Gamero Maria T, Patel Avish, Storozynsky Eugene
Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Curr Cardiol Rep. 2024 Dec;26(12):1487-1498. doi: 10.1007/s11886-024-02147-x. Epub 2024 Oct 23.
This review details the significant advancement in knowledge of Immune-checkpoint inhibitor (ICI) and its potential deleterious cardiac immune-related adverse effects (irAE). We explore their mechanisms on the cardiac tissue, providing guidance on risk factors, clinical presentations, diagnostic strategies along with treatment.
Recent findings have provided insights of cardiac irAEs that exist beyond the previously well-known ICI-induced myocarditis. We have a better understanding of the wide variety of cardiac irAEs pathologies both early and late onset. Moreover, there is more data on mechanisms of cardiotoxicity and patient and therapy-related risk factors, supporting closer routine cardiac monitoring with biomarkers and imaging for prevention and early detection. Diagnosing cardiac irAEs is a challenge given its broad clinical presentation. A high-level of suspicion in addition to early work-up is crucial to prevent serious cardiac events. A multi-disciplinary team including Cardiologists and Oncologists is essential for closely monitor patients' cardiac status on ICI therapy. There is a need of updated guidelines to establish clear recommendations in patients on ICIs.
本综述详细阐述了免疫检查点抑制剂（ICI）相关知识的重大进展及其潜在的有害心脏免疫相关不良反应（irAE）。我们探讨了它们对心脏组织的作用机制，为危险因素、临床表现、诊断策略及治疗提供指导。
最近的研究结果揭示了心脏irAE的情况，其范围超出了先前广为人知的ICI诱导的心肌炎。我们对各种早期和晚期发作的心脏irAE病理有了更好的理解。此外，关于心脏毒性机制以及患者和治疗相关危险因素的数据更多，这支持通过生物标志物和影像学进行更密切的常规心脏监测以预防和早期发现。鉴于心脏irAE临床表现广泛，诊断具有挑战性。除了早期检查外，高度怀疑至关重要，以预防严重心脏事件。包括心脏病专家和肿瘤学家在内的多学科团队对于密切监测接受ICI治疗患者的心脏状况至关重要。需要更新指南，为接受ICI治疗的患者制定明确建议。
