Key result
In patients, global pathological assessment more accurately predicted myocarditis-related mortality than hotspot assessment, while both similarly predicted fulminant myocarditis and major cardiovascular events.
Why the study?
Pathological examination is commonly used to diagnose ICI-related myocarditis, but well-organised clinicopathological evidence remains limited.
Does pathological grading and immunochemistry assessment improve risk stratification for mortality and MACE in patients with ICI-related myocarditis?
Observational (n=38)
Yes
Does pathological grading and immunochemistry assessment improve risk stratification for mortality and MACE in patients with ICI-related myocarditis?
Answers are grounded in this paper and cite their sources.
Global pathological assessment and supplementary inflammatory markers like HLA-DR and tenascin C improve the diagnosis and risk stratification of ICI-related myocarditis.
Background and Aims Pathological examination is commonly used to diagnose immune checkpoint inhibitor (ICI)-related myocarditis. However, well-organised clinicopathological evidence remains limited. In this study, we aimed to investigate the pathological and clinical characteristics of myocarditis to enhance understanding. Methods This multicentre retrospective observational study included 38 patients diagnosed with or suspected of having ICI-related myocarditis. Patients were stratified using the pathological grading system proposed by Palaskas et al. Lymphocyte infiltration was assessed using both global and hot-spot (hotspot) methods. Immunochemistry was performed for lymphocytes, macrophages, and inflammatory markers, including human leucocyte antigen–DR isotype (HLA-DR), programmed death-ligand 1 (PD-L1), granzyme B, and tenascin C. Results An increased infiltration of CD3, CD4, CD8-positive T cells, and CD68 and CD163-positive macrophages was observed with higher pathological grades. HLA-DR and tenascin C (clone 4F10) were sensitive markers of inflammation, whereas PD-L1 and tenascin C (clone 4C8) were more specific for high-grade inflammation. Global assessment more accurately predicted myocarditis-related mortality than hotspot assessment, although both methods similarly predicted fulminant myocarditis and major adverse cardiac events. Two patients presented with suspected ICI-mediated non-inflammatory left ventricular dysfunction (NILVD), with minimal myocardial inflammation. Conclusions Pathological grading using both global and hotspot assessment is valuable for the diagnosis and risk stratification of ICI-related myocarditis. As low-grade inflammation is not uncommon, supplementary markers such as HDL-DR, granzyme B, tenascin C, and PD-L1 may aid diagnosis. Furthermore, ICI-mediated NILVD may encompass cases of low-grade myocarditis.
No takes yet. Share an insight, caveat, or question.
Nishikawa et al. (2026) conducted an observational in Immune checkpoint inhibitor (ICI)-related myocarditis (n=38). Pathological grading (global and hotspot assessment) and immunochemistry was evaluated on Pathological and clinical characteristics of myocarditis. In patients, global pathological assessment more accurately predicted myocarditis-related mortality than hotspot assessment, while both similarly predicted fulminant myocarditis and major cardiovascular events.
Synapse has enriched 10 related papers. Consider them for comparative context: