Early detection and management of immune-related myocarditis: Experience from a case with advanced squamous cell lung carcinoma

Myocardial immune-related adverse effect is reported as less than 1% of immune-related adverse events but very high mortality about 50% [ [1] Moslehi J.J. Salem J.-E. Sosman J.A. Lebrun-Vignes B. Johnson D.B. Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis. Lancet. 2018; 391: 933 Abstract Full Text Full Text PDF PubMed Scopus (416) Google Scholar , [2] Salem J.-E. Manouchehri A. Moey M. Lebrun-Vignes B. Bastarache L. Pariente A. et al. Cardiovascular toxicities associated with immune checkpoint inhibitors: an observational, retrospective, pharmacovigilance study. Lancet Oncol. 2018; 19: 1579-1589 Abstract Full Text Full Text PDF PubMed Scopus (410) Google Scholar ]. Some patients progress rapidly and even deteriorate from complaining of symptoms to life crisis only in 24–48 h. Thus, early detection and comprehensive management are extremely important for good prognosis. Presently, diagnostic tests include electrocardiogram (ECG), echocardiogram, myocardial biomarkers, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) [ [3] Zhang L. Jones-O’Connor Maeve Awadalla M. Zlotoff D.A. Thavendiranathan P. Groarke J.D. et al. Cardiotoxicity of immune checkpoint inhibitors. Curr Treat Options Cardiovasc Med. 2019; 21: 32 Crossref PubMed Scopus (26) Google Scholar ]. CMR is a non-invasive gold-standard test for diagnosis, whereas EMB is an invasive one. However, it might be late to start treatment after diagnosis is confirmed by CMR or EMB, given the situation that immune-related myocarditis is a rapidly deteriorating disease with extremely high mortality. Therefore, ECG, echocardiogram and biomarkers could play more important roles in early detection. In some circumstances, diagnostic treatment is also crucial method. Here, we report a case detected by increasing myocardial biomarkers and defined by diagnostic treatment.