• cancer
• cardiac troponin T
• chemotherapy
• echocardiography
• global longitudinal strain
• immune checkpoint inhibitors

Background and Aims: Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment, but have been associated with immune-related adverse events (irAEs). Early diagnosis of irAEs is important to enact early treatment. We aimed at analyzing the prognostic role of high-sensitivity cardiac troponin T (TnT-hs) and echocardiographic parameters, including 2D global longitudinal strain (GLS), in irAEs.

Methods and Results: We prospectively studied 30 lung cancer patients, 23 men (76%), median age 68 (95% CI 58-73 years), before and after ICI therapies. Patients underwent a baseline and an 80-day (95% CI 65-107) follow-up examination, after an average 5 cycles of chemotherapy. At baseline, all patients had normal ejection fraction [57.2% (54.2-59.35)] and GLS [17.5 (15.9-19.5%)]. Median TnT-hs values across a first ICI cycle were 11 (8-19.5) and 14 (8.75-25.25) ng/L, respectively. Three (10%) patients died, and two (6%) had pericardial disease. Such major adverse CV events at follow-up all occurred in patients with baseline TnT-hs ≥14 ng/L - upper normal reference limit (p=0.01 vs patients with baseline TnT-hs<14 ng/L). TnT-hs values at baseline ≥14 ng/L were also associated with a higher (p=0.006) risk of ESC guidelines-defined cardiotoxicity. We found no correlation between basal TnT-hs values and changes in GLS (p=0.171); or between pre-/post-cycle changes in TnT-hs and changes in GLS (p=0.568). At receiver-operator curve (ROC) analysis, a TnT-hs value ≥14 ng/L was the best cut-off predicting all-cause mortality (AUC 0.807, sensitivity=100%, specificity=69%), CV events (AUC 0.865; sensitivity=100%, specificity=61%) and cardiotoxicity (AUC 0.739; sensitivity=80%, specificity=67%).

Conclusions: In early cancer treatment with ICI, baseline TnT-hs ≥14 ng/L, but not pre-/post ICI TnT-hs changes or changes in echocardiographic parameters, including GLS, predicts CV events and cardiotoxicity.