Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases

Abstract

Myocarditis associated with the use of immune checkpoint inhibitors (ICI) is a rare manifestation of their cardiotoxicity, but is characterized by a high mortality rate. A literature search was conducted using PubMed using keywords, which resulted in the selection of 679 scientific works, from which 160 articles that described 244 clinical cases were selected. The median age of the patients was 67 years (IQR, 60–74). The median time from the start of ICI therapy to the development of the first adverse symptoms was 21 days (IQR, 14–38.3). In 37% of cases, myocarditis developed after the first administration of ICI. Cardiac symptoms were present in 47.1% of cases, neuromuscular symptoms in 30.3%, and other symptoms in 12.6%, while myocarditis was asymptomatic in 10.1% of cases. New changes in the electrocardiograms were detected in 85.1% of patients compared to the initial data. A high incidence of complete atrioventricular block (25.4%), right bundle branch block (18.4%), ventricular tachycardia (13%), and sinus tachycardia (12%) were noted. In 97% of the cases, the patients received prednisolone or methylprednisolone therapy. When using ICI, special attention should be paid to the early detection of possible cardiotoxicity by analyzing the condition and function of the myocardium before treatment and its dynamics.