Cardio-oncology & otherCohort study
Immune checkpoint inhibitor-associated myocarditis: a novel risk score
- Retrospective cohort study
- multicentre registry
- 17 countries
- external validation
Authors' conclusion
Myocarditis severity is associated with magnitude of troponin, thymoma, low QRS voltage, depressed LVEF, and cardiomuscular symptoms. A risk score incorporating these features performed well.
Study context
- Population
- Patients admitted for immune checkpoint inhibitors (ICI) myocarditis, 17 countries, 2014–2023
- Participants
- 748 patients
- Outcome
- Composite:
- Time to severe arrhythmia
- HF
- Respiratory muscle failure
- Cardiomyotoxicity-related death
- Follow-up
- 30 days
Main finding
As reported in the abstract
Primary composite outcome:
- Severe arrhythmia
- HF
- Respiratory muscle failure
- Cardiomyotoxicity-related death
HR
Active thymomamultivariable
3.6(95% CI 1.7–7.7)
Presence of cardiomuscular symptomsmultivariable
2.6(CI 1.5–4.2)
Low QRS voltage on presenting ECG ≤0.5 mV vs >1 mVmultivariable
1.9(CI 1.1–3.1)
LVEF < 50%multivariable
1.7(CI 1.1–2.6)
Incremental troponin elevation20-fold above upper reference limit
1.8(CI 1.4–2.4)
Incremental troponin elevation200-fold above upper reference limit
2.9(CI 1.8–4.7)
Incremental troponin elevation2000-fold above upper reference limit
4.6(CI 2.3–9.3)
- 30-day incidence of primary composite outcome
- 33%
- 30-day primary outcome incidence, risk score = 0
- 4%
- 30-day primary outcome incidence, risk score ≥ 4
- 81%
Observational data: associations, not effects.
Further findings
30-day cardiomyotoxic death and overall death
- Cardiomyotoxic death
- 13%
- Overall death
- 17%
External validation and prospective use of risk score
- Low-risk patients managed with no immunosuppression: no cardiomyotoxic events
- 0
- Externally validated in two independent French and US cohorts
Original publication
Immune checkpoint inhibitor-associated myocarditis: a novel risk score. Eur Heart J. Published 18 June 2025. doi:10.1093/eurheartj/ehaf315
Summarised from the published abstract; every number is checked against it