High mortality rate for heart injury associated with this tumor treatment! Summary of Foreign Scholars

Immune checkpoint inhibitors such as monoclonal antibody therapy for cytotoxic T lymphocyte-related antigens 4 (CTLA-4), procedural death receptor-1 (PD-1) and their ligands have become the standard treatment for more and more tumors, and more and more patients are applying these drugs at the same time as immuno-related side effectsAlthough the rate of heart adverse events associated with immunocheckpoint inhibitors is less than 1%, it can be relatively severe or even fatalIn a review published in this journal, the experts in the hospital noted that the possible mechanism of cardiac toxicity associated with immune checkpoint inhibitors is thought to be the activation of cytotoxic T lymphocytes by immune checkpoint inhibitors, which directly attack myocardial cells leading to heart damageThe authors point out that immune checkpoint inhibitors have a variety of manifestations of cardiac toxicity, including myocarditis, ocarditis, arrhythmia, conduction disorders and ventricular function impairmentClinical manifestations vary, including increased asymptomatic heart biomarkers, nonspecific discomfort, rapid lysy chronic heart failure, and even the possibility of explosive progressionTherefore, clinicians need to be highly alert to the occurrence of cardiac toxicity associated with immunocheckpoint inhibitorsThe authors suggest that electrocardiograms, myocardial markers, imaging examinations and endocardial biopsies can help with diagnosis, but should be evaluated in combination with the clinical performance of patients and weighing the pros and consThe treatment of adverse heart events associated with immunocheckpoint inhibitors mainly includes the treatment of the disease and the causeFirst-line treatment mainly consists of high doses of glucocorticoids, if necessary, can be added to other immunosuppressants such as MMF, ATG and so onThe authors combined with the relevant research data, the immunocheckpoint inhibitor-related heart adverse event mortality rate of up to 27%, the main causes of death include heart failure, ventricular arrhythmia and cardiac arrest;For patients with mild clinically expressed cardiac toxicity, up to 50% of patients receive a complete remission of left ventricular contractionHowever, the authors also point out that the mechanism of cardiac toxicity associated with immunocheckpoint inhibitors is still not fully clear, and further studies are needed on whether there are risk factors for the risk factors associated with the toxicity of the heart associated with immunocheckpoint inhibitors, more effective early diagnosis methods and whether immunotherapy should resume after the occurrence of immunocheckpoint inhibitor-related cardiac toxicitySource: Zhao Yihe, Wang Hongjian, Song Weihua, etcimmune checkpoint inhibitors related to cardiac toxicity research progressChina Circulation Magazine, 2020, 35:518-521Author: Circulation Source: China Circulation Magazine