Association of early electrical changes with cardiovascular outcomes in immune checkpoint inhibitor myocarditis
Open accessAbstract
Background Immune-checkpoint inhibitor-associated myocarditis (ICI-myocarditis) often presents with arrhythmias, but the prognostic value of early electrocardiogram findings is unclear. Although ICI-myocarditis and acute cellular rejection (ACR) following cardiac transplantation use similar treatment strategies, differences in arrhythmia burden are unknown. Objective To evaluate the association of electrocardiogram findings in ICI-myocarditis with myocarditis-related mortality and life-threatening arrhythmia. Methods A total of 125 cases of ICI-myocarditis were identified retrospectively across 49 hospitals worldwide; 50 cases of grade 2R or 3R ACR were included as comparators. Two cardiologists blinded to clinical data interpreted electrocardiograms. Associations between electrocardiogram features, myocarditis-related mortality and the composite of myocarditis-related mortality and life-threatening arrhythmias were examined. Adjusted hazard ratios (aHRs) were calculated. Results The cohort had 78 (62.4%) men; median (interquartile range) age was 67 (58-76) years. At 30 days, myocarditis-related mortality was 20/124 (16.1%), and 28/124 (22.6%) met the composite endpoint. Patients who developed complete heart block (aHR by subdistribution hazards model [aHR(sh)] 3.29, 95% confidence interval [CI] 1.24-8.68; P=0.02) or life-threatening cardiac arrhythmias (aHR(sh) 6.82, 95% CI: 2.87-16.21; P Conclusions Electrocardiograms in ICI-myocarditis with ventricular tachycardias, heart…
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Pathological Q waves, low QRS voltage, and a low Sokolow-Lyon index on ECG carry a poor prognosis for patients with myocarditis.
“Pathological Q waves, low QRS voltage, and a low Sokolow-Lyon index on ECG carry a poor prognosis for patients.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [234]
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- Authors
- Power, J. R., Alexandre, J., Choudhary, A., Ozbay, B., Hayek, S. S., Asnani, A., Tamura, Y., Aras, M., Cautela, J., Thuny, F., Gilstrap, L., Arangalage, D., Ewer, S., Huang, S., Deswal, A., Palaskas, N. L., Finke, D., Lehmann, L. H., Ederhy, S., Moslehi, J., Salem, J.-E., Fenioux, C., Abbar, B., Allenbach, Y., Crusz, S. M., Ghosh, A. K., Moran, T., Mehegan, T., Piro, L., Chang, W.-T., Chahine, J., Flint, D., Stringer, B., Gounant, V., Nicol, M., Baroudjian, B., Zimmer, M.-C., Mervoyer, E., Leong, D., Morimoto, R., Piriou, N., Monge, C., Copeland, A., Ghafourian, K., Guha, A., Brodsky, S., Ben Zadok, O. I., Habib, M., Dy, G., Warner, E., Laufer-Perl, M., Koo Lin, L., Narezkina, A., Baik, A., Lenneman, C., Vachhani, P., Azam, T. U., Perry, D., Blakely, P., Tajiri, K., Martini, M., Nowatzke, J., Orimoloye, O. A., Hughes, A., Baldassarre, L. A., & Patel, M.
- Affiliations
- UC San Diego Health System (US)
- Université de Caen Normandie (FR)
- Beth Israel Deaconess Medical Center (US)
- University of Michigan (US)
- Mita Hospital (JP)
- University of California San Francisco Medical Center (US)
- Aix-Marseille Université (FR)
- Dartmouth–Hitchcock Medical Center (US)
- Hôpital Bichat-Claude-Bernard (FR)
- University of Wisconsin System (US)
- Vanderbilt University Medical Center (US)
- The University of Texas MD Anderson Cancer Center (US)
- German Cancer Research Center (DE)
- Sorbonne Université (FR)
- ORCID
- Power, John R.
- Alexandre, Joachim
- Ozbay, Benay
- Hayek, Salim S.
- Asnani, Aarti
- Tamura, Yuichi
- Aras, Mandar
- Cautela, Jennifer
- Thuny, Franck
- Gilstrap, Lauren
- Arangalage, Dimitri
- Ewer, Steven
- Huang, Shi
- Deswal, Anita
- Palaskas, Nicolas L.
- Finke, Daniel
- Lehmann, Lorenz H.
- Moslehi, Javid
- Salem, Joe-Elie
- Fenioux, Charlotte
- Abbar, Baptiste
- Allenbach, Yves
- Crusz, Shanthini M.
- Ghosh, Arjun K.
- Moran, Tyler
- Piro, Lawrence
- Chang, Wei-Ting
- Chahine, Johnny
- Nicol, Martin
- Baroudjian, Barouyr
- Leong, Darryl
- Morimoto, Ryota
- Piriou, Nicolas
- Monge, Cecilia
- Ghafourian, Kambiz
- Guha, Avirup
- Brodsky, Sergey
- Dy, Grace
- Baik, Alan
- Lenneman, Carrie
- Vachhani, Pankit
- Azam, Tariq U.
- Perry, Daniel
- Blakely, Pennelope
- Tajiri, Kazuko
- Orimoloye, Olusola Ayodeji
- Baldassarre, Lauren A.
- Venue
- Archives of Cardiovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 115
- Issue
- 5
- Pages
- 315-330
- ISSN
- 1875-2128 (ISSN-L)
- 1875-2136
- OpenAlex
- W4225003834
- Cited by
- 43
- References
- 35
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 8 · 2023: 14 · 2022: 1
- FWCI
- 6.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (vor, 365 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Archives of cardiovascular diseases (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by-nc)
- HAL (submittedVersion)
- Funders
- Cancer Prevention and Research Institute of Texas (CPRIT RP200670)
- National Center for Advancing Translational Sciences
- Andrew Sabin Family Foundation
- National Institutes of Health (R01HL141466, R01HL155990, R01HL156021)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Keywords
- immune checkpoint inhibitor-associated myocarditis, electrocardiographic findings, complete heart block, pathological Q waves, low QRS voltage, Sokolow-Lyon index, malignant arrhythmias, acute cellular rejection, heart transplantation, prognostic factors, arrhythmia burden
- MeSH terms
- Immune Checkpoint Inhibitors, Aged, Arrhythmias, Cardiac, Female, Heart Block, Humans, Male, Myocarditis, Retrospective Studies
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