Complete heart block is a significant predictor of mortality in immune checkpoint inhibitor myocarditis

Cardio-Oncology

Research

Shimoli Shah¹  Michael P. O’Shea¹  Suganya Arunachalam Karikalan¹  Eiad Habib¹  Ali Yusuf¹  Chadi Ayoub¹  Michael Killian¹  Hicham El Masry¹  Eman Baqal¹  Timothy Barry¹  Srishti Nayak¹  Rajeev Masson¹  Joerg Hermann²  John O’Shea³ 

[1] Department of Cardiovascular Medicine, Mayo Clinic, 5777 E Mayo Boulevard, 85054, Phoenix, AZ, USA;Mayo Clinic Rochester, Rochester, MN, USA;Saint James’s Hospital, Dublin, Ireland;

关键词: Immune checkpoint inhibitors;    Complete heart block;    Myocarditis;    Pharmacoepidemiology;    Arrhythmias;   

DOI  :  10.1186/s40959-023-00185-y

 received in 2023-06-20, accepted in 2023-08-29,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundImmune checkpoint inhibitor (ICI) myocarditis is associated with significant mortality risk. Electrocardiogram (ECG) changes in ICI myocarditis have strong prognostic value. However the impact of complete heart block (CHB) is not well defined. This study sought to evaluate the impact of CHB on mortality in ICI myocarditis, and to identify clinical predictors of mortality and CHB incidence.MethodsWe conducted a retrospective cohort study of patients with ICI myocarditis at three Mayo Clinic sites from 1st January 2010 to 31st September 2022 to evaluate mortality rates at 180 days. Clinical, laboratory, ECG, echocardiographic, and cardiac magnetic resonance imaging (CMR) characteristics were assessed. Cox and logistic regression were performed for associations with mortality and CHB respectively.ResultsOf 34 identified cases of ICI myocarditis, 7 (20.6%) had CHB. CHB was associated with higher mortality (HR 7.41, p = 0.03, attributable fraction 86.5%). Among those with CHB, troponin T (TnT) < 1000 ng/dL, low white blood cell count and high ventricular rate at admission were protective. There was trend towards increased survival among patients who underwent permanent pacemaker insertion (p = 0.051), although most experienced device lead complications. Factors associated with development of CHB included prolonged PR and QRS intervals and low Sokolow Lyon Index. Where these were normal and TnT was < 1000 ng/dL, no deaths occurred. Impaired myocardial longitudinal strain was sensitive for ICI myocarditis but was not prognostically significant.ConclusionThere is a strong temporal association between CHB and early mortality in people with ICI myocarditis. Focusing on arrhythmogenic complications can be helpful in predicting outcomes for this group of critically ill individuals.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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