Department of Internal Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States of America.
Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, United States of America.
Int J Cardiol. 2021 Jan 1;322:177-182. doi: 10.1016/j.ijcard.2020.08.024. Epub 2020 Aug 13.
Although the incidence of immune checkpoint inhibitor (ICI)-related cardiovascular (CV) toxicity is low, the overall burden of CV events after ICI is unknown. Risk factors for CV events after ICI have yet to be identified.
We sought to evaluate the association between vascular calcification on routine baseline computed tomography (CT) imaging and CV events following ICI.
This was a single-center, retrospective cohort study of 76 patients referred to Cardio-Oncology with prior ICI treatment. Coronary and aortic calcification on non-gated chest and abdominal CT imaging were qualitatively assessed. The association of baseline clinical parameters and vascular calcification with symptomatic heart failure (HF), acute coronary syndrome, myocarditis, symptomatic arrhythmia, or pericardial effusion after ICI was evaluated.
Over 11 months of follow-up, there were 80 CV events that occurred in 49 patients. Worse coronary and aortic calcification on pre-treatment CT imaging was seen in patients with a CV event (p = .018 and p = .014, respectively). There were no differences in traditional CV risk factors between those with and without a CV event. Eighteen patients (37%) were restarted on ICI therapy after a non- myocarditis or symptomatic systolic HF CV event without recurrent events or mortality over 13 months of follow-up.
Symptomatic HF was the most common CV event seen after ICI therapy. Worse coronary and aortic calcification on baseline CT imaging was associated with CV events following ICI. With careful clinical evaluation, selected patients may be re-treated with ICI following a non- myocarditis or symptomatic systolic HF CV event.
尽管免疫检查点抑制剂（ICI）相关心血管（CV）毒性的发病率较低，但 ICI 后 CV 事件的总体负担尚不清楚。ICI 后 CV 事件的危险因素尚未确定。
我们旨在评估常规基线计算机断层扫描（CT）成像中的血管钙化与 ICI 后 CV 事件之间的相关性。
这是一项单中心、回顾性队列研究，共纳入 76 例先前接受过 ICI 治疗的心脏肿瘤患者。对非门控胸部和腹部 CT 成像的冠状动脉和主动脉钙化进行定性评估。评估基线临床参数和血管钙化与 ICI 后症状性心力衰竭（HF）、急性冠状动脉综合征、心肌炎、症状性心律失常或心包积液的相关性。
在 11 个月的随访期间，49 例患者中有 80 例发生 CV 事件。在发生 CV 事件的患者中，预处理 CT 成像上的冠状动脉和主动脉钙化更严重（p =.018 和 p =.014）。有 CV 事件和无 CV 事件的患者之间，传统 CV 危险因素无差异。18 例（37%）患者在非心肌炎或症状性收缩性 HF 后重新开始 ICI 治疗，13 个月的随访期间无复发事件或死亡。
症状性 HF 是 ICI 治疗后最常见的 CV 事件。基线 CT 成像上更严重的冠状动脉和主动脉钙化与 ICI 后 CV 事件相关。通过仔细的临床评估，在非心肌炎或症状性收缩性 HF 后，某些患者可在 CV 事件后重新开始 ICI 治疗。
