Author + information
- Melissa Y.Y. Moey, MD, MSca,∗ (, )@Melissa_Moey,
- Anna N. Tomdio, MDb,
- Justin D. McCallen, BScc,
- Lauren M. Vaughan, MDd,
- Kevin O’Brien, PhDe,
- Abdul R. Naqash, MDf,g,
- Cynthia Cherry, RN, ANPf,
- Paul R. Walker, MDf and
- Blase A. Carabello, MDa
- aDepartment of Cardiovascular Sciences, Vidant Medical Center, East Carolina University, Greenville, North Carolina
- bDepartment of Cardiovascular Sciences, Virginia Commonwealth University, Richmond, Virginia
- cBrody School of Medicine, East Carolina University, Greenville, North Carolina
- dDepartment of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina
- eDepartment of Biostatistics, East Carolina University, Greenville, North Carolina
- fDepartment of Hematology and Oncology, Vidant Medical Center, East Carolina University, Greenville, North Carolina
- gU.S. National Institutes of Health, Bethesda, Maryland
- ↵∗Address for correspondence:
Dr. Melissa Y.Y. Moey, East Carolina Heart Institute, 115 Heart Drive, Greenville, North Carolina 27834.
Background Immune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is uncommon but can be fatal. There have been few reports of iRC from a rural cancer population and few data for iRC and inflammatory biomarkers.
Objectives The purpose of this study was to characterize major adverse cardiac events (MACE) in ICI-treated lung cancer patients based in a rural setting and to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in the diagnosis of iRC.
Methods Patients with lung cancer treated with ICIs at Vidant Medical Center/East Carolina University (VMC/ECU) between 2015 and 2018 were retrospectively identified. MACE included myocarditis, non-ST-segment elevated myocardial infarction (NSTEMI), supraventricular tachycardia (SVT), and pericardial disorders. Medical history, laboratory values, pre-ICI electrocardiography (ECG), and echocardiography results were compared in patients with and without MACE.
Results Among 196 ICI-treated patients, 23 patients (11%) developed MACE at a median of 46 days from the first ICI infusion (interquartile range [IQR]: 17 to 83 days). Patients who developed MACE experienced myocarditis (n = 9), NSTEMI (n = 3), SVT (n = 7), and pericardial disorders (n = 4). Ejection fraction was not significantly different at the time of MACE compared to that at baseline (p = 0.495). Compared to baseline values, NLR (10.9 ± 8.3 vs. 20.7 ± 4.2, respectively; p = 0.032) and CRP (42.1 ± 10.1 mg/l vs. 109.9 ± 15.6 mg/l, respectively; p = 0.010) were significantly elevated at the time of MACE.
Conclusions NLR and CRP were significantly elevated at the time of MACE compared to baseline values in ICI-treated patients. Larger datasets are needed to validate these findings and identify predictors of MACE that can be used in the diagnosis and management of ICI-related iRC.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: CardioOncology author instructions page.
- Received January 5, 2020.
- Revision received July 15, 2020.
- Accepted July 15, 2020.
- 2020 The Authors