Cardiac Troponin Screening and Clinical Outcomes in Patients Receiving Immunotherapy

doi:10.1016/j.jaccao.2025.06.009

Cardiac Troponin Screening and Clinical Outcomes in Patients Receiving Immunotherapy

JACC CardioOncolPublished 14 Aug 2025Retrospective cohort study

Main finding · MACE (arrhythmia, myocarditis, HF, ACS, stroke, pericardial effusion) after cTnI elevationResultSubdistribution hazard ratio 18.9 95% CI 2.2–162.5

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Authors' conclusion

cTnI surveillance integrated with symptom-based triaging can facilitate early intervention and treatment of cardiotoxicities such as myocarditis.

Study context

Population: Adults receiving immune checkpoint inhibitors with routine serial cardiac troponin I (cTnI) monitoring, January 2019 to October 202142 (9.8%) with elevated cTnI
Participants: 428 adults

Exposure: Symptomatic vs asymptomatic patients with elevated cTnI on surveillance

Methodological detailssingle-centre

Single-centre

Main finding

As reported in the abstract

MACE (arrhythmia, myocarditis, HF, ACS, stroke, pericardial effusion) after cTnI elevation · 1.5 years following cTnI elevation

Subdistribution hazard ratio

18.9

95% CI 2.2–162.5

P = 0.008

Symptomatic vs Asymptomatic

subdistribution HR 18.9 (95% CI 2.2–162.5); P = 0.008

Cumulative incidence of MACE (all with elevated cTnI): 19.0% (95% CI: 7.0%-31.1%)

Observational data: associations, not effects.

Further findings

Management after cTnI elevation

Outpatient evaluation

Symptomatic17.6%

Asymptomatic88.0%

Continued immunotherapy

Symptomatic35.3%

Asymptomatic68.0%

CMR

Symptomatic58.8%

Asymptomatic8.0%

Immunosuppression

Symptomatic47.1%

Asymptomatic8.0%

Outcome	← Lower risk with symptomatic ←→ Higher risk with symptomatic →	HR (95% CI)	P value
All-cause mortality · 2-year follow-up	0.10.31310	3.24 (1.06–9.94)	P = 0.04
	0.10.31310Hazard ratio (log scale)

Management after cTnI elevation: Outpatient evaluation P < 0.001
Management after cTnI elevation: Continued immunotherapy P < 0.001
Management after cTnI elevation: CMR P = 0.001
Management after cTnI elevation: Immunosuppression P = 0.008

Elevated cTnI detected through monitoring

Elevated cTnI: 42 (9.8%)

Myocarditis and cardiac-related deaths

Myocarditis diagnosed: 6
Cardiac-related deaths: 0

Original publication

Cardiac Troponin Screening and Clinical Outcomes in Patients Receiving Immunotherapy. JACC CardioOncol. Published 14 August 2025. doi:10.1016/j.jaccao.2025.06.009

Read the original article ↗PubMed

Summarised from the published abstract; every number is checked against it