{
  "abstract": "Background: Non-steroidal aromatase inhibitors (NSAIs) are a cornerstone of adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive (HR+) breast cancer. Given their prolonged use in an aging population with increasing cardiovascular vulnerability, we investigated whether baseline systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) could identify pretreatment immune-inflammatory susceptibility to NSAI-related early subclinical cardiac dysfunction.\n\nMethods: This single-center retrospective cohort study included 269 postmenopausal women with HR + breast cancer who received letrozole or anastrozole between January 2020 and April 2024. The primary endpoint was study-defined composite cardiac dysfunction, defined as either an absolute decline in left ventricular ejection fraction (LVEF) of ≥10 percentage points from baseline or a relative increase in B-type natriuretic peptide (BNP) of ≥40% from baseline together with a follow-up BNP concentration ≥100 pg/mL. Baseline SII and SIRI were calculated from routine blood counts and analyzed as z-standardized natural log-transformed variables. Logistic regression, restricted cubic spline, receiver operating characteristic curve, decision curve, sensitivity, subgroup, and exploratory machine-learning-assisted risk-stratification analyses were performed.\n\nResults: Among 269 patients, 63 (23.4%) met the criteria for study-defined composite cardiac dysfunction. In fully adjusted models, higher z-lnSII and z-lnSIRI were independently associated with the endpoint (SII: OR 2.148, 95% CI 1.540–2.997; SIRI: OR 1.927, 95% CI 1.376–2.697; both P < 0.001). Associations remained significant in medication- and partial available-case oncology-adjusted sensitivity analyses and remained directionally consistent in post hoc sensitivity analyses using progressively higher follow-up BNP thresholds of 125, 150, 200, and 400 pg/mL. In five-fold logistic prediction analyses, the AUC increased from 0.633 for the base model to 0.745 with SII, 0.733 with SIRI, and 0.745 with both markers.\n\nConclusion: Baseline SII and SIRI were independently associated with study-defined composite cardiac dysfunction during NSAI therapy and provided incremental discrimination beyond conventional clinical variables.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Cardiology, State Key Laboratory of Systems Medicine for Cancer, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , ,",
    "School of Mathematical Sciences, Shanghai Jiao Tong University , ,",
    "Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Cenyu Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhengyu Tao"
    },
    {
      "affs": [
        1
      ],
      "name": "Yihan Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Chen Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Zi Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaoning Wang"
    },
    {
      "affs": [
        2
      ],
      "name": "Huijuan Dai"
    },
    {
      "affs": [
        0
      ],
      "name": "Meng Jiang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jun Pu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/38gp1wc3dymkn.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1888328",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691644/?tool=EBI",
  "id": "38gp1wc3dymkn",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13691644",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2730|Inflammatory Biomarkers in Disease Prognosis"
    ]
  ],
  "openalex": "W7221143085",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691644/pdf/?tool=EBI",
  "pmcid": "PMC13691644",
  "pmid": null,
  "published": "2026-10-09",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/38gp1wc3dymkn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:59Z",
      "native_id": "PMC:PMC13691644",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13691644"
    },
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1888328",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1888328/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Inflammatory Biomarkers in Disease Prognosis",
      "subfield": "oncology"
    }
  ],
  "title": "Baseline SII and SIRI identify immune-inflammatory susceptibility and improve risk stratification of early subclinical cardiac dysfunction during non-steroidal aromatase inhibitor therapy",
  "title_text": "Baseline SII and SIRI identify immune-inflammatory susceptibility and improve risk stratification of early subclinical cardiac dysfunction during non-steroidal aromatase inhibitor therapy",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/38gp1wc3dymkn",
  "venue": "Frontiers in cardiovascular medicine",
  "versions": []
}