Journal Article

The predictive value of serial troponin measurements in patients treated with immune checkpoint inhibitors

Topilsky, Yan, Wolf, Ido, Stark, Moshe, Gvili Perelman, Moran, Banai, Shmuel, Waissengrin, Barliz, Raphael, Ari, Weiss, Noam, Khoury, Shafik, Laufer-Perl, Michal, Tzuberi, Maor, Brzezinski, Rafael Y, Havakuk, Ofer, Leshem, Yasmin, Asleh, Rabea, Perelman, Maxim, Goldiner, Ilana

2025

Overview

Abstract Background Immune checkpoint inhibitors (ICIs) may lead to immune-related adverse events, including potentially life-threatening cardiovascular (CV) complications. Despite guideline-recommended troponin monitoring, limited data exist on evaluating its predictive significance. Objective We aimed to assess the predictive value of serial high-sensitivity troponin I (hs-TnI) monitoring in patients treated with ICIs. Methods A retrospective, single-center, observational study including patients treated with ICIs and performing serial hs-TnI measurements. The primary endpoint was all-cause mortality, and the secondary endpoint was CV events, defined as the composite of myocarditis, pericarditis, acute coronary syndrome, heart failure, or arrhythmias. A tree classifier model identified the most predictive hs-TnI concentration for the main study endpoints. Results Overall, 455 patients performed baseline (T1) and follow-up hs-TnI (T2) assessments and were included in the cohort. During a mean follow-up of 25 months (IQR [12-36]), 253 (56%) patients died, and 70 (15%) developed CV events. T2 > 8 ng/L was significantly associated with increased all-cause mortality (64% vs 48%, P < .001) and CV events (22% vs 9%, P < .001), notably HF (12% vs 4%, P = .003) and myocarditis (3% vs 0%, P = .038). A multivariable analysis confirmed that T2 > 8 ng/L was an independent predictor for all-cause mortality (HR 1.67, 95% CI: 1.29-2.17, P < .001) and CV events (HR 2.59, 95% CI: 1.50-4.46, P = .001). Conclusions Our study emphasizes the significant role of serial troponin monitoring during ICIs therapy as an independent predictor of all-cause mortality and CV events, and suggests an optimal lower hs-TnI cutoff of >8 ng/L for risk stratification. Large prospective trials are needed to confirm these findings.

• Publisher: Oxford University Press
• Subject: Aged / Cancer / Cardiovascular Diseases - blood / Cardiovascular Diseases - chemically induced / Care and treatment / Complications and side effects / Coronary heart disease / Female / Health aspects / Heart diseases / Humans / Immune Checkpoint Inhibitors - adverse effects / Immune Checkpoint Inhibitors - therapeutic use / Immuno-Oncology / Israel / Male / Medical research / Medicine, Experimental / Middle Aged / Monoclonal antibodies / Mortality / Neoplasms - drug therapy / Predictive Value of Tests / Retrospective Studies / Risk factors / Troponin I - blood