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Journal Articles Journal for Immunotherapy of Cancer Year : 2021

Electrocardiographic features of immune checkpoint inhibitor associated myocarditis

Daniel Zlotoff
Malek Hassan
  • Function : Author
Amna Zafar
  • Function : Author
Raza Alvi
  • Function : Author
Magid Awadalla
  • Function : Author
Syed Mahmood
  • Function : Author
Lili Zhang
  • Function : Author
Carol Chen
  • Function : Author
Stephane Ederhy
Ana Barac
  • Function : Author
Dahlia Banerji
  • Function : Author
Maeve Jones-O'Connor
  • Function : Author
Sean Murphy
  • Function : Author
Merna Armanious
  • Function : Author
Brian Forrestal
  • Function : Author
Michael Kirchberger
  • Function : Author
Otavio Coelho-Filho
  • Function : Author
Muhammad Rizvi
  • Function : Author
Gagan Sahni
  • Function : Author
Anant Mandawat
  • Function : Author
Carlo Tocchetti
  • Function : Author
Sarah Hartmann
  • Function : Author
Hannah Gilman
  • Function : Author
Eduardo Zatarain-Nicolás
  • Function : Author
Michael Mahmoudi
  • Function : Author
Dipti Gupta
  • Function : Author
Ryan Sullivan
Sarju Ganatra
  • Function : Author
Eric Yang
  • Function : Author
Lucie Heinzerling
  • Function : Author
Leyre Zubiri
  • Function : Author
Kerry Reynolds
  • Function : Author
Justine Cohen
  • Function : Author
Alexander Lyon
  • Function : Author
John Groarke
  • Function : Author
Paaladinesh Thavendiranathan
  • Function : Author
Anju Nohria
  • Function : Author
Michael Fradley
  • Function : Author
Tomas Neilan
  • Function : Author

Abstract

Background Myocarditis is a highly morbid complication of immune checkpoint inhibitor (ICI) use that remains inadequately characterized. The QRS duration and the QTc interval are standardized electrocardiographic measures that are prolonged in other cardiac conditions; however, there are no data on their utility in ICI myocarditis. Methods From an international registry, ECG parameters were compared between 140 myocarditis cases and 179 controls across multiple time points (pre-ICI, on ICI prior to myocarditis, and at the time of myocarditis). The association between ECG values and major adverse cardiac events (MACE) was also tested. Results Both the QRS duration and QTc interval were similar between cases and controls prior to myocarditis. When compared with controls on an ICI (93±19 ms) or to baseline prior to myocarditis (97±19 ms), the QRS duration prolonged with myocarditis (110±22 ms, p<0.001 and p=0.009, respectively). In contrast, the QTc interval at the time of myocarditis (435±39 ms) was not increased compared with pre-myocarditis baseline (422±27 ms, p=0.42). A prolonged QRS duration conferred an increased risk of subsequent MACE (HR 3.28, 95% CI 1.98 to 5.62, p<0.001). After adjustment, each 10 ms increase in the QRS duration conferred a 1.3-fold increase in the odds of MACE (95% CI 1.07 to 1.61, p=0.011). Conversely, there was no association between the QTc interval and MACE among men (HR 1.33, 95% CI 0.70 to 2.53, p=0.38) or women (HR 1.48, 95% CI 0.61 to 3.58, p=0.39). Conclusions The QRS duration is increased in ICI myocarditis and is associated with increased MACE risk. Use of this widely available ECG parameter may aid in ICI myocarditis diagnosis and risk-stratification.
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hal-03654569 , version 1 (16-11-2023)

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Daniel Zlotoff, Malek Hassan, Amna Zafar, Raza Alvi, Magid Awadalla, et al.. Electrocardiographic features of immune checkpoint inhibitor associated myocarditis. Journal for Immunotherapy of Cancer, 2021, 9 (3), pp.e002007. ⟨10.1136/jitc-2020-002007⟩. ⟨hal-03654569⟩
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