Zornitzki Lior, Havakuk Ofer, Rozenbaum Zach, Viskin Dana, Arbel Yaron, Flint Nir, Arnold Joshua, Waissengein Barliz, Wolf Ido, Banai Shmuel, Topilsky Yan, Laufer-Perl Michal
Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel.
Life (Basel). 2022 Sep 1;12(9):1366. doi: 10.3390/life12091366.
Immune checkpoint inhibitor (ICI) and coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis possibly share common mechanisms secondary to overactivation of the immune system. We aimed to compare the presenting characteristics of ICIs and COVID-19 vaccine-induced myocarditis. We performed a retrospective analysis of characteristics of patients diagnosed with either ICIs or COVID-19 vaccine-induced myocarditis and compared the results to a control group of patients diagnosed with acute viral myocarditis. Eighteen patients diagnosed with ICIs (ICI group) or COVID-19 vaccine (COVID-19 vaccine group)-induced myocarditis, and 20 patients with acute viral myocarditis (Viral group) were included. The ICI group presented mainly with dyspnea vs. chest pain and fever among the COVID-19 vaccine and Viral groups. Peak median high sensitivity Troponin I was markedly lower in the ICI group (median 619 vs. 15,527 and 7388 ng/L, = 0.004). While the median left ventricular (LV) ejection fraction was 60% among all groups, the ICI group had a lower absolute mean LV global longitudinal strain (13%) and left atrial conduit strain (17%), compared to the COVID-19 vaccine (17% and 30%) and Viral groups (18% and 37%), = 0.016 and = 0.001, respectively. Despite a probable similar mechanism, ICI-induced myocarditis's presenting characteristics differed from COVID-19 vaccine-induced myocarditis.
免疫检查点抑制剂（ICI）和2019冠状病毒病（COVID-19）疫苗诱导的心肌炎可能具有共同机制，继发于免疫系统过度激活。我们旨在比较ICI和COVID-19疫苗诱导的心肌炎的临床表现特征。我们对诊断为ICI或COVID-19疫苗诱导的心肌炎的患者特征进行了回顾性分析，并将结果与诊断为急性病毒性心肌炎的对照组患者进行了比较。纳入了18例诊断为ICI（ICI组）或COVID-19疫苗（COVID-19疫苗组）诱导的心肌炎患者，以及20例急性病毒性心肌炎患者（病毒组）。与COVID-19疫苗组和病毒组相比，ICI组主要表现为呼吸困难，而COVID-19疫苗组和病毒组主要表现为胸痛和发热。ICI组的高敏肌钙蛋白I峰值中位数显著较低（中位数分别为619 ng/L，而COVID-19疫苗组和病毒组分别为15527 ng/L和7388 ng/L，P = 0.004）。虽然所有组的左心室（LV）射血分数中位数均为60%，但与COVID-19疫苗组（分别为17%和30%）和病毒组（分别为18%和37%）相比，ICI组的左心室整体纵向应变绝对值（13%）和左心房管道应变（17%）较低，P分别为0.016和0.001。尽管机制可能相似，但ICI诱导的心肌炎的临床表现特征与COVID-19疫苗诱导的心肌炎不同。
