Skip to main content

Advertisement

Log in

Role of echocardiography in patients treated with immune checkpoints inhibitors

  • Review Article
  • Published:
Journal of Echocardiography Aims and scope Submit manuscript

Abstract

Immune-related adverse events occurring in the heart (cardiac immune-related adverse events; irAEs) by immune checkpoint inhibitors (ICIs) include myocarditis, arrhythmia, conduction disturbance, pericardial diseases, and takotsubo cardiomyopathy. Cardiac irAEs are rare but life-threatening. In cardio-oncology, the study of cardiac disorders caused by cancer treatment has recently attracted attention, and such studies may elucidate the pathophysiology of cardiac irAEs and contribute to management strategies. This review discusses the pathogenic mechanisms underlying cardiac irAEs and the role of echocardiography in patients treated with ICIs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

References

  1. Onishi T, Fukuda Y, Miyazaki S, et al. Practical guidance for echocardiography for cancer therapeutics-related cardiac dysfunction. J Echocardiogr. 2021;19:1–20.

    Article  PubMed  Google Scholar 

  2. Okura Y, Ozaki K, Tanaka H, et al. The impending epidemic of cardiovascular diseases in patients with cancer in Japan. Circ J. 2019;83:2191–202.

    Article  PubMed  Google Scholar 

  3. Ball S, Ghosh RK, Wongsaengsak S, et al. Cardiovascular toxicities of immune checkpoint inhibitors. J Am Coll Cardiol. 2019;74:1714–27.

    Article  CAS  PubMed  Google Scholar 

  4. Ramos-Casals M, Brahmer JR, Callahan MK, et al. Immune-related adverse events of checkpoint inhibitors. Nat Rev Dis Primers. 2020;6:38.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Takahashi T, Tagami T, Yamazaki T, et al. Immunologic self-tolerance maintained by CD25(+) CD4(+) regulatory T cells constitutively expressing cytotoxic T lymphocyte-associated antigen 4. J Exp Med. 2000;192:303–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kadowaki H, Akazawa H, Ishida J, Komuro I. Mechanisms and management of immune checkpoint inhibitor-related cardiac adverse events. JMA J. 2021;4:91–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tajiri K, Aonuma K, Sekine I. Immune checkpoint inhibitor-related myocarditis. Jpn J Clin Oncol. 2018;48:7–12.

    Article  PubMed  Google Scholar 

  8. Salem JE, Manouchehri A, Moey M, et al. Cardiovascular toxicities associated with immune checkpoint inhibitors: an observational, retrospective, pharmacovigilance study. Lancet Oncol. 2018;19:1579–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ederhy S, Dolladille C, Thuny F, et al. Takotsubo syndrome in patients with cancer treated with immune checkpoint inhibitors: a new adverse cardiac complication. Eur J Heart Fail. 2019;21:945–7.

    Article  PubMed  Google Scholar 

  10. Johnson DB, Balko JM, Compton ML, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med. 2016;375:1749–55.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mahmood SS, Fradley MG, Cohen HV, et al. Myocarditis in patients treated with immune checkpoint inhibitors. J Am Coll Cardiol. 2018;71:1755–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wang DY, Salem JE, Cohen JV, et al. Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol. 2018;4:1721–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Escudier M, Cautela J, Malissen N, et al. Clinical features, management, and outcomes of immune checkpoint inhibitor-related cardiotoxicity. Circulation. 2017;136:2085–7.

    Article  PubMed  Google Scholar 

  14. Hu JR, Florido R, Lipson EJ, et al. Cardiovascular toxicities associated with immune checkpoint inhibitors. Cardiovasc Res. 2019;115:854–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Palaskas N, Morgan J, Daigle T, et al. Targeted cancer therapies with pericardial effusions requiring pericardiocentesis focusing on immune checkpoint inhibitors. Am J Cardiol. 2019;123:1351–7.

    Article  PubMed  Google Scholar 

  16. Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43:4229–361.

    Article  PubMed  Google Scholar 

  17. Rini B, Moslehi JJ, Bonaca M, et al. Prospective cardiovascular surveillance of immune checkpoint inhibitor-based combination therapy in patients with advanced renal cell cancer: data from the phase 3 JAVELIN Renal 101 trial. J Clin Oncol. 2022;40:1929–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Awadalla M, Mahmood SS, Groarke JD, et al. Global longitudinal strain and cardiac events in patients with immune checkpoint inhibitor-related myocarditis. J Am Coll Cardiol. 2020;75:467–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tanabe J, Watanabe N, Endo A, et al. Asymptomatic immune checkpoint inhibitor-associated myocarditis. Intern Med. 2021;60:569–73.

    Article  PubMed  Google Scholar 

  20. Tamura Y, Tamura Y, Takemura R, et al. Longitudinal strain and troponin I elevation in patients undergoing immune checkpoint inhibitor therapy. JACC CardioOncol. 2022;4:673–85.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American society of clinical oncology clinical practice guideline. J Clin Oncol. 2018;36:1714–68.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kazuaki Tanabe.

Ethics declarations

Conflict of interest

Dr. Kazuaki Tanabe has received lecture fees from Otsuka Pharmaceutical Co, Ltd. Dr. Junya Tanabe declares that he has no conflict of interests.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from the patient for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanabe, K., Tanabe, J. Role of echocardiography in patients treated with immune checkpoints inhibitors. J Echocardiogr 21, 145–148 (2023). https://doi.org/10.1007/s12574-023-00621-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12574-023-00621-z

Keywords

Navigation