Immune Checkpoint Inhibitor-Induced Myocarditis Vs. COVID-19 Vaccine-Induced Myocarditis-Same or Different?

Overview

Journal Life (Basel)

Specialty Biology

Date 2022 Sep 23

PMID 36143403

Authors

Lior Zornitzki

Ofer Havakuk

Zach Rozenbaum

Dana Viskin

Yaron Arbel

Nir Flint

Joshua Arnold

Barliz Waissengein

Ido Wolf

Shmuel Banai

Yan Topilsky

Michal Laufer-Perl

Affiliations

Soon will be listed here.

Abstract

Immune checkpoint inhibitor (ICI) and coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis possibly share common mechanisms secondary to overactivation of the immune system. We aimed to compare the presenting characteristics of ICIs and COVID-19 vaccine-induced myocarditis. We performed a retrospective analysis of characteristics of patients diagnosed with either ICIs or COVID-19 vaccine-induced myocarditis and compared the results to a control group of patients diagnosed with acute viral myocarditis. Eighteen patients diagnosed with ICIs (ICI group) or COVID-19 vaccine (COVID-19 vaccine group)-induced myocarditis, and 20 patients with acute viral myocarditis (Viral group) were included. The ICI group presented mainly with dyspnea vs. chest pain and fever among the COVID-19 vaccine and Viral groups. Peak median high sensitivity Troponin I was markedly lower in the ICI group (median 619 vs. 15,527 and 7388 ng/L, = 0.004). While the median left ventricular (LV) ejection fraction was 60% among all groups, the ICI group had a lower absolute mean LV global longitudinal strain (13%) and left atrial conduit strain (17%), compared to the COVID-19 vaccine (17% and 30%) and Viral groups (18% and 37%), = 0.016 and = 0.001, respectively. Despite a probable similar mechanism, ICI-induced myocarditis's presenting characteristics differed from COVID-19 vaccine-induced myocarditis.

Citing Articles

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Sintilimab-Induced Myocarditis in a Patient with Gastric Cancer: A Case Report and Literature Review.

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References

Woo W, Kim A, Yon D, Lee S, Hwang J, Jacob L . Clinical characteristics and prognostic factors of myocarditis associated with the mRNA COVID-19 vaccine. J Med Virol. 2021; 94(4):1566-1580. PMC: 9015469. DOI: 10.1002/jmv.27501. View

Viskin D, Topilsky Y, Aviram G, Mann T, Sadon S, Hadad Y . Myocarditis Associated With COVID-19 Vaccination: Echocardiography, Cardiac Tomography, and Magnetic Resonance Imaging Findings. Circ Cardiovasc Imaging. 2021; 14(9):e013236. PMC: 8478100. DOI: 10.1161/CIRCIMAGING.121.013236. View

Armenian S, Lacchetti C, Barac A, Carver J, Constine L, Denduluri N . Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016; 35(8):893-911. DOI: 10.1200/JCO.2016.70.5400. View

Caso F, Costa L, Ruscitti P, Navarini L, Del Puente A, Giacomelli R . Could Sars-coronavirus-2 trigger autoimmune and/or autoinflammatory mechanisms in genetically predisposed subjects?. Autoimmun Rev. 2020; 19(5):102524. PMC: 7271072. DOI: 10.1016/j.autrev.2020.102524. View

Pathan F, DElia N, Nolan M, Marwick T, Negishi K . Normal Ranges of Left Atrial Strain by Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr. 2017; 30(1):59-70.e8. DOI: 10.1016/j.echo.2016.09.007. View

Badano L, Kolias T, Muraru D, Abraham T, Aurigemma G, Edvardsen T . Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018; 19(6):591-600. DOI: 10.1093/ehjci/jey042. View

Bozkurt B, Kamat I, Hotez P . Myocarditis With COVID-19 mRNA Vaccines. Circulation. 2021; 144(6):471-484. PMC: 8340726. DOI: 10.1161/CIRCULATIONAHA.121.056135. View

Rudski L, Lai W, Afilalo J, Hua L, Handschumacher M, Chandrasekaran K . Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology,.... J Am Soc Echocardiogr. 2010; 23(7):685-713. DOI: 10.1016/j.echo.2010.05.010. View

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003. View

10.

Witberg G, Barda N, Hoss S, Richter I, Wiessman M, Aviv Y . Myocarditis after Covid-19 Vaccination in a Large Health Care Organization. N Engl J Med. 2021; 385(23):2132-2139. PMC: 8531986. DOI: 10.1056/NEJMoa2110737. View

11.

Mahmood S, Fradley M, Cohen J, Nohria A, Reynolds K, Heinzerling L . Myocarditis in Patients Treated With Immune Checkpoint Inhibitors. J Am Coll Cardiol. 2018; 71(16):1755-1764. PMC: 6196725. DOI: 10.1016/j.jacc.2018.02.037. View

12.

Kim H, Jenista E, Wendell D, Azevedo C, Campbell M, Darty S . Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination. JAMA Cardiol. 2021; 6(10):1196-1201. PMC: 8243258. DOI: 10.1001/jamacardio.2021.2828. View

13.

Delombaerde D, Vervloet D, Franssen C, Croes L, Gremonprez F, Prenen H . Clinical implications of isolated troponinemia following immune checkpoint inhibitor therapy. ESMO Open. 2021; 6(4):100216. PMC: 8287144. DOI: 10.1016/j.esmoop.2021.100216. View

14.

Nagueh S, Smiseth O, Appleton C, Byrd 3rd B, Dokainish H, Edvardsen T . Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314. DOI: 10.1016/j.echo.2016.01.011. View

15.

Palaskas N, Lopez-Mattei J, Durand J, Iliescu C, Deswal A . Immune Checkpoint Inhibitor Myocarditis: Pathophysiological Characteristics, Diagnosis, and Treatment. J Am Heart Assoc. 2020; 9(2):e013757. PMC: 7033840. DOI: 10.1161/JAHA.119.013757. View

16.

Johnson D, Balko J, Compton M, Chalkias S, Gorham J, Xu Y . Fulminant Myocarditis with Combination Immune Checkpoint Blockade. N Engl J Med. 2016; 375(18):1749-1755. PMC: 5247797. DOI: 10.1056/NEJMoa1609214. View

17.

Teo S, Yang H, Chai P, Yeo T . Impact of left ventricular diastolic dysfunction on left atrial volume and function: a volumetric analysis. Eur J Echocardiogr. 2009; 11(1):38-43. DOI: 10.1093/ejechocard/jep153. View

18.

Awadalla M, Mahmood S, Groarke J, Hassan M, Nohria A, Rokicki A . Global Longitudinal Strain and Cardiac Events in Patients With Immune Checkpoint Inhibitor-Related Myocarditis. J Am Coll Cardiol. 2020; 75(5):467-478. PMC: 7067226. DOI: 10.1016/j.jacc.2019.11.049. View

19.

Laufer-Perl M, Arias O, Sirota Dorfman S, Baruch G, Rothschild E, Beer G . Left Atrial Strain changes in patients with breast cancer during anthracycline therapy. Int J Cardiol. 2021; 330:238-244. DOI: 10.1016/j.ijcard.2021.02.013. View

20.

Bonaca M, Olenchock B, Salem J, Wiviott S, Ederhy S, Cohen A . Myocarditis in the Setting of Cancer Therapeutics: Proposed Case Definitions for Emerging Clinical Syndromes in Cardio-Oncology. Circulation. 2019; 140(2):80-91. PMC: 6779326. DOI: 10.1161/CIRCULATIONAHA.118.034497. View