Moey Melissa Y Y, Tomdio Anna N, McCallen Justin D, Vaughan Lauren M, O'Brien Kevin, Naqash Abdul R, Cherry Cynthia, Walker Paul R, Carabello Blase A
Department of Cardiovascular Sciences, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA.
Department of Cardiovascular Sciences, Virginia Commonwealth University, Richmond, Virginia, USA.
JACC CardioOncol. 2020 Sep 15;2(3):491-502. doi: 10.1016/j.jaccao.2020.07.005. eCollection 2020 Sep.
Immune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is uncommon but can be fatal. There have been few reports of iRC from a rural cancer population and few data for iRC and inflammatory biomarkers.
The purpose of this study was to characterize major adverse cardiac events (MACE) in ICI-treated lung cancer patients based in a rural setting and to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in the diagnosis of iRC.
Patients with lung cancer treated with ICIs at Vidant Medical Center/East Carolina University (VMC/ECU) between 2015 and 2018 were retrospectively identified. MACE included myocarditis, non-ST-segment elevated myocardial infarction (NSTEMI), supraventricular tachycardia (SVT), and pericardial disorders. Medical history, laboratory values, pre-ICI electrocardiography (ECG), and echocardiography results were compared in patients with and without MACE.
Among 196 ICI-treated patients, 23 patients (11%) developed MACE at a median of 46 days from the first ICI infusion (interquartile range [IQR]: 17 to 83 days). Patients who developed MACE experienced myocarditis (n = 9), NSTEMI (n = 3), SVT (n = 7), and pericardial disorders (n = 4). Ejection fraction was not significantly different at the time of MACE compared to that at baseline (p = 0.495). Compared to baseline values, NLR (10.9 ± 8.3 vs. 20.7 ± 4.2, respectively; p = 0.032) and CRP (42.1 ± 10.1 mg/l vs. 109.9 ± 15.6 mg/l, respectively; p = 0.010) were significantly elevated at the time of MACE.
NLR and CRP were significantly elevated at the time of MACE compared to baseline values in ICI-treated patients. Larger datasets are needed to validate these findings and identify predictors of MACE that can be used in the diagnosis and management of ICI-related iRC.
免疫检查点抑制剂（ICI）相关的心脏毒性（iRC）并不常见，但可能致命。关于农村癌症患者发生iRC的报道很少，且关于iRC和炎症生物标志物的数据也很少。
本研究的目的是描述以农村地区为基础的接受ICI治疗的肺癌患者的主要不良心脏事件（MACE），并评估C反应蛋白（CRP）和中性粒细胞与淋巴细胞比值（NLR）在iRC诊断中的效用。
回顾性确定2015年至2018年期间在维丹特医疗中心/东卡罗来纳大学（VMC/ECU）接受ICI治疗的肺癌患者。MACE包括心肌炎、非ST段抬高型心肌梗死（NSTEMI）、室上性心动过速（SVT）和心包疾病。比较发生和未发生MACE的患者的病史、实验室检查值、ICI治疗前的心电图（ECG）和超声心动图结果。
在196例接受ICI治疗的患者中，23例（11%）发生了MACE，从首次输注ICI开始的中位时间为46天（四分位间距[IQR]：17至83天）。发生MACE的患者经历了心肌炎（n = 9）、NSTEMI（n = 3）、SVT（n = 7）和心包疾病（n = 4）。与基线时相比，发生MACE时的射血分数无显著差异（p = 0.495）。与基线值相比，发生MACE时NLR（分别为10.9±8.3和20.7±4.2；p = 0.032）和CRP（分别为42.1±10.Ⅰmg/L和109.9±15.6mg/L；p = 0.010）显著升高。
与接受ICI治疗患者的基线值相比，发生MACE时NLR和CRP显著升高。需要更大的数据集来验证这些发现，并确定可用于ICI相关iRC诊断和管理的MACE预测指标。
