Immune checkpoint inhibitor myocarditis and left ventricular systolic dysfunction
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...
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| Auteurs principaux: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Langue: | anglais |
| Publié: |
April 2025
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| In: |
JACC: CardioOncology
Year: 2025, Volume: 7, Numéro: 3, Pages: 234-248 |
| ISSN: | 2666-0873 |
| DOI: | 10.1016/j.jaccao.2025.01.020 |
| Accès en ligne: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jaccao.2025.01.020 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2666087325000900 
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| Notes sur l'auteur: | Yen-Chou Chen, MD, Charles Dolladille, MD, PHD, Anjali Rao, MD, Nicolas L. Palaskas, MD, Anita Deswal, MD, MPH, Lorenz Lehmann, MD, the International ICI Myocarditis Registry [und 50 weitere] |
| Résumé: | 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/m2, 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. |
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| Description: | Gesehen am 21.07.2026 |
| Description matérielle: | Online Resource |
| ISSN: | 2666-0873 |
| DOI: | 10.1016/j.jaccao.2025.01.020 |