2183P - The relevance of HFpEF in immunotherapy-induced myocarditis: An analysis of 65 patients

Background

High quality evidence on the incidence of Immune checkpoint inhibitor (ICI) induced-myocarditis and its relationship with LV systolic function is lacking. Anecdotally, a relationship between ICI myocarditis with clinical heart failure in the context of a preserved ejection fraction (HFpEF) was noted and has been investigated here.

Methods

A retrospective analysis of 65 patients with ICI myocarditis was conducted over a 55 month period at the Clatterbridge Cancer Centre, Liverpool UK. A diagnosis of myocarditis was confirmed by cMRI or the cardio-oncology team. Diuresis at any point following myocarditis diagnosis, cMRI findings and peak pro-BNP (BNP) was recorded. Statistical analysis was undertaken with an unpaired t test.

Results

The incidence of ICI myocarditis across all ICI treated patients was 1.74% (n=65/3728); cMRI confirmed (n=53), clinical diagnosis in the absence of cMRI confirmation (n=5) or cMRI clinically unfeasible (n=7).The mean and median EF for all imaged patients (n=58) was 63.07% vs 64%. 82.76% (n=48/58) had a normal / above normal EF. LV impairment was found in 17.24% of patients (n=10/58); 8 mild LVSD, 1 moderate LVSD and 1 severe LVSD. Of all imaged patients 50% (n=29/58) required diuresis. The difference between the mean EF for patients requiring diuresis (EF 61.07%) vs non-diuresed patients (65.14%) was insignificant (p=0.21). 36.21% (n=21/58) of the imaged cohort had HFpEF. The mean peak BNP of diuresed patients was significantly higher (p<0.01) than the non-diuresed cohort (11287 vs 6083). The median peak BNP was also higher in the diuresed cohort (7552 vs 2577).

Conclusions

In this cohort ICI myocarditis was characterised generally by a preserved ejection fraction, however 50% of patients illustrated fluid overload and a third displayed HFpEF therefore the absence of LVSD does not exclude ICI myocarditis. Patients presenting with fluid overload and/or elevated pro-BNPs is a common clinical presentation of ICI myocarditis even in the presence of a maintained EF. Patients should be optimised with diuretics alongside immunosuppression in this setting and cMRI should be performed to confirm the diagnosis as ECHO alone is insufficient to do so.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

R. Dobson: Financial Interests, Personal, Other, Personal honoraria: BMS, Roche. A.C. Olsson-Brown: Financial Interests, Personal, Invited Speaker: BMS, MSD, Eisai, Novartis, Bo-In, Roche, AstraZeneca; Financial Interests, Personal, Research Grant: UCB Pharma, Roche, Eli Lilly, Novartis; Financial Interests, Personal, Other, Travel: Ipsen; Financial Interests, Personal, Other, Educational grant: BMS. All other authors have declared no conflicts of interest.