Value of troponin T versus I in the diagnosis of immune checkpoint inhibitor‐related myocarditis and myositis: rechallenge?

Abstract

A 54-year old patient with metastatic melanoma presented with asymptomatic myositis and myocarditis after combined immune checkpoint inhibitors (ICI) therapy (anti-programmed cell death receptor-1, anti-lymphocyte activating gene-3, and anti-indoleamine 2,3-dioxygenase-1). The diagnosis was based on the typical time window after ICI, recurrence upon rechallenge, elevations of CK, high-sensitive troponin T (hs-TnT) and I (hs-TnI), mild NT-proBNP increase, and positive magnetic resonance imaging criteria. Notably, hsTnI was found to more rapidly increase and fall and to be more heart-specific than TnT in the context of ICI-related myocarditis. This led to ICI therapy withdrawal and switch to a less effective systemic therapy. This case report highlights the differential value of hs-TnT and hs-TnI for diagnosis and monitoring of ICI-related myositis and myocarditis.

Troponin‐guided utilization of methylprednisolone pulse, intravenous immunoglobulin, and mycophenolate mofetil for successful control of immune checkpoint inhibitor–related myocarditis

“…TnI may be preferred over TnT for assessing irMC owing to its shorter plasma half-life. 3 However, in our case, the TnT level reflected the aggression of disease and decreased treatment response. Steroid-refractory cases require the incorporation of IVIG, biologics, and immunosuppressive drugs.…”

Circulating biomarkers in the diagnosis and prognosis of immune checkpoint inhibitor-related myocarditis: time for a risk-based approach

“…In patients with ICI-myocarditis, hs-cTnI has been noted to rise and fall more rapidly than cTnT ( 39 ), leading to recommendations for its preferential use in the initial assessment and diagnosis of ICI-myocarditis ( 10 , 11 ), with cTnT having additional prognostic and potentially diagnostic utility for skeletal muscle myotoxicity.…”

Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis

“…Although infrequent, it can lead to myocarditis in approximately 0.3% to 1.2% of cases, ranging from mild to severe clinical pictures, with the latter being associated with a substantial mortality rate ranging from 25% to 50% [ 17 , 18 ]. In the absence of clear imaging criteria, the finding of troponin-elevation during ICI therapy is challenging, and its practical clinical consequences are often unclear [ 19 ].…”