Adverse myocardial and vascular side effects of immune checkpoint inhibitors: a prospective multimodal cardiovascular assessment

• Published in: Clinical research in cardiology 2024-08, Vol.113 (8), p.1263-1273
• Main Authors: Mirabel, Mariana, Eslami, Assié, Thibault, Constance, Oudard, Stéphane, Mousseaux, Elie, Wahbi, Karim, Fabre, Elizabeth, Terrier, Benjamin, Marijon, Eloi, Villefaillot, Aurélie, Fayol, Antoine, Dragon-Durey, Marie-Agnès, Le Louet, Agnès Lillo, Bruno, Rosa Maria, Soulat, Gilles, Hulot, Jean Sébastien
• Format: Article
• Language: English
• Subjects: Abnormalities; Aged; Arrhythmias, Cardiac; Asymptomatic; Biomarkers; Cardiac arrhythmia; Cardiology; Cardiotoxicity; Cardiotoxicity - epidemiology; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Conduction; Congestive heart failure; Creatinine; Disorders; Echocardiography; EKG; Female; Heart - diagnostic imaging; Heart diseases; Heart Failure; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; Incidence; Inhibitors; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging; Multivariate analysis; Myocarditis; Neoplasms - drug therapy; Original Paper; Pericarditis; Prospective Studies; Rhythm; Risk Factors; Side effects; Troponin I; Ventricle
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-024-02462-x

Background Immune checkpoint inhibitors (ICIs) can induce cardiovascular toxicities. Objectives To prospectively assess the incidence of major cardiovascular events (MACE) on ICIs in solid cancer patients: myocarditis, pericarditis, acute coronary syndrome, heart failure, high-degree conduction abnormalities or sustained ventricular arrhythmias, or cardiovascular death at 6 weeks (early MACE), including asymptomatic clinical changes by an independent adjudication committee using current recommended diagnostic criteria. The secondary objective was the incidence of the above-mentioned events adding atrial fibrillation (AF) at 6 months (late MACE). Results Participants underwent pre-ICIs and repeated multimodality cardiac imaging (echocardiogram, cardiac magnetic resonance (CMR)), serum biomarkers (ultrasensitive troponin I), and rhythm surveillance (ambulatory ECG monitoring) at 6 weeks and 6 months. Forty-nine patients (38 (77.6%) male; mean age 64.3 (SD 11.0) years old) were included (June 2020–December 2021). Early MACE were observed in 9 (18.4%) patients at mean 40.1 (SD 5.9) days, with heart failure (HF) in 5 (10.2%), ventricular arrhythmias, or new conduction disorders in 4 (8.2%) patients. History of AF (HR 4.49 (CI 1.11–18.14), P  = 0.035) predicted early MACE. At 6 months follow-up, 18 MACE were observed in 15/49 (31%) patients, with 6 (12.2%) HF events, 5 (10.2%) significant ventricular arrhythmias, or conduction disorders, and 4 (8.2%) AF. There was a significant decline in LVEF ( P