Electrocardiographic Features of Immune Checkpoint Inhibitor-Associated Myocarditis

Song, Wenhua; Zheng, Yi; Dong, Mei; Zou, Lin; Bazoukis, George; Perone, Francesco; Li, Guangping; Ng, Chi Fai; Baranchuk, Adrián; Tse, Gary; Liu, Tong

doi:10.1016/j.cpcardiol.2022.101478

Cited by 16 publications

(18 citation statements)

References 87 publications

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“…31 The ECG of ICI-related myocarditis may show atrioventricular block, bundle branch block, and atrial and ventricular arrhythmias. 32 The patient in this study had significant arrhythmia characterized by myocardial infarction, mainly manifested as ST-segment elevation, and had no clinical manifestations of dyspnea and chest pain after using ICI. This indicates that we need to pay attention to the possibility of myocardial inflammation when there is potential arrhythmias.…”

Section: Discussionmentioning

confidence: 71%

Successful management of camrelizumab-induced immune-checkpoint-inhibitors-related myocarditis

Long,

Du,

Wang

et al. 2023

J Oncol Pharm Pract

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Introduction Immune checkpoint inhibitors can cause immune-related toxicity in various systems, with myocarditis being the most severe and life-threatening manifestation. This report presents a case in which myocarditis developed following administration of programmed cell death protein-1 (PD-1) inhibitors therapy. We describe the diagnosis and treatment of this patient in detail. Case report We present the case of a 59-year-old female diagnosed with post-operative esophageal cancer and hepatic metastases. The patient underwent second-line treatment with domestically-made PD-1 inhibitor, camrelizumab, in combination with paclitaxel (albumin-bound) and carboplatin for two cycles. During the course of treatment, an electrocardiogram (ECG) revealed ST segment elevation in leads II, III, aVF, V2, V3, and V4, along with T wave changes in leads I and aVL. Laboratory examinations showed abnormal levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT). Despite the absence of clinical symptoms, the patient was routinely hospitalized three weeks later. Based on the findings from the ECG, cardiac biomarkers, echocardiography, echocardiogram, cardiac magnetic resonance, and angiography, she was diagnosed with immune-checkpoint-inhibitors-related myocarditis. Management and outcome The patient received immunoglobulin (0.5 g/kg/day) and was initially given methylprednisolone (1000 mg/day). Methylprednisolone was gradually reduced to 40 mg/day in 2 weeks. During this time, the levels of biomarkers indicative of myocardial injury also exhibited a simultaneous decline. Discussion This case highlights the importance of early detection and prompt intervention, including initiating appropriate steroid therapy and discontinuing of immune checkpoint inhibitors. Such measures can effectively prevent morbidity and mortality, ultimately leading to an improved prognosis.

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Section: Discussionmentioning

confidence: 71%

Successful management of camrelizumab-induced immune-checkpoint-inhibitors-related myocarditis

Long,

Du,

Wang

et al. 2023

J Oncol Pharm Pract

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“…Histological studies have shown that ICI-mediated cardiomyocyte necrosis is characterized by the infiltration of CD4+ and CD8+ T-cells and is similar to the development of acute cardiac rejection after transplantation [ 205 , 206 ]. Lymphocytic infiltration may involve the sinoatrial and atrioventricular nodes [ 207 ].…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases

Zotova

2023

Diagnostics

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Myocarditis associated with the use of immune checkpoint inhibitors (ICI) is a rare manifestation of their cardiotoxicity, but is characterized by a high mortality rate. A literature search was conducted using PubMed using keywords, which resulted in the selection of 679 scientific works, from which 160 articles that described 244 clinical cases were selected. The median age of the patients was 67 years (IQR, 60–74). The median time from the start of ICI therapy to the development of the first adverse symptoms was 21 days (IQR, 14–38.3). In 37% of cases, myocarditis developed after the first administration of ICI. Cardiac symptoms were present in 47.1% of cases, neuromuscular symptoms in 30.3%, and other symptoms in 12.6%, while myocarditis was asymptomatic in 10.1% of cases. New changes in the electrocardiograms were detected in 85.1% of patients compared to the initial data. A high incidence of complete atrioventricular block (25.4%), right bundle branch block (18.4%), ventricular tachycardia (13%), and sinus tachycardia (12%) were noted. In 97% of the cases, the patients received prednisolone or methylprednisolone therapy. When using ICI, special attention should be paid to the early detection of possible cardiotoxicity by analyzing the condition and function of the myocardium before treatment and its dynamics.

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“…In recent years, ICI has revolutionized the treatment of advanced malignant neoplasms, although improved cancer survival often comes with increased risk of various immune-related adverse events (irAEs). Much interest has been focused on ICI-related myocarditis, and emerging preclinical and clinical studies have also indicated that ICI may also be associated with the development and exacerbation of atherosclerosis . Immune checkpoint pathways play a substantially protective role in atherogenesis and progression to advanced plaque phenotype; however, inhibition of these pathways has been associated with proinflammatory changes, increased atherosclerotic lesion size, lesion macrophage content, and enhanced plaque T-cell activation, which may develop into more advanced atherosclerosis .…”

Section: Discussionmentioning

confidence: 99%

Red Flag on Electrocardiogram Findings in a Patient With Lung Cancer

2023

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Electrocardiographic Features of Immune Checkpoint Inhibitor-Associated Myocarditis

Cited by 16 publications

References 87 publications

Successful management of camrelizumab-induced immune-checkpoint-inhibitors-related myocarditis

Successful management of camrelizumab-induced immune-checkpoint-inhibitors-related myocarditis

Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases

Red Flag on Electrocardiogram Findings in a Patient With Lung Cancer

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