Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China.
Department of Clinical Nutrition, School of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China.
Sci Rep. 2024 Oct 22;14(1):24821. doi: 10.1038/s41598-024-76829-5.
This study aimed to find the association between four common clinical biomarkers and subsequent ICICT, developing a risk scoring strategy to assess the ICICT risk. Three terminals for ICICT were : Terminal 1, cancer therapy-related cardiomyopathies; Terminal 2, myocarditis or heart failure; and Terminal 3, myocarditis, heart failure, myocardial infarction, cerebral infarction, atrial fibrillation, or death. The thresholds were : N-terminal-pro-B-type-natriuretic-peptide ≥ 125 pg/mL, cardiac troponin T ≥ 6 ng/L, high-sensitivity C-reactive protein ≥ 3 mg/L, and coronary artery calcium score > 10 U. Each of the four abnormal biomarkers received 1 point. The links between biomarkers, score stage, and ICICT were analyzed. 375 patients with a mean follow-up of 1.91 years were included. All four biomarkers measured before immunotherapy were associated with a higher risk of developing ICICT. These scores were also associated with ICICT risk. The highest risk was the very high stage (score = 4) has 7.29, 8.83, and 7.02 folder higher risk compared to low risk group for Terminal 1-3, respectively. The cumulation of incidences also showed that the higher stages of score had an earlier onset and higher incidence of ICICT. 4 biomarkers and the scoring strategy enables clinicians to assess risk easily.
本研究旨在探讨四种常见临床生物标志物与随后发生的免疫检查点抑制剂相关心血管毒性（ICICT）之间的关系，并制定一种风险评分策略来评估 ICICT 风险。ICICT 的三个终点分别为：终点 1，癌症治疗相关心肌病；终点 2，心肌炎或心力衰竭；终点 3，心肌炎、心力衰竭、心肌梗死、脑梗死、心房颤动或死亡。阈值分别为：N 端脑利钠肽前体（NT-proBNP）≥125pg/ml、心肌肌钙蛋白 T（cTnT）≥6ng/L、高敏 C 反应蛋白（hs-CRP）≥3mg/L、冠状动脉钙评分（CACS）＞10U。四种异常生物标志物中每一种异常都计 1 分。分析了生物标志物、评分阶段与 ICICT 之间的关系。共纳入 375 例患者，平均随访 1.91 年。免疫治疗前测量的所有四种生物标志物均与发生 ICICT 的风险增加相关。这些评分也与 ICICT 风险相关。风险最高的是极高风险阶段（评分=4），与低风险组相比，终点 1-3 的风险分别高 7.29、8.83 和 7.02 倍。累积发生率也表明，评分较高的阶段发病更早，ICICT 的发生率更高。这 4 种生物标志物和评分策略使临床医生能够轻松评估风险。
