Progressive and Reversible Conduction Disease With Checkpoint Inhibitors

Reddy, Neeti; Moudgil, Rohit; Lopez‐Mattei, Juan; Karimzad, Kaveh; Mouhayar, Elie; Somaiah, Neeta; Conley, Anthony P.; Patel, Shreyaskumar; Giza, Dana Elena; Iliescu, Cezar

doi:10.1016/j.cjca.2017.05.026

Cited by 47 publications

(36 citation statements)

References 5 publications

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“…For example, myocarditis associated with ICI use has almost always presented with an elevation in cardiac biomarkers such as troponin and creatinine kinase MB (CK-MB). 33 , 49 The degree of troponin elevation could also correlate with major adverse cardiac events (MACE) outcomes as shown in a prospective observational study by Mahmood et al. 43 There was a 4-fold increased risk of MACE with troponin T of ≥1.5 ng/ml (hazard ratio: 4.0; 95% confidence interval: 1.5 to 10.9; P = 0.003).…”

Section: Diagnosis and Managementmentioning

confidence: 98%

“… 33 , 58 Other immunosuppressive regimens that can be used in steroid non-responders include plasmapheresis, intravenous immunoglobulins, anti-thymocyte globulin (ATG), mycophenolate mofetil, tacrolimus and infliximab. 37 , 49 , 58 , 59 Data supporting the use of these therapies are lacking which largely limits their use in the treatment of cardiac toxicities.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

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Managing cardiotoxicity associated with immune checkpoint inhibitors

Upadhrasta

Elias

Patel

et al. 2019

Chronic Diseases and Translational Medicine

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Immuno-oncology is a fast evolving field of cancer therapy and immune checkpoint inhibitors (ICIs) are clearly a breakthrough in this field. Cardiotoxicity with conventional anti-cancer therapies has been well studied in the past and clear guidelines for management of these side effects are available in the literature. However, cardiotoxicity with novel agents such as ICIs has been fairly under-reported and/or underestimated and we are yet to formulate clear guidelines for management of these rare side effects. In the last few years, there has been an overall increase in the number of cases of cardiotoxicity related to ICIs. In this literature review, we describe the mechanism of action of the most widely used ICIs and their related cardiotoxicities. The increase in number of case reports about the potential of cardiotoxicities with these novel agents clearly indicates the need for a new insight into the field of cardio-immuno-oncology.

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Section: Diagnosis and Managementmentioning

confidence: 98%

Section: Diagnosis and Managementmentioning

confidence: 99%

Managing cardiotoxicity associated with immune checkpoint inhibitors

Upadhrasta

Elias

Patel

et al. 2019

Chronic Diseases and Translational Medicine

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show abstract

“…[59][60][61] Several side effects, including adverse cardiovascular events, have been recognized. [59][60][61][62][63] In particular, ICI induced myocarditis is a common cardiovascular side effect, with an approximate incidence of 1.9% amongst patients treated and a median time of onset of 34 days after starting ICI. 60 The disease requires immediate treatment due to a high mortality rate.…”

Section: Medications That May Cause Eosinophilic Myocardi-mentioning

confidence: 99%

Update on myocarditis – what we know so far and where we may be heading

Rroku

Kottwitz

Heidecker

2020

European Heart Journal. Acute Cardiovascular Care

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“…However, 17% had minimally elevated high sensitivity troponin with no other evidence of myocarditis, suggesting a low screening yield for identification of clinical disease, but perhaps suggesting subclinical cardiotoxicity (20). Electrocardiogram (ECG) findings with ICI-associated myocarditis are highly variable, ranging from nonspecific ST segment and T wave changes, ST elevations, and 1st and 2nd degree AB block to complete heart block (8,21,22).…”

Section: Presentation and Diagnosis Of Ici-associated Myocarditismentioning

confidence: 99%

Clinical and Advanced MRI Techniques for Detection of Checkpoint Inhibitor Associated Myocarditis

Arbune

Soufer

Baldassarre

2020

Curr Cardiovasc Imaging Rep

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Purpose of Review With the advent of immune checkpoint inhibitors (ICIs), cancer treatment has been revolutionized; however, these agents are associated with immune-related adverse events, including myocarditis, which ranges from mild to fulminant in severity. Currently, there are no established guidelines in diagnosing ICI-associated myocarditis, and the gold standard test for diagnosis of myocarditis in general is invasive endomyocardial biopsy (EMB). Cardiac magnetic resonance (CMR) imaging is a noninvasive test with the advantage of providing structural, functional and tissue characterization information. Additionally, it provides high spatial and temporal resolution without exposure to ionizing radiation, iodinated contrast, or radioactive isotopes. Recent Findings With an increasing number of reported cases of ICI associated myocarditis, understanding of the disease process and associated CMR findings is growing. Diagnostic testing with cardiac biomarkers, electrocardiogram, and echocardiogram can be nonspecific and EMB can have sampling errors. CMR as a diagnostic tool can provide functional assessment of biventricular ejection fraction, myocardial strain, tissue characterization of myocardial edema and inflammation as well as fibrosis. Furthermore, with advanced parametric mapping techniques, CMR provides even more sensitive and quantitative information about myocardial inflammation and fibrosis, including measurements of extracellular volume. Summary ICI-associated myocarditis is a serious immune adverse event, and CMR plays a vital role in establishing its diagnosis, providing prognostic information, and has the potential for use as a tool for screening and serial monitoring in patients exposed to ICIs.

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Progressive and Reversible Conduction Disease With Checkpoint Inhibitors

Cited by 47 publications

References 5 publications

Managing cardiotoxicity associated with immune checkpoint inhibitors

Managing cardiotoxicity associated with immune checkpoint inhibitors

Update on myocarditis – what we know so far and where we may be heading

Clinical and Advanced MRI Techniques for Detection of Checkpoint Inhibitor Associated Myocarditis

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