclinical CTRCD was defined as a preserved left ventricular ejection fraction (LVEF) with a relative reduction in GLS ≥ 15% from baseline. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of T2 NLR, T2 GLS, and their combined model for subclinical CTRCD at T4. Logistic regression analysis was performed to determine their independent predictive value. Results The area under the ROC curve (AUC) for T2 NLR was 0.722 (cutoff = 3.11, sensitivity 70.8%, specificity 63.8%). The AUC for T2 GLS was 0.787 (cutoff = − 20.58%, sensitivity 91.7%, specificity 56.9%). The combined logistic regression model of NLR and GLS further improved the AUC to 0.844 (sensitivity 66.7%, specificity 86.2%). Multivariate logistic regression revealed that both T2 NLR (odds ratio [OR] = 1.451, 95% confidence interval [CI]: 1.129–1.865, P  = 0.004) and T2 GLS (OR = 1.917, 95% CI: 1.342–2.738, P  < 0.001) were independent predictors of subclinical CTRCD. Conclusions The combination of NLR and GLS at T2 significantly enhances the predictive accuracy for subclinical CTRCD in BC patients receiving anthracycline-based chemotherapy, which may facilitate early identification of high-risk individuals and guide timely clinical intervention.