Cardiac Troponin Screening and Clinical Outcomes in Patients Receiving Immunotherapy (JACC: CardioOncology State-of-the-Art Review October 2025)-Article: Cardiac Troponin Screening and Clinical Outcomes in Patients Receiving Immunotherapy

Article: Cardiac Troponin Screening and Clinical Outcomes in Patients Receiving Immunotherapy

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This single-center retrospective cohort study evaluated the impact of routine cardiac troponin I (cTnI) monitoring integrated with symptom-based triaging in 428 adult cancer patients receiving immune checkpoint inhibitor (ICI) therapy from 2019 to 2021. ICIs, while effective oncologic treatments, carry risks of cardiotoxicities including myocarditis—a potentially fatal immune-related adverse event. The study aimed to assess how systematic cTnI surveillance influences early detection, management, and cardiovascular outcomes.<br /><br />Patients underwent serial cTnI testing prior to each ICI dose. Elevated cTnI was defined as >55 ng/L (99th percentile upper limit). When elevations were detected, patients were triaged by a dedicated cardio-oncology team based on presence or absence of cardiac symptoms. Symptomatic patients (40.5% of those with elevated cTnI) received urgent inpatient evaluation including cardiac MRI and immunosuppression if myocarditis was diagnosed. Asymptomatic patients primarily had outpatient assessments and more frequently continued ICI therapy.<br /><br />Key findings included: 9.8% (42/428) had cTnI elevations during treatment, with myocarditis diagnosed in 14.3% (6/42) of these cases. Median time to cTnI elevation was 56 days post-ICI initiation. Symptomatic patients had significantly higher initial and peak cTnI levels, received more intensive cardiac diagnostics, higher immunosuppression rates (47.1% vs 8.0%), and discontinued ICI therapy more often compared to asymptomatic patients. The cumulative incidence of major adverse cardiac events (MACE) at 1.5 years after elevation was 19%, substantially higher in symptomatic individuals (subdistribution HR 18.9). Importantly, no myocarditis-related deaths occurred over 2 years.<br /><br />The study demonstrates that cTnI surveillance combined with symptom-based triage is feasible and facilitates early detection and management of ICI cardiotoxicity in outpatient settings, enabling safe continuation of cancer therapy in many patients. Symptom presence alongside elevated cTnI strongly predicts cardiac events and guides intensity of evaluation and treatment. Limitations include single-center design, lack of a control group without monitoring, and dependence on specialized cardio-oncology resources.<br /><br />In conclusion, integrating routine cTnI monitoring with clinical symptom assessment offers a practical approach to identifying and managing cardiac complications of ICI therapy. Further prospective randomized studies are needed to confirm long-term benefits, cost-effectiveness, and generalizability of this biomarker-based screening strategy in diverse oncology settings.

Keywords

cardiac troponin I

immune checkpoint inhibitors

cardiotoxicity

myocarditis

cancer patients

symptom-based triage

cardio-oncology

immune-related adverse events

major adverse cardiac events

biomarker surveillance