|
Baseline Patient Characteristics
| | | |
|
Age, mean (SD)
|
72.7 (6.5)
|
61.8 (4.6)
|
0.016
|
|
Gender (male)
|
6 (86 %)
|
2 (50 %)
|
0.20
|
|
BMI, mean (SD)
|
23.4 (4.8)
|
27.7 (9.8)
|
0.35
|
|
Hypertension
|
2 (29 %)
|
2 (50 %)
|
0.48
|
|
Diabetes
|
1 (14 %)
|
0 (0 %)
|
0.43
|
|
Tobacco Use
|
0 (0 %)
|
0 (0 %)
| |
|
Coronary Artery Disease
|
1 (17 %)
|
0 (0 %)
|
0.39
|
|
Heart Failure
|
2 (29 %)
|
0 (0 %)
|
0.24
|
|
Cerebral Vascular Accident
|
7 (100 %)
|
4 (100 %)
| |
|
Obstructive Sleep Apnea
|
7 (100 %)
|
4 (100 %)
| |
|
Chronic Kidney Disease
|
2 (29 %)
|
1 (25 %)
|
0.90
|
|
Baseline Cancer Demographics
| | | |
|
Total No. of ICI doses, median (IQR)
|
2.0 (1.0, 14.0)
|
2.5 (1.5, 6.0)
|
0.77
|
|
Time from ICI dose to Onset of Symptoms, Days, (median IQR)
|
53.0 (21.0, 424.0)
|
74.0 (52.0, 171.5)
|
0.71
|
|
Malignancy
| | |
0.23
|
|
Metastatic Melanoma
|
1 (14 %)
|
2 (50 %)
| |
|
Metastatic RCC
|
0 (0 %)
|
1 (25 %)
| |
|
Ovarian Adenocarcinoma
|
0 (0 %)
|
1 (25 %)
| |
|
NSCLC
|
3 (43 %)
|
0 (0 %)
| |
|
Metastatic SCC of tongue
|
1 (14 %)
|
0 (0 %)
| |
|
Laryngeal SCC
|
1 (14 %)
|
0 (0 %)
| |
|
DLBCL
|
1 (14 %)
|
0 (0 %)
| |
|
Immune Checkpoint Inhibitor
| | |
0.31
|
|
Nivolumab
|
2 (29 %)
|
3 (75 %)
| |
|
Pembrolizumab
|
4 (57 %)
|
1 (25 %)
| |
|
Darvalumab
|
1 (14 %)
|
0 (0 %)
| |
|
Combined ICI (anti-CTLA-4 + anti-PD1/PDL1)
|
1(14 %)
|
0 (0 %)
|
0.77
|
|
Prior Chemotherapy or Radiation
| | | |
|
Radiation
|
6 (86 %)
|
1 (25 %)
|
0.044
|
|
Anthracycline
|
0 (0 %)
|
0 (0 %)
| |
|
VEGF inhibitors
|
0 (0 %)
|
0 (0 %)
| |
|
Myocarditis Presentation and Management
| | | |
|
Follow up time, days (mean SD)
|
279.0 (219.8)
|
287.2 (258.2)
|
0.96
|
|
BNP, mean (SD)
|
8562.0 (14856.4)
|
11749.3 (9355.2)
|
0.75
|
|
Admission Troponin, ng/ml (median IQR)
|
0.2 (0.0, 0.6)
|
0.7 (0.4, 4.8)
|
0.089
|
|
Peak Troponin ng/ml (median IQR)
|
0.2 (0.1, 0.6)
|
1.0 (0.5, 4.9)
|
0.13
|
|
Time for Troponin Normalization, days (median IQR)
|
1740 (1245, 2160)
|
4545 (1680, 9315)
|
0.25
|
|
ICI Myocarditis Grade
| | |
0.023
|
|
1
|
0 (0 %)
|
0 (0 %)
| |
|
2
|
4 (57 %)
|
0 (0 %)
| |
|
3
|
2 (29 %)
|
0 (0 %)
| |
|
4
|
1 (14 %)
|
4 (100 %)
| |
|
Clinical Presentation
| | | |
|
MACE
|
1 (14 %)
|
4 (100 %)
|
0.006
|
|
Congestive Heart Failure
|
4 (57 %)
|
4 (100 %)
|
0.12
|
|
Cardiogenic Shock
|
0 (0 %)
|
2 (50 %)
|
0.039
|
|
Complete Heart Block
|
1 (14 %)
|
2 (50 %)
|
0.20
|
|
Ventricular Tachycardia
|
0 (0 %)
|
4 (100 %)
|
< 0.001
|
|
Cardiac Arrest
|
1 (14 %)
|
1 (25 %)
|
0.66
|
|
Echocardiogram
| | | |
|
Pre-ICI EF, mean (SD) (n = 4)
|
57.5 (15.0)
|
63.3 (2.9)
|
0.54
|
|
New EF, mean (SD)
|
42.5 (20.2)
|
38.8 (4.8)
|
0.73
|
|
Mitral Inflow E, cm/s (mean SD) (n = 7)
|
85 (27)
|
75 (31)
|
0.65
|
|
Mitral Inflow A, cm/s (mean SD) (n = 7)
|
89 (13)
|
50 (9)
|
0.007
|
|
E/A, mean (SD) (n = 7)
|
0.9 (0.3)
|
1.5 (0.7)
|
0.16
|
|
Average Mitral E/e’, (mean SD) (n = 7)
|
12.3 (3.0)
|
12.3 (7.5)
|
0.99
|
|
Cardiac MRI
| | | |
|
ECV, % (n = 4)
|
32.0
|
35.5
|
0.65
|
|
Native T1 value (ms) (n = 5)
|
1076 (102)
|
1130 (27)
|
0.53
|
|
Predominant LGE Pattern (n = 6)
| | |
0.63
|
|
Sub-endocardial/Transmural
|
0
|
2
| |
|
Sub-epicardial
|
0
|
0
| |
|
Mid-myocardial
|
2
|
2
| |
|
Diffuse
|
0
|
0
| |
|
Treatment
| | | |
|
Initial Treatment on Presentation
|
Prednisone 1 mg/kg
|
IV solumedrol 1 g x3 days and infliximab 5 mg/kg
| |
|
Prednisone Duration, days (median IQR)
|
90 (60,150)
|
150 (75, 300)
|
0.32
|
|
Survival at discharge
|
7 (100 %)
|
4 (100 %)
| |
