Frontiers in immunology · 2026
Clinical characteristics analysis of immune checkpoint inhibitors-related myocarditis.
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Wang Rui, Hao Cuijun, Liu Jiaqi, Zhang Zhanshuai, Qin Shaoqiang
Аннотация
OBJECTIVE: To investigate the clinical characteristics of immune checkpoint inhibitors (ICIs)-related myocarditis and the differences between mild and severe cases, aiming to provide evidence for early identification and stratified management.
METHODS: A total of 74 patients diagnosed with ICIs-related myocarditis at our hospital from April 2020 to April 2024 were retrospectively enrolled. According to the *Chinese Expert Consensus on the Surveillance and Management of Immune Checkpoint Inhibitor-Related Myocarditis (2020 Edition)* and CTCAE 5.0 criteria, patients were divided into mild group (n=49) and severe group (n=25). The two groups were compared in terms of demographic characteristics, clinical manifestations, laboratory tests, auxiliary examinations, concomitant irAEs, treatment, and outcomes.
RESULTS: The time of onset in the severe group was significantly earlier than that in the mild group [23 days (18, 85) vs. 80 days (48, 132), P = 0.004]. Severe group more frequently presented with multisystem involvement: incidences of myasthenia (56.0% vs. 6.1%), dyspnea (24.0% vs. 0), and ptosis (16.0% vs. 0) were significantly higher (all P<0.05). Levels of cardiac biomarkers (cTnT/I, CK, NT-proBNP) and liver enzymes (ALT, AST) were markedly elevated (all P<0.01). Electrocardiographic ST-T segment changes (56.0% vs. 10.2%) and conduction blocks (32.0% vs. 4.1%) were more common in the severe group. Echocardiography showed higher rates of regional wall motion abnormality (28.0% vs. 6.1%) and pericardial effusion (28.0% vs. 6.1%) in the severe group. The severe group also had higher rates of concomitant myositis (68.0% vs. 40.8%), hepatitis (28.0% vs. 6.1%), and neurotoxicity (32.0% vs. 2.0%) (all P<0.05). Regarding treatment, 100% of the severe group received glucocorticoids (vs. 28.6%), 60.0% required intravenous immunoglobulin, and 28.0% needed respiratory support. Regarding outcomes, all patients in the mild group improved, while the mortality rate in the severe group was 32.0% (8/25).
CONCLUSION: Patients with severe ICIs-related myocarditis are characterized by early onset, multisystem involvement, marked elevation of cardiac enzymes, prominent electrocardiographic/echocardiographic abnormalities, frequent concomitant irAEs, and high mortality. Clinicians should be highly vigilant for patients presenting with early myasthenia, conduction blocks, or markedly elevated CK/cTn, and promptly initiate intensified immunosuppressive therapy to improve prognosis.
METHODS: A total of 74 patients diagnosed with ICIs-related myocarditis at our hospital from April 2020 to April 2024 were retrospectively enrolled. According to the *Chinese Expert Consensus on the Surveillance and Management of Immune Checkpoint Inhibitor-Related Myocarditis (2020 Edition)* and CTCAE 5.0 criteria, patients were divided into mild group (n=49) and severe group (n=25). The two groups were compared in terms of demographic characteristics, clinical manifestations, laboratory tests, auxiliary examinations, concomitant irAEs, treatment, and outcomes.
RESULTS: The time of onset in the severe group was significantly earlier than that in the mild group [23 days (18, 85) vs. 80 days (48, 132), P = 0.004]. Severe group more frequently presented with multisystem involvement: incidences of myasthenia (56.0% vs. 6.1%), dyspnea (24.0% vs. 0), and ptosis (16.0% vs. 0) were significantly higher (all P<0.05). Levels of cardiac biomarkers (cTnT/I, CK, NT-proBNP) and liver enzymes (ALT, AST) were markedly elevated (all P<0.01). Electrocardiographic ST-T segment changes (56.0% vs. 10.2%) and conduction blocks (32.0% vs. 4.1%) were more common in the severe group. Echocardiography showed higher rates of regional wall motion abnormality (28.0% vs. 6.1%) and pericardial effusion (28.0% vs. 6.1%) in the severe group. The severe group also had higher rates of concomitant myositis (68.0% vs. 40.8%), hepatitis (28.0% vs. 6.1%), and neurotoxicity (32.0% vs. 2.0%) (all P<0.05). Regarding treatment, 100% of the severe group received glucocorticoids (vs. 28.6%), 60.0% required intravenous immunoglobulin, and 28.0% needed respiratory support. Regarding outcomes, all patients in the mild group improved, while the mortality rate in the severe group was 32.0% (8/25).
CONCLUSION: Patients with severe ICIs-related myocarditis are characterized by early onset, multisystem involvement, marked elevation of cardiac enzymes, prominent electrocardiographic/echocardiographic abnormalities, frequent concomitant irAEs, and high mortality. Clinicians should be highly vigilant for patients presenting with early myasthenia, conduction blocks, or markedly elevated CK/cTn, and promptly initiate intensified immunosuppressive therapy to improve prognosis.