Predictors of Long-Term Survival in Patients With Immune Checkpoint Inhibitor-Associated Myocarditis

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitor-associated myocarditis (ICIM) presents a significant risk of mortality, yet clinical outcomes exhibit considerable variability.
• Predictors of long-term survival in ICIM remain poorly understood, hindering effective patient management.

Purpose of the Study:

• To identify clinical variables associated with long-term survival in patients diagnosed with ICIM.
• To aid in risk stratification and personalization of immunosuppressive therapy for ICIM.

Main Methods:

• A case-control study involving 35 patients diagnosed with ICIM between 2016 and 2022.
• Patients were stratified into short-term (<30 days), intermediate-term (30-365 days), and long-term (>365 days) survival groups.
• Analysis included baseline characteristics, ICI regimens, laboratory values, ECG parameters, and treatment responses.

Main Results:

• Older age was associated with short-term survival (P=0.003).
• Long-term survival correlated with a longer interval from ICI initiation to ICIM diagnosis (≥75 days) and a significant troponin T decrease (≥42% by day 8).
• Multivariate analysis identified lower troponin T levels (≤1000 ng/L) and a lower neutrophil/lymphocyte ratio (≤4.4) as independent predictors of longer survival.

Conclusions:

• The time of ICIM onset relative to ICI initiation, specific clinical test results, and response to immunosuppression are associated with long-term survival.
• These factors can inform risk stratification and guide individualized immunosuppressive treatment strategies for ICIM patients.