Machine learning models using multimodal data accurately predict chemotherapy-induced cardiotoxicity in breast cancer

Background Despite significant advances in breast cancer therapy, chemotherapy-related cardiac dysfunction (CTRCD) remains a critical clinical challenge. This study aimed to develop and validate machine learning (ML) models that integrate multimodal data to predict the risk of CTRCD in female breast cancer patients. Methods We retrospectively analyzed data from 423 female breast cancer patients who received chemotherapy between January 2020 and January 2025. Multimodal data included demographic information, clinical variables, echocardiographic parameters, electrocardiographic (ECG) findings, and cardiac biomarkers. The dataset was randomly split into training and validation sets in a 7:3 ratio. Seven feature selection methods and eight ML algorithms were employed to construct and compare predictive models. Results Among the 423 patients, CTRCD occurred in 111 patients (26.24%). Five variables were identified as robust predictors: age, baseline left ventricular ejection fraction 60%, anthracycline–trastuzumab combination therapy, chemotherapy cycles, and abnormal ECG findings. Among all models evaluated, the extreme gradient boosting (XGBoost) algorithm demonstrated the best performance, achieving an area under the curve of 0.782 (95% CI: 0.681–0.883) in 10-fold cross-validation. Conclusion The XGBoost-based model showed strong predictive ability and may serve as a practical tool for early risk stratification and timely clinical management of CTRCD.