PMID- 36301334 OWN - NLM STAT- MEDLINE DCOM- 20230313 LR - 20230313 IS - 1861-0692 (Electronic) IS - 1861-0684 (Linking) VI - 112 IP - 3 DP - 2023 Mar TI - The predictive value of high sensitivity troponin measurements in patients treated with immune checkpoint inhibitors. PG - 409-418 LID - 10.1007/s00392-022-02118-8 [doi] AB - BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer; however, at the potential cost of serious adverse events including cardiac injury. OBJECTIVE: To assess the baseline and longitudinal changes in high sensitivity-Troponin (hs-Tn) in patients treated with pembrolizumab as a potential predictor for the development of major adverse cardiac events (MACE) and survival. METHODS: We performed a retrospective analysis of cancer patients treated with pembrolizumab at our center. All participants had baseline measurements of hs-TnI prior to initiation of pembrolizumab (T1), with half of the patients performing follow-up measurements at their second encounter for therapy introduction (T2). We first evaluated the prevalence of abnormally elevated serum hs-TnI (> 50 nanogram per liter) at T1 and T2. We then evaluated the predictive value of abnormal levels at T1 or T2 in relation to the development of MACE (composite outcomes of myocarditis, acute coronary syndrome, heart failure, venous thromboembolism, cardiovascular hospitalization and cardiovascular mortality) and all-cause mortality. RESULTS: Among 135 patients, the mean age was 72 years, predominantly male (61%). Abnormally elevated hs-TnI at T1 was observed in 7 (5%) patients and emerged as a significant independent predictor for MACE (HR 8.1, 95% CI 1.67-37.4, p = 0.009) and all-cause mortality (HR 5.37, 95% CI 2.1-13.57, p < 0.001). Abnormally elevated hs-TnI at T2 was observed in 8 (11%) patients and emerged as a significant independent predictor for MACE (HR 10.49, 95% CI 1.68-65.5, p = 0.009), but not for mortality (p = 0.200). CONCLUSIONS: Abnormally elevated baseline and follow-up hs-TnI served as significant independent predictors for MACE, with an increased risk of development being 8-tenfold. Furthermore, elevated baseline hs-TnI showed a predictive value for all-cause mortality. Central illustration: Novel immune checkpoint inhibitor (ICIs) therapy has been found to revolutionize cancer therapy through increased activation of host immune systems to target and reduce tumor burden, but may come at the cost of serious adverse cardiac events. Identification of early biomarkers for the prediction and detection of these events is necessary. CI - (c) 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. FAU - Waissengein, Barliz AU - Waissengein B AD - Division of Oncology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Abu Ata, Bian AU - Abu Ata B AD - Division of Oncology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Merimsky, Ofer AU - Merimsky O AD - Division of Oncology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Shamai, Sivan AU - Shamai S AD - Division of Oncology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Wolf, Ido AU - Wolf I AD - Division of Oncology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Arnold, Joshua H AU - Arnold JH AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA. FAU - Bar-On, Tali AU - Bar-On T AD - Department of Internal Medicine T, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Banai, Shmuel AU - Banai S AD - Division of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Khoury, Shafik AU - Khoury S AD - Division of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Laufer-Perl, Michal AU - Laufer-Perl M AUID- ORCID: 0000-0001-9105-2559 AD - Division of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Tel Aviv, Israel. michallp@tlvmc.gov.il. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. michallp@tlvmc.gov.il. LA - eng PT - Journal Article DEP - 20221027 PL - Germany TA - Clin Res Cardiol JT - Clinical research in cardiology : official journal of the German Cardiac Society JID - 101264123 RN - 0 (Immune Checkpoint Inhibitors) RN - 0 (Biomarkers) RN - 0 (Troponin) RN - 0 (Troponin T) SB - IM MH - Humans MH - Male MH - Aged MH - Female MH - *Immune Checkpoint Inhibitors/adverse effects MH - Retrospective Studies MH - Biomarkers MH - *Heart Failure MH - Troponin MH - Prognosis MH - Troponin T OTO - NOTNLM OT - Cardio-oncology OT - Cardio-toxicity OT - High sensitivity OT - Immune checkpoint inhibitor OT - Troponin EDAT- 2022/10/28 06:00 MHDA- 2023/03/14 06:00 CRDT- 2022/10/27 11:24 PHST- 2022/08/10 00:00 [received] PHST- 2022/10/13 00:00 [accepted] PHST- 2022/10/28 06:00 [pubmed] PHST- 2023/03/14 06:00 [medline] PHST- 2022/10/27 11:24 [entrez] AID - 10.1007/s00392-022-02118-8 [pii] AID - 10.1007/s00392-022-02118-8 [doi] PST - ppublish SO - Clin Res Cardiol. 2023 Mar;112(3):409-418. doi: 10.1007/s00392-022-02118-8. Epub 2022 Oct 27.