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Immune Checkpoint Inhibitor-Associated Myocarditis: A Retrospective Case Series
Michael Acevedo Monsanto1, Artur Schneider1, Razvan M Chirila2
1Department of Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA.
Summary
Immune checkpoint inhibitors (ICIs) can cause myocarditis, a serious side effect. This study reviewed five patients, finding varied presentations and outcomes, highlighting the need for vigilance in managing ICI-related cardiac events.
Area of Science:
- Cardiology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are vital cancer therapies.
- Immune-related adverse events (irAEs), including myocarditis, are significant complications.
- ICI-associated myocarditis carries a high case-fatality rate.
Purpose of the Study:
- To review cases of potential ICI-associated myocarditis.
- To categorize myocarditis severity based on diagnostic criteria.
- To summarize clinical presentation, management, and outcomes.
Main Methods:
- Retrospective review of five patients treated at Mayo Clinic Florida (2019-2024).
- Categorization of myocarditis as definite, probable, or possible using cardiac magnetic resonance (CMR) and histopathology.
- Literature summarization.
Main Results:
- Median age 74, four of five patients male; myocarditis onset 5-30 days post-anti-PD-1 therapy.
- Presentations included dyspnea, chest pain, and asymptomatic troponin elevation; all had elevated troponin T.
- CMR supported myocarditis in two cases; one endomyocardial biopsy showed no active inflammation. One definite, one probable, three possible cases identified.
Conclusions:
- ICI-associated myocarditis presents heterogeneously with cardiac biomarker elevation and ECG changes.
- Corticosteroids were administered to all patients; some required escalated immunosuppression.
- Outcomes varied, with three recoveries and two deaths where myocarditis was a contributing factor.
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