Heart failure & cardiomyopathies
Cardiomuscular Biomarkers in the Diagnosis and Prognostication of Immune Checkpoint Inhibitor Myocarditis
Authors' conclusion
cTnT is associated with MACE and is sensitive for diagnosis and surveillance in patients with ICI myocarditis. A cTnT:URL ratio <32 within 72 hours of diagnosis is associated with a subgroup at low risk for MACE.
Study context
- Population
- Patients with ICI myocarditis, 1-year follow-up
- Participants
- 57 / 42 / 57
- Comparison
- cTnT vs cTnI vs creatine kinase (CK)
- cTnTn = 57
- cTnIn = 42
- CKn = 57
- Outcome
- Diagnostic accuracy and prognostic performance for MACE (HF, ventricular arrhythmia, AV or sinus block requiring pacemaker, respiratory muscle failure requiring mechanical ventilation, SCD)
- Follow-up
- 1-year follow-up
Methodological details2 cardio-oncology units (Paris, Heidelberg), validation in international registry
- 2 cardio-oncology units (Paris, Heidelberg)
- Validation in international registry
Performance
As reported in the abstract
Increased vs URL within 72 h of admission · within 72 hours of admission
cTnI vs cTnT: P = 0.03 · CK vs cTnT: P < 0.001
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| cTnT:URL ≥32 within 72 h and MACE within 90 dayscTnT:URL ≥32vs cTnT:URL <32Adjusted for age and sex | 11.1 (3.2–38.0) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
Marker within 72 h of first MACE
Increased cTnT 23 of 23
Below URL cTnI 2 of 19 · CK 6 of 22
| Outcome | cTnT | cTnI | CK | P value |
|---|---|---|---|---|
| Positivity on admission, international registrycTnT vs cTnI | 93% | 64% | — not stated in the abstract | P < 0.001 |
| Association of peak marker:URL within 72 h with MACE within 90 days | ||||
| AUC | 0.84 | — not stated in the abstract | 0.70 |
— not stated in the abstract
- Positivity on admission, international registry: 87 independent cases
- Marker within 72 h of first major adverse cardiomyotoxic events (MACE): P<0.001
≥1 MACE, Franco-German cohort
- Patients with ≥1 MACE
- 24 of 60 (40%)
- Total MACE
- 52
- Median time to first MACE
- 5 [interquartile range, 2-16] days
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Cardiomuscular Biomarkers in the Diagnosis and Prognostication of Immune Checkpoint Inhibitor Myocarditis. Circulation. Published 15 June 2023. doi:10.
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