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March 13, 2023Cardio-OncologyOpen Access

Only 2/17 EMBs satisfied Dallas criteria, while CD68 IHC identified 7 additional patients with >50 CD68+ cells/HPF; macrophage abundance positively correlated with Troponin I (P=0.010) and NT-proBNP (P=0.047).

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Why the study?

The sensitivity of endomyocardial biopsy for diagnosing ICI myocarditis is not well defined, and pathological features correlating with clinical diagnosis remain incompletely understood.

Does quantification of macrophage abundance using CD68 IHC improve the diagnostic yield of endomyocardial biopsy in suspected ICI-associated myocarditis compared to traditional Dallas criteria?

Population

26 patients with suspected ICI-associated myocarditis (17 undergoing EMB)

Comparison

Routine H&E staining vs supplemental IHC staining for CD68

Design

Retrospective study

Authors

JJJesús JiménezNKNicolas KosteleckyJMJoshua D. Mitchell

Discussion

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Overview

Retrospective patterns in suspected ICI myocarditis may refine EMB-based classification; leaves open prospective validation of macrophage quantification.

Structured PICO

Does quantification of macrophage abundance using CD68 IHC improve the diagnostic yield of endomyocardial biopsy in suspected ICI-associated myocarditis compared to traditional Dallas criteria?

P
Population
26 patients with suspected immune checkpoint inhibitor (ICI)-associated myocarditis based on institutional major and minor criteria (17 of whom underwent endomyocardial biopsy)
I
Intervention
Immunohistochemical (IHC) staining for CD68 (a macrophage marker) and quantification of macrophage abundance on endomyocardial biopsy
C
Comparator
Routine hematoxylin and eosin (H&E) staining (traditional Dallas criteria)
O
Outcome
Diagnostic yield of ICI-associated myocarditis and correlation of macrophage abundance with serum Troponin I and NT-proBNPsurrogate

Quantification of macrophage abundance using CD68 IHC on endomyocardial biopsy may improve the diagnostic sensitivity for ICI-associated myocarditis over traditional Dallas criteria.

Cite This Study

Jiménez et al. (2023) studied this question.

synapsesocial.com/papers/6a756347a44b96c1f7dbfa96https://doi.org/10.1186/s40959-023-00166-1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Pathological spectrum of immune checkpoint myocarditis: The fast track ICI cohort study2025
  2. 2Immune checkpoint inhibitor myocarditis: elucidating the spectrum of disease through endomyocardial biopsy2021 · 132 citations
  3. 3Novel Insights into the Histopathological Characteristics of Immune Checkpoint Inhibitor-Related Myocarditis2026 · 1 citations
  4. 4Diagnosing Immune Checkpoint Inhibitor-Induced Myocarditis: Insights, Challenges, and Uncertainties2024
  5. 5Expansion of Disease Specific Cardiac Macrophages in Immune Checkpoint Inhibitor Myocarditis2023 · 4 citations