Immune checkpoint inhibitor-associated myocarditis: a novel risk score.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Power John R, Dolladille Charles, Ozbay Benay, Procureur Adrien, Ederhy Stephane, Palaskas Nicolas L, Lehmann Lorenz H, Cautela Jennifer, Courand Pierre-Yves, Hayek Salim S, Zhu Han, Zaha Vlad G, Cheng Richard K, Alexandre Joachim, Roubille François, Baldassarre Lauren A, Chen Yen-Chou, Baik Alan H, Laufer-Perl Michal, Tamura Yuichi, Asnani Aarti, Francis Sanjeev, Gaughan Elizabeth M, Rainer Peter P, Bailly Guillaume, Flint Danette, Arangalage Dimitri, Cariou Eve, Florido Roberta, Narezkina Anna, Liu Yan, Sandhu Shahneen, Leong Darryl, Issa Nahema, Piriou Nicolas, Heinzerling Lucie, Peretto Giovanni, Crusz Shanthini M, Akhter Nausheen, Levenson Joshua E, Turker Isik, Eslami Assié, Fenioux Charlotte, Moliner Pedro, Obeid Michel, Chan Wei Ting, Ewer Stephen M, Kassaian Seyed Ebrahim, Johnson Douglas B, Nohria Anju, Ben Zadok Osnat Itzhaki, Moslehi Javid J, Salem Joe-Elie, International ICI-Myocarditis Registry
Аннотация
METHODS: A multicentre registry collected data retrospectively from 17 countries between 2014 and 2023. A multivariable Cox regression model was used to determine risk factors for the primary composite outcome: time to severe arrhythmia, heart failure, respiratory muscle failure, and/or cardiomyotoxicity-related death. Covariates included demographics, comorbidities, cardiomuscular symptoms, diagnostics, and treatments. Time-dependent covariates were used, and missing data were imputed. A point-based prognostic risk score was derived and externally validated.
RESULTS: In 748 patients (67% male, age 23-94 years), 30-day incidence of the primary composite outcome, cardiomyotoxic death, and overall death were 33%, 13%, and 17%, respectively. By multivariable analysis, the primary composite outcome was associated with active thymoma (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7-7.7), presence of cardiomuscular symptoms (HR 2.6 [1.5-4.2]), low QRS voltage on presenting electrocardiogram (HR for ≤0.5 mV vs >1 mV 1.9 [1.1-3.1]), left ventricular ejection fraction (LVEF) < 50% (HR 1.7 [1.1-2.6]), and incremental troponin elevation (HR 1.8 [1.4-2.4], 2.9 [1.8-4.7], and 4.6 [2.3-9.3], for 20, 200, and 2000-fold above upper reference limit, respectively). A prognostic risk score developed using these parameters showed good performance; 30-day primary outcome incidence increased gradually from 4% (risk score = 0) to 81% (risk score ≥ 4). This risk score was externally validated in two independent French and US cohorts. This risk score was used prospectively in the external French cohort to identify low-risk patients who were managed with no immunosuppression resulting in no cardiomyotoxic events.
CONCLUSIONS: ICI-associated myocarditis can manifest with high morbidity and mortality. Myocarditis severity is associated with magnitude of troponin, thymoma, low QRS voltage, depressed LVEF, and cardiomuscular symptoms. A risk score incorporating these features performed well.
CLINICAL TRIAL REGISTRATION: NCT04294771 and NCT05454527.