Asymptomatic Troponin Elevation and Early Mortality Following Immune Checkpoint Inhibitor Therapy in Patients Without Cardiac Adverse Events.

BACKGROUND/AIM: Although immune checkpoint inhibitors (ICIs) have demonstrated high therapeutic efficacy against malignant tumors, immune-related cardiovascular adverse events remain a significant concern. While myocarditis is a well-recognized complication, mild troponin elevations without clinical symptoms have been increasingly observed. The prognostic significance of such subclinical elevations remains unclear. This study aimed to evaluate the relationship between asymptomatic troponin elevation and early mortality in patients receiving ICIs without cardiac adverse events.

PATIENTS AND METHODS

This retrospective, single-center study included 108 patients who received ICIs and had high-sensitivity troponin T (hs-TnT) levels measured at baseline and after treatment initiation. Patients diagnosed with myocarditis or other overt cardiac events were excluded. The patients were categorized into two groups based on hs-TnT elevation after ICI therapy.

RESULTS

Among the 108 patients, 26 (24.1%) exhibited hs-TnT elevation post-ICI without developing myocarditis or other cardiac diseases. The peak hs-TnT levels were significantly higher in these patients compared to those without elevation [28 (IQR=18-38) ng/l 11 (8-13) ng/l, 0.001], though still mildly elevated. Over a median follow-up of 174 days, 24 patients died, all due to cancer progression. Notably, those who died within one month of peak hs-TnT had higher levels than those who died after 1-3 or >3 months.

CONCLUSION

Subclinical troponin elevation is common in patients treated with ICIs. Higher troponin levels may be associated with earlier death; however, the underlying mechanisms remain unclear. Careful interpretation is needed and further research is required to clarify its prognostic value.