完全性心脏传导阻滞是免疫检查点抑制剂心肌炎死亡率的重要预测因素。

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Michael P O'Shea, Suganya Arunachalam Karikalan, Ali Yusuf, Timothy Barry, Eiad Habib, John O'Shea, Michael Killian, Eman Baqal, Srishti Nayak, Rajeev Masson, Joerg Hermann, Shimoli Shah, Chadi Ayoub, Hicham El Masry
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引用次数: 0

摘要

背景:免疫检查点抑制剂(ICI)心肌炎与显著的死亡风险相关。心电图改变对ICI心肌炎有很强的预后价值。然而,完全性心脏传导阻滞(CHB)的影响尚不明确。本研究旨在评估慢性乙型肝炎对ICI心肌炎死亡率的影响,并确定死亡率和慢性乙型肝炎发病率的临床预测因素。方法:我们对2010年1月1日至2022年9月31日在梅奥诊所三个地点的ICI心肌炎患者进行了回顾性队列研究,以评估180天的死亡率。评估了临床、实验室、心电图、超声心动图和心脏磁共振成像(CMR)特征。Cox和logistic回归分别用于与死亡率和慢性乙型肝炎的相关性。结果:34例ICI心肌炎中,7例(20.6%)为慢性乙型肝炎。慢性乙型肝炎与较高的死亡率相关(HR 7.41,p = 0.03,可归因分数86.5%)。在CHB患者中,肌钙蛋白T(TnT) 结论:慢性乙型肝炎与ICI心肌炎患者的早期死亡率有很强的时间相关性。关注致心律失常并发症有助于预测这组危重患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Complete heart block is a significant predictor of mortality in immune checkpoint inhibitor myocarditis.

Complete heart block is a significant predictor of mortality in immune checkpoint inhibitor myocarditis.

Complete heart block is a significant predictor of mortality in immune checkpoint inhibitor myocarditis.

Background: Immune checkpoint inhibitor (ICI) myocarditis is associated with significant mortality risk. Electrocardiogram (ECG) changes in ICI myocarditis have strong prognostic value. However the impact of complete heart block (CHB) is not well defined. This study sought to evaluate the impact of CHB on mortality in ICI myocarditis, and to identify clinical predictors of mortality and CHB incidence.

Methods: We conducted a retrospective cohort study of patients with ICI myocarditis at three Mayo Clinic sites from 1st January 2010 to 31st September 2022 to evaluate mortality rates at 180 days. Clinical, laboratory, ECG, echocardiographic, and cardiac magnetic resonance imaging (CMR) characteristics were assessed. Cox and logistic regression were performed for associations with mortality and CHB respectively.

Results: Of 34 identified cases of ICI myocarditis, 7 (20.6%) had CHB. CHB was associated with higher mortality (HR 7.41, p = 0.03, attributable fraction 86.5%). Among those with CHB, troponin T (TnT) < 1000 ng/dL, low white blood cell count and high ventricular rate at admission were protective. There was trend towards increased survival among patients who underwent permanent pacemaker insertion (p = 0.051), although most experienced device lead complications. Factors associated with development of CHB included prolonged PR and QRS intervals and low Sokolow Lyon Index. Where these were normal and TnT was < 1000 ng/dL, no deaths occurred. Impaired myocardial longitudinal strain was sensitive for ICI myocarditis but was not prognostically significant.

Conclusion: There is a strong temporal association between CHB and early mortality in people with ICI myocarditis. Focusing on arrhythmogenic complications can be helpful in predicting outcomes for this group of critically ill individuals.

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来源期刊
Cardio-oncology
Cardio-oncology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
5.00
自引率
3.00%
发文量
17
审稿时长
7 weeks
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