Optimizing troponin T screening for immune checkpoint inhibitor-associated myocarditis

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ID: 323284
2026
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Ranked #112 of 282 articles by views in European heart journal supplements : journal of the European Society of Cardiology

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Abstract
Abstract Background Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs), such as ICI-associated myocarditis (ICI-myocarditis). Current ESC guideline endorses cycle-dependent monitoring with high-sensitivity troponin-T (hs-TnT), yet treatment intervals vary from two to six weeks. Purpose This study evaluates real-world hs-TnT dynamics for early identification of ICI-myocarditis. Methods We evaluated hs-TnT in two independent cohorts: a ‘fixed sampling cohort’ (FSC) of high-risk patients on combination ICI, measured at baseline and week six, and a ‘serial sampling cohort’ (SSC) on mono/ combination ICI, measured at each treatment cycle. Associations between baseline hs-TnT and ICI-myocarditis were assessed using logistic regression, and longitudinal changes with generalized estimating equations. Results In the FSC (6 cases and 141 non-cases), baseline hs-TnT did not differ significantly between groups (7.8 versus 6.0 ng/L, p=0.422), though 21% of non-cases exceeded the 14 ng/L threshold. In the SSC (8 cases and 156 non-cases), baseline hs-TnT was higher in cases (15 vs 10 ng/L, p=0.022), and 35% of all patients exceeded the 14 ng/L threshold. Median onset of ICI-myocarditis was in the FSC 25 days and in the SCC 40 days. In the SSC, non-linear models confirmed an early divergence in hs-TnT trajectories between groups (5% increase/cycle, p=0.004), while extended follow-up showed greater variability without additional diagnostic value. Conclusion Baseline hs-TnT mainly serves as reference, while repeated measurements at week-based intervals may improve early detection of ICI-myocarditis compared to cycle-based monitoring. These findings may implicate a shift from ESC guideline endorsed cycle-dependent monitoring, that may otherwise miss cases in regimens with extended ICI-dosing intervals.
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Authors T J J Uyl, S A Ditta, P F Van Den Berg, M M Hofman, F Jongbloed, I Kardys, E Oomen- De Hoop, O C Manintveld, A A M Van Der Veldt, J G J V Aerts, R H N Van Schaik, R A De Boer, D W Dumoulin, A H J Mathijssen, W C Meijers
Journal European heart journal supplements : journal of the European Society of Cardiology
Year 2026
DOI
10.1093/eurheartjsupp/suag097.041
URL
https://doi.org/10.1093/eurheartjsupp/suag097.041
Keywords Keywords not found

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