Immune Checkpoint Inhibitor Myocarditis and Left Ventricular Systolic Dysfunction (JACC: CardioOncology State-of-the-Art Review April 2025)-Article: Immune Checkpoint Inhibitor Myocarditis and Left Ventricular Systolic Dysfunction

Article: Immune Checkpoint Inhibitor Myocarditis and Left Ventricular Systolic Dysfunction

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The research focuses on the complications of immune checkpoint inhibitors (ICIs), specifically ICI-induced myocarditis (ICI-M) and left ventricular systolic dysfunction. ICIs are a transformative cancer treatment that harnesses the immune system to target cancer cells but can lead to autoimmune complications like myocarditis, which has an incidence of 0.5% to 1.0%. This study evaluates factors predicting reduced left ventricular ejection fraction (LVEF) during ICI-M and its impact on 30-day mortality.<br /><br />The International ICI-Myocarditis Registry, involving 707 patients with ICI-M, showed that 35% had an LVEF under 50% at admission. Important factors linked to reduced LVEF included pre-existing heart failure, dyspnea, use of certain oncogene inhibitors, and longer time from ICI initiation to myocarditis symptoms. Despite the differences in LVEF, mortality was only marginally higher in patients with reduced LVEF.<br /><br />Predictors of reduced LVEF included a history of cardiac issues and exposure to therapies like BRAF/MEK inhibitors. Conversely, patients with myositis symptoms often had preserved LVEF, pointing to potentially distinct phenotypes of ICI-M. Echocardiography and cardiac magnetic resonance imaging (CMR) used for diagnosing ICI-M are not always accurate, suggesting muscle biopsy may offer better insights.<br /><br />The research suggests the necessity for early and accurate diagnosis of ICI-M, taking into account previous cardiovascular health and treatments. Given the potential for muscle involvement in ICI-M, therapies targeting muscle inflammation might be advantageous. The study advocates for more research, particularly prospective studies, to refine diagnostic criteria and treatment modalities for ICI-M. Overall, monitoring and management of cardiovascular health should be a critical part of treatment plans for patients receiving ICIs.

Keywords

immune checkpoint inhibitors

ICI-induced myocarditis

left ventricular systolic dysfunction

reduced LVEF

International ICI-Myocarditis Registry

cardiac magnetic resonance imaging

muscle biopsy

BRAF/MEK inhibitors

myositis symptoms

cardiovascular health