免疫检查点抑制剂相关心肌炎:一种新的风险评分
John R Power1, Charles Dolladille2, Benay Ozbay3
1University of California San Diego, USA.
European heart journal
|June 26, 2025
概括
一个新的风险评分有助于预测免疫检查点抑制剂 (ICI) 肌肌炎患者的严重结果. 该工具可以识别患有严重心脏问题风险的患者,指导治疗决策,以改善患者护理.
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) 可以导致危及生命的心肌炎,越来越多地识别了较温和的形式.
- 在ICI心肌炎中的自身免疫过程也可能导致肌炎,肌类似综合征和呼吸衰竭.
- 目前缺乏ICI相关心肌毒性预后因素.
研究的目的:
- 为了确定ICI心肌炎住院患者负面结果的预测因素.
- 开发和验证ICI诱导心肌毒性的预后风险评分.
主要方法:
- 来自17个国家的多中心注册 (2014-2023) 的回顾性分析,包括748名患者.
- 多变量考克斯回归确定了复合结果 (严重心律失常,心力衰竭,呼吸衰竭,死亡) 的风险因素.
- 使用已识别的参数,并通过外部验证,得出基于点的风险评分.
主要成果:
- 综合结局的30天发病率为33%;与心肌毒性相关的死亡率为13%.
- 综合结局的预测因素包括活跃的胸腺瘤,心肌症状,低QRS电压,LVEF<50%,和素升高.
- 衍生风险得分表现良好,30天的结果发生率在得分的基础上从4%到81%不等.
结论:
- 与ICI相关的心肌炎具有显著的发病率和死亡率.
- 肌心炎的严重程度与热素水平,胸腺瘤,低QRS电压,减少LVEF和心肌症状相关.
- 开发的风险评分有效预测结果,并可能指导管理,如前性使用所示.
更多相关视频
14:24Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model
Published on: January 21, 2018
11.8K
08:03Hybrid Cell Analysis System to Assess Structural and Contractile Changes of Human iPSC-Derived Cardiomyocytes for Preclinical Cardiac Risk Evaluation
Published on: October 20, 2022
1.9K
相关概念视频
01:27Myocarditis II: Clinical Features and Diagnostic Tests
32
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
32
01:14Myocarditis III: Medical Management
18
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
18
01:22Myocarditis IV: Nursing Management
36
Myocarditis is an inflammatory condition of the myocardium requiring meticulous nursing management for optimal patient outcomes. Effective management begins with a thorough assessment of the patient's medical history, paying close attention to past infections, autoimmune disorders, travel history, and exposure to toxins or drugs. Recent viral infections and systemic diseases are particularly relevant due to their potential role in triggering myocarditis.Physical Examination and MonitoringThe...
36
01:21Myocarditis I: Introduction
35
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
35
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
42
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
42
01:25Cardiomyopathy I: Introduction and Classification
71
Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
71