Central Illustration.

Longitudinal Biomarker Associations With ICI Myocarditis

In this cohort study of patients with and without myocarditis, almost all patients with myocarditis had elevations in (A) alanine aminotransferase (ALT), (B) aspartate aminotransferase (AST), (C) lactate dehydrogenase (LDH), and (D) creatine phosphokinase (CPK), compared with only 5% of patients without myocarditis. All biomarkers began to rise prior to the diagnosis of myocarditis with CPK rising the fastest and peaking prior to hospitalization of myocarditis. Elevations in CPK had the best performance, with a sensitivity and specificity of 99% and 23%, respectively. Elevations in these biomarkers should prompt further evaluation for immune checkpoint inhibitor (ICI) myocarditis.