ArticleClinical research in cardiology : official journal of the German Cardiac Society2024
High neutrophil-to-lymphocyte ratio is associated with cancer therapy-related cardiovascular toxicity in high-risk cancer patients under immune checkpoint inhibitor therapy.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 21 citations in OpenAlex.
- The Cardio-Onco-Immune Axis: immunopathological mechanisms in the cardiac microenvironment of checkpoint inhibitor-induced myocarditis.Acta pharmacologica Sinica · 2026Review
- Endomyocardial Biopsies in the Diagnostic Workup of Immune Checkpoint Inhibitor Associated Myocarditis.Current heart failure reports · 2026Review
- 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.The Journal of international medical research · 2026Observational
- Predictors of Immune-Related Cardiac Adverse Events in Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Mechanisms and biomarkers of immune checkpoint inhibitor-associated myocarditis: from T cell imbalance to multicellular crosstalk.Frontiers in immunology · 2026Review
- Immune checkpoint inhibitor-associated arrhythmias: clinical challenges, artificial intelligence-enhanced monitoring, and management strategies.Frontiers in cardiovascular medicine · 2026Review
- Predicting cardiovascular toxicity in anti-PD-1/PD-L1 therapy: a risk factor analysis and model development.Frontiers in cardiovascular medicine · 2026Article
- Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy.International journal of cardiology. Heart & vasculature · 2025Article
- Neutrophil-to-Lymphocyte Ratio as a Predictor of Mortality and Clinical Outcomes in Heart Failure Patients.Cureus · 2025Review
- Multifaceted roles of neutrophils in cardiac disease.Journal of leukocyte biology · 2025Review
- Immune checkpoint inhibitor-associated myocarditis: a historical and comprehensive review.American journal of physiology. Heart and circulatory physiology · 2025Review
- Prevention of cancer-therapy related cardiac dysfunction.Current heart failure reports · 2025Review
- Effects of sex and obesity on immune checkpoint inhibition-related cardiac systolic dysfunction in aged mice.Basic research in cardiology · 2025Article
- Integration of multi-omics and machine learning strategies identifies immune related candidate biomarkers in inflammation-associated hypertrophic cardiomyopathy.Frontiers in immunology · 2025Article
- Blood-derived ratio indexes associated with severity and prognosis of immune checkpoint inhibitor-related cardiotoxicity: a retrospective analysis.Frontiers in oncology · 2025Article
- Nomograms based on ratio indexes to predict severity and prognosis in immune checkpoint inhibitors-related myocarditis: a retrospective analysis.Journal of cancer research and clinical oncology · 2024Article
- Cardiovascular adverse events associated with immune checkpoint inhibitors: A retrospective multicenter cohort study.Cancer medicine · 2024Article
- Peripheral biomarkers to assess risk, severity, and prognosis of immune checkpoint inhibitor-associated myocarditis: a retrospective clinical study.Frontiers in cardiovascular medicine · 2024Article
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Authors and funding
10 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundCancer therapy-related cardiovascular toxicity (CTR-CVT) from immune checkpoint inhibitor (ICI) therapy is still incompletely characterized, and patients with pre-existing cardiovascular disease represent a particularly high-risk cohort. Valid parameters for risk stratification of these patients are missing. Neutrophil-to-lymphocyte ratio (NLR) has been shown to predict mortality and adverse events in other cardiovascular cohorts. The present study aims to examine the predictive capacity of NLR for risk stratification of patients particularly vulnerable for CTR-CVT under ICI therapy.
methodsWe performed an analysis of 88 cancer patients (69 ± 11 years, 25% female) with pre-existing cardiovascular disease under ICI therapy from the prospective Essen Cardio-Oncology Registry (ECoR). NLR was assessed at patient enrollment and the population was divided through receiver operator characteristic (ROC) curve analysis in patients with low (< 4.57) and high (≥ 4.57) NLR. Endpoint was the whole spectrum of CTR-CVT, according to the European guidelines on cardio-oncology. The median follow-up was 357 days (interquartile range (IQR): 150-509 days).
resultsWe observed 4 cases of myocarditis, 17 cases of vascular toxicity, 3 cases of arterial hypertension, 22 cases of arrhythmia or QTc prolongation and 17 cases of cardiovascular dysfunction. NLR was associated with overall CTR-CVT by univariable Cox regression (hazard ratio (HR): 1.443; 95% confidence interval (CI) 1.082-1.925; p = 0.013). However, this association was attenuated after adjusting for further confounders.
conclusionNLR is moderately associated with CTR-CVT in cancer patients with pre-existing cardiovascular disease under ICI therapy. Surveillance of NLR during ICI therapy might be an effective and economically biomarker for risk stratification in these high-risk patients.
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