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Power, John R; Alexandre, Joachim; Choudhary, Arrush; ozbay, benay; Palaskas, Nicolas L; Lehmann, Lorenz H; Finke, Daniel; Cautela, Jennifer; Thuny, Franck; Tamura, Yuichi; Hayek, Salim S; Azam, Tariq U; Asnani, Aarti; Mehegan, Tyler; Aras, Mandar A; Baik, Alan H; Gilstrap, Lauren; Laufer-Perl, Michal; Arangalage, Dimitri; Ewer, Steven; Martini, Matthew; Nowatzke, Joseph; Orimoloye, Olusola A; Brinkley, Douglas M; [...]

Abstract 14843: Electrocardiographic Manifestations of Immune Checkpoint Inhibitor Associated Myocarditis

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  • Medientyp: E-Artikel
  • Titel: Abstract 14843: Electrocardiographic Manifestations of Immune Checkpoint Inhibitor Associated Myocarditis
  • Beteiligte: Power, John R; Alexandre, Joachim; Choudhary, Arrush; ozbay, benay; Palaskas, Nicolas L; Lehmann, Lorenz H; Finke, Daniel; Cautela, Jennifer; Thuny, Franck; Tamura, Yuichi; Hayek, Salim S; Azam, Tariq U; Asnani, Aarti; Mehegan, Tyler; Aras, Mandar A; Baik, Alan H; Gilstrap, Lauren; Laufer-Perl, Michal; Arangalage, Dimitri; Ewer, Steven; Martini, Matthew; Nowatzke, Joseph; Orimoloye, Olusola A; Brinkley, Douglas M; [...]
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2020
  • Erschienen in: Circulation
  • Sprache: Englisch
  • DOI: 10.1161/circ.142.suppl_3.14843
  • ISSN: 0009-7322; 1524-4539
  • Schlagwörter: Physiology (medical) ; Cardiology and Cardiovascular Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:p> <jats:bold>Introduction:</jats:bold> Immune checkpoint inhibitor (ICI)-myocarditis is a new syndrome with estimated 50% mortality. Similar to acute cellular rejection (ACR), it is pathologically characterized by lymphocytic infiltration. We aimed to characterize the electrocardiograph features of ICI-myocarditis, compare them to ACR, and evaluate their association with adverse outcome. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> Presenting ECG of 130 cases of ICI-myocarditis were collected from a multicenter network spanning 12 countries and compared to 50 cases of ACR. ECG were quantified and interpreted by two blinded cardiologists. 53 patients with ICI-myocarditis had baseline ECG available for comparison via paired univariate analysis. Cox models correcting for age and sex determined association with a composite outcome of life-threatening arrhythmia or myocarditis-related death. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> ICI-myocarditis patients had average age of 68(58-76), were 61.2% male, and 64.8% had prior cardiovascular disease. QRS prolongation (26% vs 13%, p=0.008), conduction disorders (67% vs 44%, p=0.007) such as left bundle branch block (LBBB) (18% vs 4% p=0.008), ST/T wave changes (50% vs 24%, p=0.004), and PVCs (16% vs 6%, p=0.020) were more prevalent on presenting ECG compared to baseline. ICI-myocarditis showed more PVCs (16% vs 2%, p=0.011) and less ST/T wave changes (41% vs 66%, p=0.002) when compared to ACR. On multivariate analysis, the combined outcome of life-threatening arrhythmia or myocarditis-related death was associated with pathological Q waves (HR=3.60 (1.78-7.27) p&lt;0.001), QRS prolongation (HR=3.35 [1.00-11.21] p=0.05), LBBB (HR=2.24 [1.13-4.45] p=0.021), and supraventricular arrhythmia (HR=2.03 [1.05-3.91] p=0.035) on presenting EKG. </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> ICI-myocarditis manifests as new conduction delays, ST/T-wave changes, and PVCs. QRS prolongation, LBBB, pathological Q waves, and supraventricular arrhythmias were associated with subsequent adverse outcomes. </jats:p> <jats:p> <jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" orientation="portrait" position="float" xlink:href="g14843.jpg" /> </jats:p>
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