Immune checkpoint inhibitor-associated cardiotoxicity: incidence, diagnosis, and management

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but are associated with immune-related adverse events (irAEs), including cardiotoxicity. This review provides a comprehensive overview of the incidence, mechanisms, diagnosis, and management of ICI-associated cardiotoxicity, highlighting emerging biomarkers, diagnostic algorithms, and risk stratification strategies.

We conducted a narrative review of the literature, synthesizing findings from recent clinical studies, guidelines, and case reports concerning ICI-associated cardiovascular complications such as myocarditis, pericarditis, and arrhythmias. As a narrative rather than systematic review, studies were selected to illustrate current concepts and were not appraised against predefined eligibility criteria.

ICIs are associated with a low overall incidence of cardiovascular toxicities; however, myocarditis remains the most severe and potentially life-threatening manifestation. Reported case-fatality estimates vary widely, and the highest figures derive largely from early case series and pharmacovigilance data. Emerging biomarkers, evolving risk stratification tools, and updated diagnostic and management frameworks may improve early recognition, guide timely intervention, and support multidisciplinary care for patients with suspected ICI-associated cardiotoxicity, although most supporting evidence remains retrospective.

Early recognition and prompt management of ICI-associated cardiotoxicities are essential for improving patient outcomes. This review provides oncologists and cardiologists with updated diagnostic approaches, treatment frameworks, and practical considerations for monitoring at-risk patients, while acknowledging that current recommendations rest largely on low-certainty evidence.