Immune Checkpoint Inhibitor Myocarditis and Left Ventricular Systolic Dysfunction
- Author(s)
- Chen, YC; Dolladille, C; Rao, A; Palaskas, NL; Deswal, A; Lehmann, L; Cautela, J; Courand, PY; Hayek, S; Zhu, H; Cheng, RK; Alexandre, J; Baldassarre, LA; Roubille, F; Laufer-Perl, M; Asnani, A; Ederhy, S; Tamura, Y; Francis, S; Gaughan, EM; Johnson, DB; Flint, DL; Rainer, PP; Bailly, G; Ewer, SM; Aras, MA; Arangalage, D; Cariou, E; Florido, R; Peretto, G; Itzhaki Ben Zadok, O; Akhter, N; Narezkina, A; Levenson, JE; Liu, Y; Crusz, SM; Issa, N; Piriou, N; Leong, D; Sandhu, S; Turker, I; Moliner, P; Obeid, M; Heinzerling, L; Chang, WT; Stewart, A; Venkatesh, V; Du, Z; Yadavalli, A; Kim, D; Chandra, A; Zhang, KW; Power, JR; Moslehi, J; Salem, JE; Zaha, VG; International ICI Myocarditis Registry;
- Details
- Publication Year 2025-04,Volume 7,Issue #3,Page 234-248
- Journal Title
- JACC Cardiooncology
- Publication Type
- Research article
- Abstract
- BACKGROUND: Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, but ICI myocarditis (ICI-M) remains a potentially fatal complication. The clinical implications and predictors of left ventricular ejection fraction (LVEF) <50% in ICI-M are not well understood. OBJECTIVES: The aim of this study was to identify factors associated with LVEF <50% vs ≥50% at the time of hospitalization for ICI-M. A secondary objective was to evaluate the relationship between LVEF and 30-day all-cause mortality. METHODS: The International ICI-Myocarditis Registry, a retrospective, international, multicenter database, included 757 patients hospitalized with ICI-M. Patients were stratified by LVEF as reduced LVEF (<50%) or preserved LVEF (≥50%) on admission. Cox proportional hazards models were used to assess the associations between LVEF and clinical events, and multivariable logistic regression was conducted to examine factors linked to LVEF. RESULTS: Of 757 patients, 707 had documented LVEFs on admission: 244 (35%) with LVEF <50% and 463 (65%) with LVEF ≥50%. Compared with patients with LVEF ≥50%, those with LVEF <50% were younger (<70 years), had a body mass index of <25 kg/m(2), and were more likely to have received chest radiation (24.2% vs 13.5%; P < 0.001). Multivariable analysis identified predictors of LVEF <50%, including exposure to v-raf murine sarcoma viral oncogene homolog B1/mitogen-activated protein kinase inhibitors, pre-existing heart failure, dyspnea at presentation, and at least 40 days from ICI initiation to ICI-M onset. Conversely, myositis symptoms were associated with LVEF ≥50%. LVEF <50% was marginally associated with 30-day all-cause mortality (unadjusted log-rank P = 0.062; adjusted for age, cancer types, and ICI therapy, HR: 1.50; 95% CI: 1.02-2.20). CONCLUSIONS: Dyspnea, time from ICI initiation, a history of heart failure, and prior cardiotoxic therapy may be predictors of an initial LVEF <50% in patients with ICI-M.
- Publisher
- Elsevier
- Keywords
- cardiac magnetic resonance; echocardiography; heart failure; immune checkpoint inhibitor myocarditis; immunotherapy; left ventricular ejection fraction; myocarditis; troponin
- Department(s)
- Medical Oncology
- Publisher's Version
- https://doi.org/10.1016/j.jaccao.2025.01.020
- Open Access at Publisher's Site
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- Refer to copyright notice on published article.
Creation Date: 2025-05-27 04:30:45
Last Modified: 2025-05-27 04:31:03