Keeping immune checkpoint inhibitor myocarditis in check: advanced circulatory mechanical support as a bridge to recovery

Ashley F Stein-Merlob; Jeffrey J Hsu; Bradley Colton; Christopher J Berg; Allison Ferreira; Megan M Price; Zev Wainberg; Arnold S Baas; Mario C Deng; Rushi V Parikh; Eric H Yang

doi:10.1002/ehf2.13545

Keeping immune checkpoint inhibitor myocarditis in check: advanced circulatory mechanical support as a bridge to recovery

ESC Heart Fail. 2021 Oct;8(5):4301-4306. doi: 10.1002/ehf2.13545. Epub 2021 Aug 13.

Authors

Ashley F Stein-Merlob¹, Jeffrey J Hsu^{1

2}, Bradley Colton³, Christopher J Berg¹, Allison Ferreira⁴, Megan M Price⁵, Zev Wainberg³, Arnold S Baas^{1

2}, Mario C Deng^{1

2}, Rushi V Parikh^{1

2}, Eric H Yang^{1

6}

Affiliations

¹ Division of Cardiology, Department of Medicine, University of California, Los Angeles, MD 650 Charles E. Young Dr. South, A2-27 CHS, Los Angeles, CA, 90095, USA.
² Ahmanson UCLA-Cardiomyopathy Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
³ Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁴ Division of Critical Care, Department of Emergency Medicine, University of California, Los Angeles, CA, USA.
⁵ Division of Hematology/Oncology, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX, USA.
⁶ UCLA-Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.

Abstract

Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare, potentially life-threatening complication of immunotherapy. We report a case of a 60-year-old female with a history of colorectal cancer treated with nivolumab immunotherapy who presented with new cardiomyopathy complicated by cardiogenic shock and ventricular arrhythmias. Treatment of ICI-associated myocarditis requires aggressive immunosuppression and supportive therapy. In this case, the patient required advanced mechanical circulatory support as a bridge to recovery. This case highlights the complexity of diagnosis, haemodynamic management, and treatment of fulminant ICI myocarditis.

Keywords: Acute heart failure; Cardiac assist device; Cardiomyopathy; Cardiooncology; Immune checkpoint inhibitor myocarditis.

Publication types

Case Reports
Research Support, N.I.H., Extramural

MeSH terms

Cardiomyopathies*
Female
Heart-Assist Devices*
Humans
Immune Checkpoint Inhibitors
Middle Aged
Myocarditis* / diagnosis
Myocarditis* / etiology
Myocarditis* / therapy
Shock, Cardiogenic / diagnosis
Shock, Cardiogenic / etiology
Shock, Cardiogenic / therapy

Substances

Immune Checkpoint Inhibitors

Grants and funding

T32 HL007895/HL/NHLBI NIH HHS/United States