The predictive value of high sensitivity troponin measurements in patients treated with immune checkpoint inhibitors

Background Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer; however, at the potential cost of serious adverse events including cardiac injury. Objective To assess the baseline and longitudinal changes in high sensitivity-Troponin (hs-Tn) in patients treated with pembr...

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Published in:Clinical research in cardiology 2023-03, Vol.112 (3), p.409-418
Main Authors: Waissengein, Barliz, Abu Ata, Bian, Merimsky, Ofer, Shamai, Sivan, Wolf, Ido, Arnold, Joshua H., Bar-On, Tali, Banai, Shmuel, Khoury, Shafik, Laufer-Perl, Michal
Format: Article
Language:English
Subjects:
Aged
Biomarkers
Calcium-binding protein
Cancer
Cardiology
Cardiovascular diseases
Congestive heart failure
Evaluation
Female
Heart diseases
Heart Failure
Humans
Immune checkpoint inhibitors
Immune Checkpoint Inhibitors - adverse effects
Inhibitors
Male
Medicine
Medicine & Public Health
Mortality
Myocarditis
Original Paper
Pembrolizumab
Prognosis
Retrospective Studies
Thromboembolism
Troponin
Troponin T
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Summary:Background Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer; however, at the potential cost of serious adverse events including cardiac injury. Objective To assess the baseline and longitudinal changes in high sensitivity-Troponin (hs-Tn) in patients treated with pembrolizumab as a potential predictor for the development of major adverse cardiac events (MACE) and survival. Methods We performed a retrospective analysis of cancer patients treated with pembrolizumab at our center. All participants had baseline measurements of hs-TnI prior to initiation of pembrolizumab (T1), with half of the patients performing follow-up measurements at their second encounter for therapy introduction (T2). We first evaluated the prevalence of abnormally elevated serum hs-TnI (> 50 nanogram per liter) at T1 and T2. We then evaluated the predictive value of abnormal levels at T1 or T2 in relation to the development of MACE (composite outcomes of myocarditis, acute coronary syndrome, heart failure, venous thromboembolism, cardiovascular hospitalization and cardiovascular mortality) and all-cause mortality. Results Among 135 patients, the mean age was 72 years, predominantly male (61%). Abnormally elevated hs-TnI at T1 was observed in 7 (5%) patients and emerged as a significant independent predictor for MACE (HR 8.1, 95% CI 1.67–37.4, p  = 0.009) and all-cause mortality (HR 5.37, 95% CI 2.1–13.57, p  
ISSN:1861-0684
1861-0692
DOI:10.1007/s00392-022-02118-8