Incidence of adverse cardiovascular events associated with immune checkpoint inhibitors and risk factors for left ventricular dysfunction: A single-center prospective clinical study

作者全名："Zhang, Chuan; Chen, Zhulu; Qin, Shu; Zhu, Yuxi; Shu, Linjie; Zuo, Zhong"

作者地址："[Zhang, Chuan; Chen, Zhulu; Qin, Shu; Zuo, Zhong] Chongqing Med Univ, Affiliated Hosp 1, Dept Cardiol, Chongqing, Peoples R China; [Zhu, Yuxi; Shu, Linjie] Chongqing Med Univ, Affiliated Hosp 1, Dept Oncol, Chongqing, Peoples R China"

通信作者："Zuo, Z (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Cardiol, Chongqing, Peoples R China."

来源：FRONTIERS IN CARDIOVASCULAR MEDICINE

ESI学科分类：　

WOS号：WOS:000926133800001

JCR分区：Q2

影响因子：3.6

年份：2023

卷号：10

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：immune checkpoint inhibitor; cardiotoxicity; left ventricular dysfunction; myocarditis; myocardial fibrosis

摘要："BackgroundThe incidence of immune checkpoint inhibitors (ICI)-related adverse cardiovascular events (ACEs) may be underestimated, and there are few reports on the incidence and risk factors of ICI-induced left ventricular dysfunction (LVD). ObjectivesThis study aimed to investigate the incidence of ACEs caused by ICI, in particular to analyze the incidence and risk factors of LV systolic and diastolic dysfunction. Materials and methodsA prospective clinical study was performed on patients who received ICI in our hospital from November 2020 to October 2021. They received regular cardiovascular examinations, including echocardiography, ECG, cTnT, and NT-proBNP, etc. The incidence of various ACEs was counted, and the risk factors of LVD were analyzed. ResultsA total of 106 cancer patients treated with ICI were recruited. During the follow-up, 41 patients (38.68%) developed various ECG abnormalities, 39 patients (36.79%) developed LVDD, 9 patients (8.49%) developed CTRCD, and 2 patients (1.89%) developed new pericardial effusion. The patients with elevated cTnT, CK-MB, and NT-proBNP were 10 (9.43%), 8 (7.55%), and 8 (7.5%), respectively. Thirteen of the 52 patients with LVD had hypertension, while 4 of the 54 patients without LVD had hypertension (OR = 4.17, 95% CI: 1.26-13.78; P = 0.019). The baseline LVEF and LVFS of patients with LVD were 61.54 +/- 4.15% and 33.78 +/- 2.73%, while those of the control group were 64.16 +/- 3.68% and 34.95 +/- 2.84, respectively (P = 0.003 and P = 0.048). Compared with patients without LVD, patients with LVD had lower e' (6.99 +/- 1.33 cm/s vs. 7.64 +/- 1.39 cm/s, P = 0.029) and higher E to e' ratio (11.89 +/- 3.15 cm/s vs. 10.43 +/- 2.52, P = 0.024). Multiple regression analysis showed that a history of hypertension (HR = 26.52, 95% CI: 2.479-283.667, P = 0.007) and lower baseline e' (HR = 0.04, 95% CI: 0.003-0.709, P = 0.028) were risk factors for developing LVD. ConclusionPatients treated with ICI may develop multiple ACEs, including acute myocarditis, pericarditis, ECG abnormalities, and elevated cardiac biomarkers. ICI may lead to a high incidence of LVD, and echocardiography is helpful for early detection of LVD. Patients with hypertension or poor LV systolic or diastolic function at baseline were predictors of LVD after ICI treatment."

基金机构：Chongqing Medical Scientific Research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) [2023ZDXM011]

基金资助正文：This work was supported by Chongqing Medical Scientific Research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) (grant no. 2023ZDXM011).