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Clinical Characteristics and Risk Factors of Immune Checkpoint Inhibitor-Related Myocarditis: A Real World
Mei Zhan1,2, Qinran Long1,2,3, Ran Liu4
1Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Clinical Cardiology
|April 20, 2026
Summary
Immune checkpoint inhibitor (ICI)-related myocarditis incidence is higher than previously thought, affecting nearly 20% of patients. High-risk groups, including those with specific cancers and comorbidities, require vigilant cardiac monitoring during ICI therapy.
Area of Science:
- Cardiology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are crucial cancer therapies.
- ICI-related myocarditis is a rare but serious adverse event.
- Existing literature poorly documents the incidence and risk factors of ICI-related myocarditis.
Purpose of the Study:
- To determine the incidence of suspected ICI-related myocarditis in a large patient cohort.
- To identify clinical characteristics associated with an increased risk of ICI-related myocarditis.
Main Methods:
- Retrospective review of 8199 patients receiving ICI therapy up to June 2023.
- Follow-up extended until May 2024 or death.
- Logistic regression analysis to identify risk factors for ICI-related myocarditis.
Main Results:
- The incidence of suspected ICI-related myocarditis was 19.98% (1638/8199 patients).
- Risk factors included thymomas/carcinomas, lung cancer, older age, male sex, dual immune checkpoint blockade, hypertension, and hyperlipidemia.
- Specific odds ratios and p-values were reported for each risk factor.
Conclusions:
- The incidence of ICI-related myocarditis may be significantly underestimated in prior studies.
- Routine cardiac surveillance is essential for patients receiving ICI therapy, especially those in high-risk groups.
- This study underscores the importance of monitoring for myocarditis during ICI treatment.
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