Adverse cardiovascular events and cardiac imaging findings in patients on immune checkpoint inhibitors

• Published in: PloS one 2024-12, Vol.19 (12), p.e0314555
• Main Authors: Kwan, Jennifer M, Shen, Miles, Akhlaghi, Narjes, Hu, Jiun-Ruey, Mora, Ruben, Cross, James L, Jiang, Matthew, Mankbadi, Michael, Wang, Peter, Zaman, Saif, Lee, Seohyuk, Im, Yunju, Feher, Attila, Liu, Yi-Hwa, Ma, Shuangge S, Tao, Weiwei, Wei, Wei, Baldassarre, Lauren A
• Format: Article
• Language: English
• Subjects: Abnormalities; Aged; Archives & records; Arrhythmia; Blood circulation disorders; Cancer; Cancer therapies; Cardiac arrhythmia; Cardiac patients; Cardiotoxicity; Cardiovascular agents; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - diagnostic imaging; Care and treatment; Cell death; Central nervous system; Cerebral infarction; Cohort analysis; Computational linguistics; Congestive heart failure; Coronary artery disease; Data analysis; Decision making; Diagnosis; Echocardiography; Ejection fraction; FDA approval; Female; Gadolinium; Health aspects; Health risks; Heart attack; Heart attacks; Heart diseases; Heart failure; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; Ipilimumab; Kinases; Language processing; Lung cancer; Lung diseases; Magnetic resonance; Magnetic Resonance Imaging; Male; Malignancy; Medical imaging; Medicine and Health Sciences; Middle Aged; Mortality; Mortality risk; Myocardial infarction; Myocarditis; Natural language interfaces; Neoplasms - drug therapy; Oncology, Experimental; Patients; Pericarditis; Radiation therapy; Research and Analysis Methods; Retrospective Studies; Risk Factors; Therapy; Toxicity; Vascular diseases; Ventricle
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0314555

There is an urgent need to better understand the diverse presentations, risk factors, and outcomes of immune checkpoint inhibitor (ICI)-associated cardiovascular toxicity. There remains a lack of consensus surrounding cardiovascular screening, risk stratification, and clinical decision-making in patients receiving ICIs. We conducted a single center retrospective cohort study including 2165 cancer patients treated with ICIs between 2013 and 2020. The primary outcome was adverse cardiovascular events (ACE): a composite of myocardial infarction, coronary artery disease, stroke, peripheral vascular disease, arrhythmias, heart failure, valvular disease, pericardial disease, and myocarditis. Secondary outcomes included all-cause mortality and the individual components of ACE. We additionally conducted an imaging substudy examining imaging characteristics from echocardiography (echo) and cardiac magnetic resonance (CMR) imaging. In our cohort, 44% (n = 962/2165) of patients experienced ACE. In a multivariable analysis, dual ICI therapy (hazard ratio [HR] 1.23, confidence interval [CI] 1.04-1.45), age (HR 1.01, CI 1.00-1.01), male sex (HR 1.18, CI 1.02-1.36), prior arrhythmia (HR 1.22, CI 1.03-1.43), lung cancer (HR 1.17, CI 1.01-1.37), and central nervous system (CNS) malignancy (HR 1.23, CI 1.02-1.47), were independently associated with increased ACE. ACE was independently associated with a 2.7-fold increased risk of mortality (P