AUTHOR=Peng Xiongjun , Zheng Yawen , Zhu Zhaowei , Liu Na , Zhou Shenghua , Long Junke 

TITLE=Which cardiac parameters best predict the cardiovascular outcomes among patients with anti-PD-1 immunotherapy-induced myocardial injury?

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.922095

DOI=10.3389/fcvm.2022.922095

ISSN=2297-055X

ABSTRACT=Aims: To explore the association of cardiac parameters with different clinical outcomes in patients with anti-PD-1 immunotherapy induced myocardial injury.
Methods and Results: We enrolled 134 patients diagnosed with anti-PD-1 immunotherapy induced myocardial injury at the Second Xiangya Hospital, 24 patients with cardiovascular symptoms were divided into the MACE group, and 110 patients without cardiovascular symptoms were divided into the Non-MACE group. We compared CK-MB, hsTNT, NT-ProBNP, ECG and echocardiographic parameters between the two groups of patients. CK-MB, hsTNT, NT-proBNP [2600.0 (1317.00-7950.00) vs 472.9 (280.40-788.80), p=<0.001], left Ventricular End Diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF) and QRS interval are statistically different. Receiver operating curve (ROC) was used to compare the accuracy of various indicators to predict the occurrence of MACE events. NT-ProBNP (AUC 97.1) is the best predictor, followed by CK-MB (AUC 94.1) , LVEF(AUC 83.4), LVEDd (AUC 81.5) and other indicators. In the MACE group, 11/24 patients experienced cardiogenic death until the end of follow-up. Compared with the survivors, the CK-MB, hsTNT [300.0 (218.5-729.0) vs 112.0 (84.0-122.0), p=<0.001] ,NT-proBNP, LVEDd, LVEF and QRS interval of the deceased patients were statistically different. ROC curve shows that hsTNT is the most accurate marker for predicting cardiogenic death in MACE group (AUC 91.6).
Conclusions: In patients with myocardial injury after PD-1 inhibitor treatment, NT-proBNP was most strongly associated with the development of cardiovascular symptoms, whereas in symptomatic patients, hsTNT was most strongly associated with the development of death compared with other cardiac parameters.