Heart failure & cardiomyopathies
Electrophysiologic Phenotype Outperforms Left Ventricular Ejection Fraction for Mortality Prediction in Immune Checkpoint Inhibitor Myocarditis
- Cluster-robust logistic regression of immune checkpoint inhibitor (ICI)-associated myocarditis cases with extractable patient-level data, systematically searched in PubMed
Authors' conclusion
Electrophysiologic involvement is a dominant prognostic marker in ICI-associated myocarditis, particularly for risk stratification among patients with an LVEF >35%. Risk stratification should prioritize cardiac rhythm monitoring and identification of conduction abnormalities over reliance on LVEF alone.
Study context
- Population
- Patients with immune checkpoint inhibitor (ICI)-associated myocarditis reported in the literaturewith complete data comprised the analytical cohort, 319 cases extracted from 242 publications
- Participants
- 180 patients
- Comparison
- prognostic value of electrophysiologic involvement vs left ventricular ejection fraction (LVEF) in ICI-associated myocarditis
Main finding
As reported in the abstract
Mortality, analytical cohort
deaths
77
mortality
42.8%
Electrophysiologic phenotype (EP) involvement, share of cases
66.7%
Further findings
| Outcome | EP involvement | EP-negative | LVEF ≤35% | LVEF >35% | Estimate | P value | |
|---|---|---|---|---|---|---|---|
| Mortality, EP involvement vs EP-negative | 55.0% | 18.3% | Not reported in the abstract | Not reported in the abstract | risk ratio 3.00 (95% CI 1.72–5.24) | P < 0.001 | LVEF ≤35%, LVEF >35%: not reported in the abstract |
| Mortality, adjusted models · adjusted | OR 5.27 (95% CI 2.29–12.13) | P < 0.001 | |||||
| Mortality, adjusted models · adjusted | RR 2.94 (95% CI 1.54–5.59) | P < 0.001 | |||||
| 0.050.21520Ratio (log scale) |
| Outcome | EP involvement | EP-negative | LVEF ≤35% | LVEF >35% | Estimate | P value | |
|---|---|---|---|---|---|---|---|
| Mortality, LVEF ≤35% · not significantly associated with mortality | Not reported in the abstract | Not reported in the abstract | 50.7% | 38.1% | EP involvement, EP-negative: not reported in the abstract | ||
| Mortality, EP involvement among patients with an LVEF >35% | 55.1% | 11.4% | Not reported in the abstract | Not reported in the abstract | LVEF ≤35%, LVEF >35%: not reported in the abstract |
- Mortality, LVEF ≤35%: P = 0.125
- Mortality, EP involvement among patients with an LVEF >35%: P < 0.001
- Mortality, EP involvement among patients with an LVEF >35%: among patients with an LVEF >35%
Mortality, adjusted models
- LVEF ≤35% was not independently associated with mortality
Original publication
Electrophysiologic Phenotype Outperforms Left Ventricular Ejection Fraction for Mortality Prediction in Immune Checkpoint Inhibitor Myocarditis. JACC Adv. Published 13 October 2026. doi:10.
Summarised from the published abstract; every number is checked against it