11185 Background: Immune-checkpoint inhibitors (ICI) are standard of care for many solid tumors but are linked to cardiovascular adverse events (CVD-AEs). Real-world comparative data on CVD-AE incidence between IT IV:158), endometrial IV (157), gastric (II-III:797; IV:590), H IV:223), melanoma (45) IV:1609), NSCLC squamous (IIIB:182; IV:366) 38% were female, & 87% were White. ICI accounted for 99.9% of IT. During follow-up, 163 CVD-AEs occurred, including arrhythmias (n = 59), cardiac arrest (n = 35), myocarditis/heart failure (n = 21), pericarditis (n = 10) & acute coronary syndromes (NSTEMI n = 17, STEMI n = 15, unstable angina n = 5). Median follow-up was 14 months (CI 6-35). The CVD-AE CIRs were slightly higher in IT vs. non-IT groups (0.12 vs 0.11 /100 PY). The 4-year CIR was 5% in IT & 3.5% in non-IT (P = 0.4). In time-dependent Cox models, IT was not associated with a significant increase in composite CVD-AEs, though a borderline association with the composite of cardiac dysrhythmia & conduction disorders was observed (HR 1.43, P = 0.06). Echo analyses showed no association between IT & adverse changes in LV/RV systolic function (EF, GLS, TAPSE), pulmonary pressures or diastolic function (E/e’). In contrast, 1st-line IT was associated with increased odds of aortic root dilation (OR 2.95, p = 0.028), mitral valve sclerosis (OR 4.17, P = 0.02) & a trend toward mitral stenosis (OR 3.7, P = 0.05). Abnormal baseline Echo parameters remained the strongest predictors of future worsening. Conclusions: We found that IT was not associated with a significant rise in overall CVD-AEs or myocardial dysfunction, possibly reflecting less use of traditional cardiotoxic agents like anthracyclines. Novel associations with aortic root dilation & mitral valve sclerosis suggest vascular & structural remodeling effects. Findings highlight the need for long-term surveillance of structural heart changes beyond ejection fraction monitoring.
Mohamed et al. (Wed,) studied this question.