TABLE 1.
Description of Cases and Controls
| Myocarditis (n = 35) | Controls (n = 105) | Odds Ratio | 95% Confidence Interval | p Value | |
|---|---|---|---|---|---|
| Age at start of ICI, yrs | 65 ± 13 | 65 ± 13 | – | – | 0.85 |
| Female | 10 (29.0) | 33 (31.0) | 0.87 | 0.38–2.02 | 0.83 |
| CV risk factors | |||||
| Current or prior smoking | 15 (43.0) | 65 (62.0) | 0.51 | 0.23–1.13 | 0.075 |
| Hypertension | 25 (71.0) | 65 (62.0) | 1.54 | 0.67–3.53 | 0.31 |
| Diabetes mellitus | 12 (34.0) | 14 (13.0) | 3.36 | 1.37–8.20 | 0.01 |
| No CV risk factors | 1 (2.9) | 4 (3.8) | 0.74 | 0.08–6.90 | – |
| Coronary artery disease | 7 (20.0) | 17 (16.0) | 1.29 | 0.49–3.44 | 0.61 |
| Prior myocardial infarction | 3 (8.6) | 6 (5.7) | 1.55 | 0.37–6.54 | 0.69 |
| Prior coronary stenting | 2 (5.7) | 2 (1.9) | 3.13 | 0.42–23.26 | – |
| Coronary artery bypass graft | 3 (8.6) | 7 (6.7) | 1.31 | 0.32–5.38 | 1.00 |
| Stroke | 2 (5.7) | 11 (10.5) | 0.52 | 0.11–2.46 | 0.52 |
| Heart failure | 1 (2.9) | 9 (8.6) | 0.31 | 0.04–2.57 | 0.45 |
| Chronic obstructive pulmonary disease | 4 (11.0) | 14 (13.0) | 0.84 | 0.26–2.74 | 1.00 |
| Obstructive sleep apnea | 5 (14.0) | 4 (3.8) | 4.2 | 1.06–16.67 | 0.04 |
| Chronic kidney disease* | 2 (5.9) | 19 (18.0) | 0.28 | 0.06–1.28 | 0.10 |
| Body mass index, kg/m2 | 29.0 ± 8.4 | 26.0 ± 6.0 | – | – | 0.02 |
| Primary cancer type | |||||
| Head and neck | 2 (5.7) | 10 (9.5) | 0.58 | 0.12–2.76 | 0.73 |
| Breast | 1 (2.9) | 0 (0.0) | – | – | – |
| Hodgkin’s lymphoma | 1 (2.9) | 2 (1.9) | 1.52 | 0.13–17.24 | – |
| Melanoma | 16 (46.0) | 50 (48.0) | 0.19 | 0.02–1.51 | 1.00 |
| Non-small cell lung cancer | 4 (11.0) | 26 (25.0) | 0.39 | 0.13–1.22 | 0.15 |
| Small cell lung cancer | 0 (0.0) | 4 (3.8) | – | – | 0.57 |
| Pancreatic | 1 (2.9) | 0 (0.0) | – | – | – |
| Renal cell carcinoma | 2 (5.7) | 1 (1.0) | 6.29 | 0.55–71.43 | – |
| Glioblastoma | 1 (2.9) | 0 (0.0) | – | – | – |
| Other | 7 (20.0) | 12 (11.0) | 1.94 | 0.70–5.41 | 0.25 |
| Prior chemotherapy or radiation | |||||
| Radiation | 14 (40.0) | 61 (58.0) | 0.48 | 0.22–1.05 | 0.078 |
| Anthracyclines | 2 (5.7) | 3 (2.9) | 2.06 | 0.33–12.82 | 0.60 |
| Vascular endothelial growth factor inhibitors | 1 (2.9) | 2 (1.9) | 1.52 | 0.13–17.24 | – |
| Pre-ICI treatment echocardiogram† | |||||
| LVEF, % | 60 ± 7 | 62 ± 10 | – | – | 0.28 |
| Left ventricular internal dimension in diastole, mm | 43 ± 6 | 45 ± 6 | – | – | 0.38 |
| Pre-ICI treatment ECG | |||||
| Sinus rhythm | 27 (96.0) | 83 (91.0) | 0.50 | 0.18–1.37 | 0.81 |
| ST-segment or T-wave changes | 6 (21.0) | 32 (35.0) | 2.60 | 0.31–21.74 | 0.199 |
| Heart rate, beats/min | 81 ± 15 | 82 ± 24 | – | – | 0.82 |
| QRS interval, ms | 96 ± 17 | 94 ± 23 | – | – | 0.71 |
| QTc interval, ms | 443 ± 26 | 440 ± 31 | – | – | 0.63 |
| Pre-ICI home CV medications | |||||
| Statin | 11 (31.0) | 26 (25.0) | 1.39 | 0.60–3.23 | 0.51 |
| Aspirin | 12 (34.0) | 23 (22.0) | 1.86 | 0.81–4.29 | 0.18 |
| Beta-blockers | 10 (29.0) | 34 (32.0) | 0.84 | 0.36–1.93 | 0.83 |
| Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker | 15 (43.0) | 20 (19.0) | 3.18 | 1.39–7.30 | 0.007 |
| Calcium-channel blocker | 4 (11.4) | 20 (19.0) | 0.55 | 0.17–1.73 | 0.44 |
Values are mean ± SD or n (%), unless otherwise indicated.
*
Chronic kidney disease = glomerular filtration rate <60 ml/min/1.73 m2.
†
Twenty-three of the 35 cases had a pre-treatment echocardiogram, and 50 of the 105 controls had a pre-treatment echocardiogram.
CV = cardiovascular; ECG = electrocardiogram; ICI = immune checkpoint inhibitors; QTc = QT interval corrected for heart rate.