A unique reason for coronary spasm causing temporary ST elevation myocardial infarction (inferior STEMI) – systemic inflammatory response syndrome after use of pembrolizumab

Nykl, Radomir; Fischer, Ö.; Vykoupil, Karel; Táborský, Miloš

doi:10.5114/amsad.2017.72531

Cited by 40 publications

(23 citation statements)

References 4 publications

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“…These include Takotsubo-like syndrome with both apical 6,25,26 and basal variants 27 ; asymptomatic non-inflammatory left-ventricular dysfunction 28 ; myocardial infarction 29 ; and coronary vasospasm. 30 Arrhythmias have also emerged as a sign of cardiotoxicity in patients receiving ICI. 24 However, arrhythmias are common in the cancer population and were shown to co-occur with other immunerelated adverse events, suggesting that they may not necessarily be a direct effect of ICI itself.…”

Section: Overview Of Immune-related Adverse Events From Icismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

360

300

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Cardiovascular toxicities associated with immune checkpoint inhibitors (ICIs) have been reported in case series but have been underappreciated due to their recent emergence, difficulties in diagnosis and non-specific clinical manifestations. ICIs are antibodies that block negative regulators of the T cell immune response, including cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and PD-1 ligand (PD-L1). While ICIs have introduced a significant mortality benefit in several cancer types, the augmented immune response has led to a range of immune-related toxicities, including cardiovascular toxicity. ICI-associated myocarditis often presents with arrhythmias, may co-exist with myositis and myasthenia gravis, can be severe, and portends a poor prognosis. In addition, pericardial disease, vasculitis, including temporal arteritis, and non-inflammatory heart failure, have been recently described as immune-related toxicities from ICI. This narrative review describes the epidemiology, diagnosis, pathophysiology, and treatment of cardiovascular toxicities of ICI therapy, highlighting recent developments in the field in the past year. Keywords Cardio-oncology • Immune checkpoint inhibitors • Myocarditis • Vasculitis • Pericarditis • Cardiovascular toxicity This article is part of the Spotlight Issue on Cardio-oncology.

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Section: Overview Of Immune-related Adverse Events From Icismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

360

300

View full text Add to dashboard Cite

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“…Lyon et al [ 52 ] suggested that the development of ICI-induced myocardial infarction could be due to the activation of an inflammatory reaction that triggers atherosclerotic coronary plaque formation and acute infarction. Conversely, Nykl et al [ 53 ] argued that the PD-1 inhibitory effect of ICIs leads to coronary vasospasm and ST-segment elevation. The mechanism by which coronary vasospasm develops is unclear but could be associated with systemic inflammatory response syndrome[ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac adverse events of immune checkpoint inhibitors in oncology patients: A systematic review and meta-analysis

Nso

Antwi‐Amoabeng

Beutler

et al. 2020

WJC

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BACKGROUND Immune checkpoint inhibitors (ICIs) are novel therapeutic agents used for various types of cancer. ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients. However, immune-related adverse effects of ICI therapy are common. Cardiovascular immune-related adverse events (irAEs) are rare but potentially life-threatening complications. AIM To estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies. METHODS We conducted this systematic review and meta-analysis by searching PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs. We performed a single-arm meta-analysis using OpenMeta [Analyst] software of the following outcomes: Myocarditis, pericardial effusion, heart failure, cardiomyopathy, atrial fibrillation, myocardial infarction, and cardiac arrest. We assessed the heterogeneity using the I 2 test and managed to solve it with Cochrane’s leave-one-out method. The risk of bias was performed with the Cochrane’s risk of bias tool. RESULTS A total of 26 studies were included. The incidence of irAEs follows: Myocarditis: 0.5% [95% confidence interval (CI): 0.1%-0.9%]; Pericardial effusion: 0.5% (95%CI: 0.1%-1.0%); Heart failure: 0.3% (95%CI: 0.0%-0.5%); Cardiomyopathy: 0.3% (95%CI: -0.1%-0.6%); atrial fibrillation: 4.6% (95%CI: 1.0%-14.1%); Myocardial infarction: 0.4% (95%CI: 0.0%-0.7%); and Cardiac arrest: 0.4% (95%CI: 0.1%-0.8%). CONCLUSION The most common cardiovascular irAEs were atrial fibrillation, myocarditis, and pericardial effusion. Although rare, data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICI-associated cardiovascular complications.

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“…MI usually presents with chest pain, abnormal ST electrocardiogram ischemic changes (elevation or depression), T-wave inversion, a rise of cardiac troponin, and structural wall abnormalities in new echocardiogram or cardiac MRI. Furthermore, coronary vasospasm with ST-elevation has been reported and could exist secondary to PDL-1 inhibitor treatment [80] . Although elevated troponin makes the difference in acute coronary syndrome, whether troponin elevation is associated with increased rupture of atherosclerotic plaque, coronary vacuities caused by PD-1/PDL-1 antibodies, or focal myocarditis that is misdiagnosed as MI remains unknown.…”

Section: Managementmentioning

confidence: 99%