完全的心脏阻塞是免疫检查点抑制剂心肌炎死亡率的重要预测因素
Michael P O'Shea1, Suganya Arunachalam Karikalan2, Ali Yusuf2
1Department of Cardiovascular Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA. oshea.michael@mayo.edu.
Cardio-oncology (London, England)
|September 20, 2023
概括
完全心脏阻塞 (CHB) 在免疫检查点抑制剂 (ICI) 心肌炎患者中显著增加死亡风险. 早期识别CHB和心律失常并发症对于预测这一高风险组的结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 心肌炎携带高死亡风险.
- 电心电图 (ECG) 变化是ICI心肌炎的预后.
- 完全心脏阻塞 (CHB) 对ICI心肌炎死亡率的影响需要进一步定义.
研究的目的:
- 评估CHB对ICI心肌炎患者死亡率的影响.
- 为了确定ICI心肌炎中死亡率的临床预测因素.
- 为了确定ICI心肌炎中CHB发病率的临床预测因素.
主要方法:
- 对34名ICI心肌炎患者 (2010-2022) 的回顾性队列研究.
- 评估临床,实验室,心电图,心声学和心脏MRI数据.
- 对于死亡率和CHB关联的Cox和后勤回归分析.
主要成果:
- 慢性心脏病发生在20.6%的患者中,并与7.41倍的死亡风险增加有关 (p=0.03).
- 在CHB患者中死亡的保护因素包括热血素T < 1000 ng/dL,低白细胞计数和高心室率.
- 长时间的PR/QRS间隔和低的索科洛·里昂指数预测了CHB的发展;TnT<1000 ng/dL的正常间隔表明没有死亡.
结论:
- CHB与ICI心肌炎的早期死亡率密切相关.
- 专注于心律失常并发症有助于预测重症ICI心肌炎患者的结果.
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