Background: Diagnosis of immune checkpoint inhibitor-related myocarditis (ICI-M) represents a substantial challenge in clinical practice. A range of imaging and laboratory parameters are frequently utilized for diagnosis, but the reliability of these modalities remains controversial. The present meta-analysis evaluates diagnostic and prognostic parameters in ICI-M.
Methods and results: After screening PubMed, Cochrane, and Wiley Library, data from 29 trials with 3568 patients were included. In ICI-M, abnormal cardiac magnetic resonance imaging (CMR) was present in 63.4%, including late gadolinium enhancement (LGE) in 65.3% (odds ratio (OR) 5.32, 95% confidence interval (CI) 1.61-17.50; n = 424; p = 0.006) and myo- or pericardial oedema in 16.4% (OR 4.79, 95% CI 0.96-23.92; n = 145; p = 0.06). The most common LGE pattern was mid-myocardial (43%) distribution. Decreased left ventricular ejection fraction (LVEF) was present in 35.9% (OR 5.22, 95% CI 2.02-8.42; n = 1319; p = 0.001) of transthoracic echocardiography (TTE). Cardiac troponins (cTn) (standardized mean difference (SMD) 0.79, 95% CI 0.14-1.44; n = 323; p = 0.02) and brain natriuretic peptides (SMD 0.92, 95% CI 0.30-1.54; n = 201; p = 0.003) were increased in ICI-M. Reduced LVEF (OR 5.11, 95% CI 2.53-7.68; n = 222; p < 0.001) and cTnI elevation (SMD 2.27, 95% CI 0.33-4.22; n = 76; p = 0.02) predicted major adverse cardiovascular events. The study was registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD420251087222).
Conclusion: Distinct CMR-, TTE-, and laboratory parameters were associated with ICI-M, but did not serve as standalone diagnostic criterium. Aggregate data emphasize the heterogeneity of ICI-M, underscoring the necessity for a multimodal diagnostic approach.
Keywords: Cardio-oncology; Cardiotoxicity; Immune checkpoint inhibitor; Immune-related adverse event; Meta-analysis; Myocarditis.
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