Zornitzki Lior, Viskin Dana, Freund Ophir, Wolf Ido, Hemed Anna Rozenfeld, Weiss Noam, Frydman Shir, Tzuberi Maor, Khoury Shafik, Havakuk Ofer, Topilsky Yan, Banai Shmuel, Laufer-Perl Michal
Division of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel.
CJC Open. 2025 Feb 13;7(8):1075-1082. doi: 10.1016/j.cjco.2025.02.005. eCollection 2025 Aug.
Immune checkpoint inhibitors (ICIs) have revolutionized the clinical outcomes of cancer. Nevertheless, their use may lead to myocardial injury. The 2022 European Society of Cardiology cardio-oncology guidelines recommend routine follow-up of troponin level; however, current guidelines do not provide specific protocols for managing elevated troponin levels during ICI therapy. We aimed to describe the real-life assessment of patients treated with ICIs, presenting with an elevated high-sensitivity troponin I (hs-TnI) level following therapy.
Tel Aviv Sourasky Medical Center has implemented a routine follow-up of hs-TnI level measurement during ICI therapy. We performed a retrospective analysis evaluating the clinical assessment and management of patients presenting with an elevated hs-Tnl level (> 50 ng/L) following therapy.
Among 455 patients performing baseline and follow-up hs-TnI measurements, 50 patients (11%) presented with an elevated hs-TnI level (median 159 ng/L; interquartile range 76-362) following ICI therapy. All patients underwent an electrocardiogram, showing changes in 5 patients (10%). Among 24 patients (48%) who received echocardiography, 4 (8%) showed abnormalities. A cardiology consultation was ordered for 17 patients (34%), and none received cardiac magnetic resonance imaging or coronary angiography. A total of 13 patients (26%) were diagnosed with probable or possible myocarditis, resulting in corticosteroid therapy and discontinuation of ICI therapy in 84% and 92% of the patients, respectively. Only 2 patients reinitiated ICI therapy at a later stage.
We describe for the first time the management of elevated hs-TnI levels following ICI therapy, which was diagnosed in routine serial surveillance. We found a wide diversity in management, low cardiology involvement, and high interruption of therapy, emphasizing the need for standardized protocol management guidelines.
免疫检查点抑制剂（ICIs）彻底改变了癌症的临床治疗结果。然而，其使用可能导致心肌损伤。2022年欧洲心脏病学会心脏肿瘤学指南建议对肌钙蛋白水平进行常规随访；然而，目前的指南并未提供在ICI治疗期间管理肌钙蛋白水平升高的具体方案。我们旨在描述接受ICI治疗的患者在治疗后出现高敏肌钙蛋白I（hs-TnI）水平升高的实际评估情况。
特拉维夫索罗卡医疗中心在ICI治疗期间实施了hs-TnI水平测量的常规随访。我们进行了一项回顾性分析，评估治疗后hs-Tnl水平升高（>50 ng/L）的患者的临床评估和管理情况。
在455例进行基线和随访hs-TnI测量的患者中，50例（11%）在ICI治疗后出现hs-TnI水平升高（中位数159 ng/L；四分位间距76-362）。所有患者均接受了心电图检查，其中5例（10%）出现变化。在接受超声心动图检查的24例患者（48%）中，4例（8%）显示异常。17例患者（34%）接受了心脏科会诊，无一例接受心脏磁共振成像或冠状动脉造影。共有13例患者（26%）被诊断为可能或疑似心肌炎，分别导致84%和92%的患者接受皮质类固醇治疗并停用ICI治疗。只有2例患者在后期重新开始使用ICI治疗。
我们首次描述了ICI治疗后hs-TnI水平升高的管理情况，这是在常规系列监测中诊断出来的。我们发现管理方式存在很大差异，心脏科参与度低，治疗中断率高，强调需要标准化的方案管理指南。
