Mudra Sarah E, Rayes Danny L, Agrawal Ankit, Kumar Ashwin K, Li Jason Z, Njus Meredith, McGowan Kevin, Kalam Kazi A, Charalampous Charalompos, Schleicher Mary, Majid Muhammad, Syed Alvena, Yesilyaprak Abdullah, Klein Allan L
Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
Cardiooncology. 2024 May 17;10(1):29. doi: 10.1186/s40959-024-00234-0.
Despite the growing use of immune checkpoint inhibitors (ICI) in cancer treatment, data regarding ICI-associated pericardial disease are primarily derived from case reports and case series. ICI related pericardial disease can be difficult to diagnose and is associated with significant morbidity. We conducted a systematic review to further characterize the epidemiology, clinical presentation, and outcomes of this patient population.
A search of four databases resulted in 31 studies meeting inclusion criteria. Patients > 18 years old who presented with ICI mediated pericardial disease were included. Intervention was medical + surgical therapy and outcomes were development of cardiac tamponade, morbidity, and mortality.
Thirty- eight patients across 31 cases were included. Patients were majority male (72%) with a median age of 63. Common symptoms included dyspnea (59%) and chest pain (32%), with 41% presenting with cardiac tamponade. Lung cancer (81%) was the most prevalent, and nivolumab (61%) and pembrolizumab (34%) were the most used ICIs. Pericardiocentesis was performed in 68% of patients, and 92% experienced symptom improvement upon ICI cessation. Overall mortality was 16%.
This study provides the most comprehensive analysis of ICI-mediated pericardial disease to date. Patients affected were most commonly male with lung cancer treated with either Nivolumab or Pembrolizumab. Diagnosis may be challenging in the setting of occult presentation with normal EKG and physical exam as well as delayed onset from therapy initiation. ICI-associated pericardial disease demonstrates high morbidity and mortality, as evidenced by a majority of patients requiring pericardiocentesis.
尽管免疫检查点抑制剂（ICI）在癌症治疗中的应用日益广泛，但关于ICI相关心包疾病的数据主要来自病例报告和病例系列。ICI相关心包疾病可能难以诊断，且与显著的发病率相关。我们进行了一项系统综述，以进一步描述该患者群体的流行病学、临床表现和预后。
对四个数据库进行检索，得到31项符合纳入标准的研究。纳入年龄>18岁且出现ICI介导的心包疾病的患者。干预措施为药物+手术治疗，结局指标为心脏压塞的发生、发病率和死亡率。
纳入31例中的38名患者。患者以男性居多（72%），中位年龄为63岁。常见症状包括呼吸困难（59%）和胸痛（32%），41%的患者出现心脏压塞。肺癌（81%）最为常见，纳武单抗（61%）和帕博利珠单抗（34%）是最常用的ICI。68%的患者进行了心包穿刺术，92%的患者在停用ICI后症状改善。总体死亡率为16%。
本研究提供了迄今为止对ICI介导的心包疾病最全面的分析。受影响的患者最常见为男性，患有肺癌，接受纳武单抗或帕博利珠单抗治疗。在心电图和体格检查正常的隐匿性表现以及治疗开始后延迟发作的情况下，诊断可能具有挑战性。ICI相关心包疾病显示出高发病率和死亡率，大多数患者需要心包穿刺术证明了这一点。
