ArticleEuropean heart journal2026
Immune checkpoint inhibitor-associated myocarditis: a novel risk score.
Article in European heart journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 52 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
JOint Use of Database to Identify Risk Factors of CARDio-vascular Adverse Reactions Induced by Immune Checkpoint InhibiTors: VigiBase, Entrepot de Données de Santé (EDS), Système National Des Données de Santé (SNDS) Databases and a Retrospective International Multicenter Registry of ICI-associated Myocarditis
Follow-up of a Cohort of Patients With Inflammatory Myopathies Associated With a Biobank: MASC 2 Project (Myositis, Muscles, DNA/RNA Serum Cells)
Who cites it
52 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prediction models for immune checkpoint inhibitor-related cardiovascular toxicity: a systematic review.Frontiers in immunology · 2026Pooled it
- Cardiac biomarkers in patients with renal cell carcinoma treated with immune checkpoint inhibitors.The oncologist · 2026Trial
- Mapping the global landscape of research on immune checkpoint inhibitor-associated cardiotoxicity: A quantitative and visualized bibliometric study (2016-2025).Human vaccines & immunotherapeutics · 2026Article
- The Immune Checkpoint Inhibitors Journey: From Early Promise to Lasting Impact.Journal of immunotherapy and precision oncology · 2026Review
- Programmed Cell Death-1/Programmed Cell Death-Ligand 1 Pathway in High-Risk Lymphocytic Acute Myocarditis.JACC. Advances · 2026Article
- Genetic and Molecular Determinants of Cancer Therapy-Related Cardiovascular Toxicity.Cardiovascular toxicology · 2026Review
- Review
- Risk-guided cardioprotection in cardio-oncology.Nature cardiovascular research · 2026Review
- Abatacept for steroid-refractory fulminant immune checkpoint inhibitor myocarditis with triple M overlap syndrome: a case report with serial endomyocardial biopsy assessment.European heart journal. Case reports · 2026Article
- The gut-heart axis in cardio-oncology.Cardiovascular research · 2026Review
- Mitochondrial Imaging Detects Early Cardiac Changes Following Cancer Immunotherapy.Clinical cancer research : an official journal of the American Association for Cancer Research · 2026Article
- Cardiotoxicity of Immune Checkpoint Inhibitors and Chimeric Antigen Receptor T-Cell Therapy.Journal of cardiovascular development and disease · 2026Review
- Reply: Refining the Prognostic Interpretation of Myocardial PD-L1 Expression in ICI-Associated Myocarditis.JACC. CardioOncology · 2026Article
- Review
- Post-viral myocarditis.Heart failure reviews · 2026Review
- Endomyocardial Biopsy in Suspected Immune Checkpoint Inhibitor-Myocarditis: Histologic Spectrum and Correlations With Clinical and Cardiac Magnetic Resonance Features.Journal of the American Heart Association · 2026Article
- Troponin Screening and Major Cardiovascular Adverse Events During Immune Checkpoint Inhibitor Therapy.JAMA network open · 2026Observational
- Immune Profiling Identifies Inflammatory Signatures in Immune Checkpoint Inhibitor-Related Myocarditis.JACC. CardioOncology · 2026Article
- Immune checkpoint inhibitor-induced myocarditis with atrioventricular conduction abnormalities: a case report.ESMO gastrointestinal oncology · 2026Article
- IL-6 in Checkpoint Myocarditis: A Promising Biomarker and Therapeutic Target.JACC. CardioOncology · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
54 authors.
Funding
Abstract
BACKGROUND AND
aimsImmune checkpoint inhibitors (ICI) are associated with life-threatening myocarditis but milder presentations are increasingly recognized. The same autoimmune process that causes ICI myocarditis can manifest concurrent generalized myositis, myasthenia-like syndrome, and respiratory muscle failure. Prognostic factors for this 'cardiomyotoxicity' are lacking. The main aim of this study was to determine predictors and construct a risk score associated with negative outcomes in patients admitted for ICI myocarditis.
methodsA multicentre registry collected data retrospectively from 17 countries between 2014 and 2023. A multivariable Cox regression model was used to determine risk factors for the primary composite outcome: time to severe arrhythmia, heart failure, respiratory muscle failure, and/or cardiomyotoxicity-related death. Covariates included demographics, comorbidities, cardiomuscular symptoms, diagnostics, and treatments. Time-dependent covariates were used, and missing data were imputed. A point-based prognostic risk score was derived and externally validated.
resultsIn 748 patients (67% male, age 23-94 years), 30-day incidence of the primary composite outcome, cardiomyotoxic death, and overall death were 33%, 13%, and 17%, respectively. By multivariable analysis, the primary composite outcome was associated with active thymoma (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7-7.7), presence of cardiomuscular symptoms (HR 2.6 [1.5-4.2]), low QRS voltage on presenting electrocardiogram (HR for ≤0.5 mV vs >1 mV 1.9 [1.1-3.1]), left ventricular ejection fraction (LVEF) < 50% (HR 1.7 [1.1-2.6]), and incremental troponin elevation (HR 1.8 [1.4-2.4], 2.9 [1.8-4.7], and 4.6 [2.3-9.3], for 20, 200, and 2000-fold above upper reference limit, respectively). A prognostic risk score developed using these parameters showed good performance; 30-day primary outcome incidence increased gradually from 4% (risk score = 0) to 81% (risk score ≥ 4). This risk score was externally validated in two independent French and US cohorts. This risk score was used prospectively in the external French cohort to identify low-risk patients who were managed with no immunosuppression resulting in no cardiomyotoxic events.
conclusionsICI-associated myocarditis can manifest with high morbidity and mortality. Myocarditis severity is associated with magnitude of troponin, thymoma, low QRS voltage, depressed LVEF, and cardiomuscular symptoms. A risk score incorporating these features performed well. CLINICAL
trial registrationNCT04294771 and NCT05454527.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.