The predictive value of follow-up troponin measurements in patients treated with immune checkpoint inhibitors

Abstract Background Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but are associated with immune-related adverse events (irAEs), including potentially life-threatening cardiovascular (CV) complications. Despite class IIa guideline recommendations for follow-up troponin monitoring, the predictive value of high-sensitivity troponin I (hs-TnI) remains underexplored. Objective To evaluate the predictive value of follow-up hs-TnI for clinical outcomes in patients treated with ICIs. Methods A retrospective, single-center, observational study including patients treated with ICIs and performing hs-TnI measurements following the 1st ICIs cycle. A hs-TnI level 50ng/L was considered abnormal, adopted by Siemens recommendations cutoff. The primary endpoint was all-cause mortality, and the secondary endpoint was CV irAEs, defined as the composite of myocarditis, pericarditis, acute coronary syndrome, heart failure, and arrhythmias. Results The cohort included 621 patients, with a mean age of 69±12 years, and was predominantly male (64%). Lung cancer was the most common malignancy (20%), and pembrolizumab (anti-PD-1) was the most frequently used ICIs (65%). Baseline cardiovascular (CV) risk factors were common, including hypertension (48%), diabetes mellitus (24%), and hyperlipidemia (38%), while ischemic heart disease was present in 22% of patients. Sixty-two patients (10%) presented with abnormal follow-up hs-TnI. During follow-up, abnormal hs-TnI was significantly associated with increased all-cause mortality (adjusted HR 1.816 95% CI = 1.302-2.532, p 0.001) and increased incidence of CV irAEs (adjusted HR 2.395 95% CI = 1.277-4.492, p = 0.006). Conclusions Follow-up hs-TnI emerged as a significant independent predictor for all-cause mortality and CV irAEs in patients treated with ICIs. These findings highlight the clinical utility of serial hs-TnI monitoring for early risk stratification. Prospective, multicenter studies are warranted to validate these results and optimize CV monitoring strategies in this population.