Departments of Oncology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Immunother. 2021 Jun 1;44(5):179-184. doi: 10.1097/CJI.0000000000000371.
The widespread use of immune checkpoint inhibitors (ICI) has become a mainstay of care for a variety of malignancies. However, these therapies portend a range of adverse effects, including a potentially fatal form of cardiotoxicity which to date has not been elucidated. We aimed to evaluate the baseline characteristics of ICI-mediated cardiotoxicity. We performed a retrospective study evaluating patients treated with ICI who performed at least 2 echocardiography examinations, before and after the initiation of ICI. Cardiotoxicity was defined as Cancer Therapeutics-related Cardiac Dysfunction (CTRCD) development, with an absolute left ventricular ejection fraction reduction of >10%, to a value <53%. Fifty-two patients were included with a male preponderance (65%) and a mean age of 66 (±12) years. Twelve (23%) patients developed CTRCD, of which 2 patients were diagnosed with myocarditis. Among the CTRCD group, patients tended to be older and more likely to have baseline diastolic dysfunction: lower e' septal (P=0.026), higher E/e' septal (P=0.035), and a trend of E/e' average (P=0.076). All-cause and cardiovascular hospitalizations were significantly more common among the CTRCD group (P=0.028 and 0.001, respectively). Higher prevalence of cardiovascular mortality was observed among the CTRCD group (25% vs. 2%, P=0.034). We evaluated the development of CTRCD among patients treated with ICI therapies. Our findings suggest that baseline diastolic parameters may be associated with CTRCD development assisting in the early diagnosis of ICI-induced cardiac injury.
免疫检查点抑制剂(ICI)的广泛应用已成为多种恶性肿瘤治疗的主要手段。然而,这些治疗方法预示着一系列不良反应,包括迄今为止尚未阐明的潜在致命性心脏毒性。我们旨在评估 ICI 介导的心脏毒性的基线特征。我们进行了一项回顾性研究,评估了接受 ICI 治疗且至少进行了 2 次超声心动图检查(ICI 治疗前后)的患者。心脏毒性定义为癌症治疗相关心脏功能障碍(CTRCD)的发展,即绝对左心室射血分数降低>10%,降至<53%。52 例患者中男性居多(65%),平均年龄为 66(±12)岁。12 例(23%)患者发生 CTRCD,其中 2 例诊断为心肌炎。在 CTRCD 组中,患者年龄较大且更可能存在基线舒张功能障碍:间隔侧 e' 值较低(P=0.026),E/e' 间隔较高(P=0.035),E/e' 平均值呈趋势性升高(P=0.076)。全因和心血管住院在 CTRCD 组中更为常见(P=0.028 和 0.001)。在 CTRCD 组中观察到心血管死亡率较高(25% vs. 2%,P=0.034)。我们评估了接受 ICI 治疗的患者中 CTRCD 的发展情况。我们的研究结果表明,基线舒张参数可能与 CTRCD 的发展有关,有助于早期诊断 ICI 引起的心脏损伤。