The following is a summary of “Adverse myocardial and vascular side effects of immune checkpoint inhibitors: a prospective multimodal cardiovascular assessment,” published in the May 2024 issue of Cardiology by Mirabel et al.
Immune checkpoint inhibitors (ICI) are associated with serious cardiovascular issues. Events like myocarditis and heart failure within 6 weeks are called early MACE, or later, at 6 months, are called late MACE.
Researchers conducted a prospective study to notice how common major heart problems are with ICIs.
They conducted pre- and post-ICI cardiac tests (like echocardiograms and cardiac magnetic resonance (CMRs)), serum biomarkers (ultrasensitive troponin I), and rhythm surveillance (ambulatory ECG monitoring) at 6 weeks and 6 months.
The results showed that 49 patients with cancer were studied between June 2020 and December 2021. Around 38 (77.6%) were male; the mean age was 64.3±11.0 years old. Early MACE was observed in 9 (18.4%) patients at a mean of 40.1±5.9 days, with HF in 5 (10.2%), ventricular arrhythmias, or new conduction disorders in 4 (8.2%) patients. The AF history predicted early MACE (HR 4.49 [95% CI: (1.11-18.14), P=0.035]). At 6 months, 31% (n=15/49) had 18 MACE, with 6 HF events, 5 significant ventricular arrhythmias or conduction disorders, and 4 AF. A substantial decline in LVEF (P<0.001) was observed in patients with no MACE (P=0.003) or HF (P=0.0028). Higher creatinine at baseline predicted HR on multivariate analysis (HR 0.99 [0.98-1.00], P=0.006). There were no significant T1 or T2 mapping changes in our study cohort on repeated CMR.
Investigators concluded that with a comprehensive detection method, cardiotoxicity from ICIs is more common than thought, mainly showing up as heart failure and silent rhythm issues.
Source: link.springer.com/article/10.1007/s00392-024-02462-x