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Left Ventricular Thrombosis in Immune Checkpoint Inhibitor Myocarditis Mimicking ST-Segment Elevation Myocardial
Miriam Compagnone1, Gianni Dall'Ara1,2, Luca Bergamaschi2,3
1Cardiology Unit, Morgagni Pierantoni Hospital Forlì, Italy.
JACC. Case Reports
|December 2, 2024
Summary
We report a rare case of ventricular thrombosis in immune checkpoint inhibitor (ICI) myocarditis, presenting as myocardial infarction and cardiogenic shock. Managing these life-threatening ICI cardiovascular complications poses significant challenges.
Area of Science:
- Cardiology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are associated with various cardiovascular adverse events, including myocarditis.
- Myocarditis due to ICIs can present with myocardial infarction and cardiogenic shock.
- Intraventricular thrombus formation is an extremely rare complication of ICI-induced myocarditis.
Purpose of the Study:
- To present a rare case of ventricular thrombosis in the context of immune checkpoint inhibitor (ICI) myocarditis.
- To highlight the diagnostic challenges in differentiating ventricular thrombosis from tumoral masses in oncologic patients.
- To discuss the management difficulties associated with life-threatening cardiovascular complications of ICIs.
Main Methods:
- Case report presentation.
- Review of clinical evaluation and multimodality imaging findings.
- Discussion of management strategies for refractory cardiogenic shock and ventricular thrombosis.
Main Results:
- A patient developed ventricular thrombosis secondary to ICI-induced myocarditis, presenting as myocardial infarction.
- The patient experienced refractory cardiogenic shock.
- Differential diagnosis between ventricular thrombosis and tumoral mass was challenging.
Conclusions:
- Ventricular thrombosis is a rare but critical complication of ICI-induced myocarditis.
- Accurate diagnosis requires careful clinical assessment and multimodality imaging.
- Effective management of these severe cardiovascular complications remains challenging due to their high associated mortality.
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