ArticleJACC. CardioOncology2026
Myocardial Expression of PD-L1 as a Marker of Poor Prognosis in Immune Checkpoint Inhibitor-Associated Myocarditis.
Article in JACC. CardioOncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Programmed Cell Death-1/Programmed Cell Death-Ligand 1 Pathway in High-Risk Lymphocytic Acute Myocarditis.JACC. Advances · 2026Article
- Reply: Refining the Prognostic Interpretation of Myocardial PD-L1 Expression in ICI-Associated Myocarditis.JACC. CardioOncology · 2026Article
- Refining the Prognostic Interpretation of Myocardial PD-L1 Expression in ICI-Associated Myocarditis.JACC. CardioOncology · 2026Article
- PD-L1 in ICI Myocarditis: When the Immune Brake Fails.JACC. CardioOncology · 2026Article
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13 authors.
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Abstract
backgroundImmune checkpoint inhibitors (ICIs) have improved cancer outcomes but are associated with severe immune-related adverse events, including myocarditis. PD-L1 plays an important role in immune regulation and homeostasis. Myocardial PD-L1 up-regulation has been reported in ICI-associated myocarditis; however, its clinical significance and prognostic value remain unclear.
objectivesThis study sought to investigate the association between myocardial PD-L1 expression and ICI-associated myocarditis severity and prognosis.
methodsTwenty consecutive cases of biopsy-proven ICI-associated myocarditis were analyzed. Endomyocardial biopsy specimens underwent immunohistochemical staining for PD-L1, and patients were categorized into high (≥8%) or low (<8%) PD-L1 expression groups. Clinical presentation and the incidence of major adverse cardiotoxic events, defined as a composite of severe heart failure, severe arrhythmia, or cardiac death, were compared between groups.
resultsThe median follow-up time for the cohort was 189 days (Q1-Q3: 88-308 days). The absolute risk of 30-day major adverse cardiotoxic events was significantly higher in the high PD-L1 group (n = 5 of 7 [71.4%], 95% CI: 29.0%-96.3%) than in the low PD-L1 group (n = 1 of 13 [7.7%], 95% CI: 0.2%-36.0%; P = 0.007). The median peak normalized troponin level (× upper limit of normal) was significantly higher in the high PD-L1 group than in the low PD-L1 group (662 [Q1-Q3: 204-855] vs 64 [Q1-Q3: 26-108]; P = 0.010). Patients in the high PD-L1 group also had longer QRS duration on electrocardiography (124 ms [Q1-Q3: 108-131 ms] vs 96 ms [Q1-Q3: 90-102 ms]; P = 0.021). Myocardial inflammatory cell infiltration was greater in the high PD-L1 group, with higher CD3
conclusionsHigh myocardial PD-L1 expression is associated with greater disease severity and a higher risk of major adverse cardiotoxic events in ICI-associated myocarditis. Assessment of PD-L1 expression in endomyocardial biopsy specimens may help identify patients at high risk who may benefit from early intervention and closer monitoring.
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