Electrocardiographic features of immune checkpoint inhibitor associated myocarditis

Zlotoff, Daniel A.; Hassan, M; Zafar, Amna; Alvi, Raza M.; Awadalla, Magid; Mahmood, Syed; Zhang, Lili; Chen, Carol L.; Éderhy, Stéphane; Barac, Ana; Banerji, Dahlia; Jones‐O'Connor, Maeve; Murphy, Sean; Armanious, Merna; Forrestal, Brian J.; Kirchberger, Michael C.; Coelho‐Filho, Otávio R.; Rizvi, Muhammad A.; Sahni, Gagan; Mandawat, Anant; Tocchetti, Carlo G.; Hartmann, Sarah; Gilman, Hannah; Zataraín-Nicolás, Eduardo; Mahmoudi, Michael; Gupta, Dhiraj; Sullivan, Ryan J.; Ganatra, Sarju; Yang, Eric H.; Heinzerling, Lucie; Thuny, Franck; Zubiri, Leyre; Reynolds, Kerry L.; Cohen, Justine V.; Lyon, Alexander R.; Groarke, John D.; Thavendiranathan, Paaladinesh; Nohria, Anju; Fradley, Michael G.; Neilan, Tomas G.

doi:10.1136/jitc-2020-002007

Cited by 44 publications

(35 citation statements)

References 50 publications

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“…The subsequent parameters associated with diagnosis of myocarditis are electrocardiographic features. Beside ST-segment and T-wave changes, QRS duration, and QRS-T angle, the QTc interval is supposed to be associated with abnormal tissue characteristics and may play a role in risk stratification [37][38][39]. In our study, the inverse correlation between QTc duration and LVEF was revealed irrespective of the final diagnosis.…”

Section: Discussionsupporting

confidence: 47%

Symptomatic Young Adults with ST-Segment Elevation—Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

Wieczorkiewicz

Przybylak

Supel

et al. 2022

JCM

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Myocarditis may mimic myocardial infarction (MI) due to a similar clinical presentation, including chest pain, electrocardiography changes, and laboratory findings. The purpose of the study was to investigate the diagnostic value of clinical, laboratory, and electrocardiography characteristics of patients with acute coronary syndrome - like myocarditis and MI. We analysed 90 patients (≤45 years old) with an initial diagnosis of ST-segment elevation myocardial infarction; 40 patients (44.4%), through the use of cardiac magnetic resonance, were confirmed to have myocarditis, and 50 patients (55.6%) were diagnosed with MI. Patients with myocarditis were younger and had fewer cardiovascular risk factors than those with MI. The cutoff value distinguishing between myocarditis and MI was defined as the age of 36 years. The history of recent infections (82.5% vs. 6%) and C-reactive protein (CRP) levels on admission (Me 45.9 vs. 3.4) was more associated with myocarditis. Further, the QTc interval was inversely correlated with the echocardiographic ejection fraction in both groups but was significantly longer in patients with MI. Non-invasive diagnostics based on clinical features and laboratory findings are basic but still essential tools for differentiation between MI and myocarditis. The three-factor model including the criteria of age, abnormal CRP, and history of recent infections might become a valuable clinical indication.

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Section: Discussionsupporting

confidence: 47%

Symptomatic Young Adults with ST-Segment Elevation—Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

Wieczorkiewicz

Przybylak

Supel

et al. 2022

JCM

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“…Zlotoff et al examined the ECG from a registry of myocarditis in ICI patients [20]. The study included 140 cases of myocarditis that were compared to 179 of the control cases.…”

Section: Electrocardiogrammentioning

confidence: 99%

The Diagnosis and Management of Immune Checkpoint Inhibitor Cardiovascular Toxicity: Myocarditis and Beyond

2022

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Recent years have brought major advancements in the use of immune therapy and specifically immune checkpoint inhibitors (ICIs) in cancer patients, with expanding indications for various malignancies resulting in the treatment of a large and increasing number of patients. While this therapy significantly improves outcomes in a variety of hematologic and solid tumors, the use of ICIs is associated with a substantial risk of immune-related adverse events. Cardiovascular toxicity, while not the most common side effect of ICIs, is associated with significant morbidity and mortality. It is therefore crucial for oncologists and cardiologists, as well as internists and emergency room physicians, to have a good understanding of this increasingly common clinical problem. In the present review, we discuss the cardiac aspects of ICI therapy with special emphasis on the clinical manifestations of their cardiovascular toxicity, diagnostic approaches, treatment and suggested surveillance.

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“…Они включают синусовую тахикардию, удлинение QT, расширение QRS, нарушения проводимости, появление патологических зубцов Q, инверсию зубцов T, другие неспецифические изменения ST и T. Нормальная ЭКГ не исключает диагноз миокардита. Расширение комплекса QRS является неблагоприятным прогностическим признаком [428].…”

Section: диагностикаunclassified

Eurasian clinical guidelines for cardiovascular complications of cancer treatments: diagnosis, prevention and treatment (2022)

Чазова

Агеев²,

Аксенова

et al. 2022

Evrazijskij kardiologičeskij žurnal

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Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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Electrocardiographic features of immune checkpoint inhibitor associated myocarditis

Cited by 44 publications

References 50 publications

Symptomatic Young Adults with ST-Segment Elevation—Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

Symptomatic Young Adults with ST-Segment Elevation—Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

The Diagnosis and Management of Immune Checkpoint Inhibitor Cardiovascular Toxicity: Myocarditis and Beyond

Eurasian clinical guidelines for cardiovascular complications of cancer treatments: diagnosis, prevention and treatment (2022)

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