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Diagnostic and Prognostic Value of High‐Sensitivity Troponin T for Cardiovascular Outcomes in Patients Receiving Immune Checkpoint Inhibitor Therapy

Year: 2025

Type: article

Abstract: BACKGROUND: Immune-checkpoint inhibitors (ICI) are associated with adverse cardiac events. Although troponin elevation is a diagnostic criterion for ICI-related myocarditis (ICIrM) and myocardial infarction, data on other causes of troponin elevation and their outcomes in ICI-treated patients are limited. METHODS: All patients treated with ICI who had hs-TnT (high-sensitivity troponin T) measured at a multicenter institution from 2011 to 2022 were included. Clinical data, outcomes (cardiac death, heart failure (HF), major adverse cardiovascular events [myocardial infarction, stroke, heart failure]), and cause of hs-TnT elevation were assessed. Risks of cardiac events were compared across hs-TnT elevation causes. RESULTS: <0.001), followed by myocardial infarction/type 2 ischemia (HR, 8.1), heart failure (HR, 7.6), pulmonary embolus (HR, 5.1), infection/sepsis (HR, 4.1), and indeterminate cause (HR, 2.4). Among ICIrM, HsTnT value >576 ng/L best predicted risk for cardiac death and >319 ng/L for major adverse cardiovascular events. CONCLUSIONS: Hs-TnT elevation after ICI therapy is associated with increased risk of cardiac events, particularly in ICIrM, and a graded prognostic association depending on the cause of hs-TnT elevation. Identifying the underlying cause and troponin thresholds may guide risk stratification and management.

Source: Journal of the American Heart Association

DOI: 10.1161/jaha.125.041680