Immune Checkpoint Inhibitor Myocarditis With Normal Cardiac Magnetic Resonance Imaging: Importance of Cardiac Biopsy and Early Diagnosis

Stephane Ederhy; Charlotte Fenioux; Clement Cholet; Philippe Rouvier; Alban Redheuil; Ariel Cohen; Joe-Elie Salem

doi:10.1016/j.cjca.2020.12.022

Immune Checkpoint Inhibitor Myocarditis With Normal Cardiac Magnetic Resonance Imaging: Importance of Cardiac Biopsy and Early Diagnosis

Can J Cardiol. 2021 Oct;37(10):1654-1656. doi: 10.1016/j.cjca.2020.12.022. Epub 2020 Dec 26.

Authors

Stephane Ederhy¹, Charlotte Fenioux², Clement Cholet³, Philippe Rouvier⁴, Alban Redheuil⁵, Ariel Cohen⁶, Joe-Elie Salem⁷

Affiliations

¹ Department of Cardiology, Assistance Publique‒Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France and Sorbonne Université, UNICO-GRECO Cardio-oncology Program, Paris, France. Electronic address: [email protected].
² Sorbonne Université, INSERM, CIC-1901 Paris-Est, UNICO-GRECO Cardio-oncology Program, Assistance Publique‒Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France.
³ Department of Radiology, Assistance Publique‒Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France.
⁴ Department of Pathology, Pitié-Salpêtrière Hospital, Paris, France Sorbonne Université, Paris, France.
⁵ Sorbonne Université, Cardiothoracic Imaging Unit Hôpital Pitié-Salpétriêre, LIB INSERM, CNRS, ICAN Imaging, Institute of Cardiometabolism and Nutrition, Paris, France.
⁶ Department of Cardiology, Assistance Publique‒Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France and Sorbonne Université, UNICO-GRECO Cardio-oncology Program, Paris, France.
⁷ Sorbonne Université, INSERM, CIC-1901 Paris-Est, UNICO-GRECO Cardio-oncology Program, Assistance Publique‒Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France; Department of Medecine, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PMID: 33373722
DOI: 10.1016/j.cjca.2020.12.022

Abstract

Immune checkpoint inhibitors (ICIs) have improved the management and the prognosis of patients with cancer but are associated with an increased risk of toxicities that can affect every organ. ICI-associated myocarditis has a low incidence (< 1%) but a high fatality rate (30%-50%). Herein we report a patient treated with ICI admitted for suspicion of myocarditis. Cardiac magnetic resonance imaging (cMRI) was normal. An endomyocardial biopsy (EMB) was in favour of ICI-related myocarditis with cardiac lymphohistiocytic infiltrate. This case highlights the role of a systematic evaluation with electrocardiography and troponin and the potential value of EMB in patients without a suggestive cMRI.

Publication types

Case Reports

MeSH terms

Biomarkers / blood
Biopsy / methods*
Early Diagnosis*
Electrocardiography
Female
Humans
Immune Checkpoint Inhibitors / administration & dosage
Immune Checkpoint Inhibitors / adverse effects*
Infusions, Intravenous
Ipilimumab / administration & dosage
Ipilimumab / adverse effects
Lung Neoplasms / diagnosis
Lung Neoplasms / drug therapy*
Lung Neoplasms / secondary
Magnetic Resonance Imaging, Cine / methods*
Middle Aged
Myocarditis / blood
Myocarditis / chemically induced
Myocarditis / diagnosis*
Myocardium / pathology*
Neoplasm Metastasis
Nivolumab / administration & dosage
Nivolumab / adverse effects
Troponin / blood

Substances

Biomarkers
Immune Checkpoint Inhibitors
Ipilimumab
Troponin
Nivolumab