Key result
Among 100 patients treated with immune checkpoint inhibitors, 10% developed ICI-related myocardial damage, indicating a higher prevalence than previously expected.
Why the study?
Diagnostic criteria for immune checkpoint inhibitor-related myocarditis are not sufficiently established, leaving the real-world incidence or prevalence of related myocardial damage unknown.
Cohort (n=100)
No
Serial cardiac troponin I monitoring reveals that the real-world prevalence of ICI-related myocardial damage (10%) is much higher than previously expected, highlighting the need for early detection strategies in cardio-oncology.
Supports closer cardiac monitoring in ICI recipients; leaves open whether routine troponin screening improves outcomes.
An increasing number of patients with cancer are being treated with immune checkpoint inhibitors. Consequently, the incidence of immune checkpoint inhibitor-related myocarditis has been increasing. Nonetheless, the diagnostic criteria for the immune checkpoint inhibitor-related myocarditis have not been sufficiently established. Therefore, the real-world incidence or prevalence of immune checkpoint inhibitor-related myocardial damage remains unknown. This was a single-center cohort study that included 100 patients admitted for immune checkpoint inhibitor therapy for any type of cancer. The patients underwent monthly measurement of cardiac troponin I and N-terminal pro-brain natriuretic peptide levels with electrocardiography. Additionally, echocardiography was performed every 3 months. Our protocol was continued until 6 months after the initiation of immune checkpoint inhibitors. We defined immune checkpoint inhibitor-related myocardial damage as an increase in cardiac troponin I levels by >0.026 ng/mL and/or a decrease in the left ventricular ejection fraction by >10% to <53% on echocardiography. The mean patient age was 64 years; 71% were men. The most commonly used immune checkpoint inhibitor was nivolumab (47%), followed by pembrolizumab (29%). Overall, 5% of patients received combination therapy. Among 100 patients, 10 (10%) were diagnosed with immune checkpoint inhibitor-related myocardial damage. Among them, five patients underwent endomyocardial biopsy. Of these patients, four were histopathologically observed to have lymphocyte infiltration in their myocardium. In conclusion, serial cardiac troponin I measurement during immune checkpoint inhibitor treatment could help detect early-phase myocardial damage. The prevalence of myocardial damage was much higher than previously expected.
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Nishikawa et al. (2022) conducted a cohort in Cancer (n=100). Immune checkpoint inhibitors was evaluated on Prevalence of ICI-related myocardial damage (increase in cardiac troponin I >0.026 ng/mL and/or decrease in LVEF >10% to <53%). Among 100 patients treated with immune checkpoint inhibitors, 10% developed ICI-related myocardial damage, indicating a higher prevalence than previously expected.
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