F. Deharo, J. Cautela, F. Thuny, M. Gaubert, F. Paganelli, N. Resseguier, F. Cadour, J. Alexandre, C. Dolladille
{"title":"国际心脏肿瘤学会(IC-OS)定义对疑似免疫检查点抑制剂相关性心肌炎的诊断价值","authors":"F. Deharo, J. Cautela, F. Thuny, M. Gaubert, F. Paganelli, N. Resseguier, F. Cadour, J. Alexandre, C. Dolladille","doi":"10.1016/j.acvdsp.2023.04.021","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>The diagnosis of immune checkpoint inhibitor-associated myocarditis (ICI-M) is challenging. Recently, the International Society of Cardio-Oncology (IC-OS) proposed an empirical definition of ICI-M; however, this definition has never been validated. We aimed to assess the diagnostic value at admission of the IC-OS definition in a cohort of patients with suspected ICI-M and to determine whether the addition of other criteria to this definition would improve its performance.</p></div><div><h3>Method</h3><p>Between May 2017 and November 2021, all patients with suspected ICI-M were consecutively included in a multicenter cohort. The final diagnosis was the one recorded in the patient's electronic medical record, established within one month of hospital discharge by the expert cardio-oncology team that managed the patient.</p></div><div><h3>Results</h3><p>Of the 68 patients included, 45 patients presented with ICI-M. The sensitivity, specificity, and positive and negative likelihood ratios of the IC-OS definition were 93% (95% CI: 82%–99%), 70% (95% CI: 47%–87%), 3.1 (95% CI: 1.7–5.7), and 0.1 (95% CI: 0–0.3), respectively. A delay in the onset of the first events < 3 months after the introduction of ICIs was the only variable that was both significantly associated with the final diagnosis of ICI-M and did not already meet the criteria of the IC-OS definition (72% vs. 52%, <em>P</em> <!-->=<!--> <!-->0.03). By including this variable as a new minor criterion and increasing the number of minor criteria for defining ICI-M to 3, the specificity increased from 70% to 83% (<em>P</em> <!-->=<!--> <!-->0.08), and the sensitivity remained unchanged (93%).</p></div><div><h3>Conclusion</h3><p>The IC-OS definition for the diagnosis of ICI-M showed excellent sensitivity and moderate specificity. The latter could be increased by a modified definition including the time of the onset of the first events < 3 months after the introduction of ICIs (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic value of the International Society of Cardio-Oncology (IC-OS) definition for suspected immune checkpoint inhibitor-associated myocarditis\",\"authors\":\"F. Deharo, J. Cautela, F. Thuny, M. Gaubert, F. Paganelli, N. Resseguier, F. Cadour, J. Alexandre, C. Dolladille\",\"doi\":\"10.1016/j.acvdsp.2023.04.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>The diagnosis of immune checkpoint inhibitor-associated myocarditis (ICI-M) is challenging. Recently, the International Society of Cardio-Oncology (IC-OS) proposed an empirical definition of ICI-M; however, this definition has never been validated. We aimed to assess the diagnostic value at admission of the IC-OS definition in a cohort of patients with suspected ICI-M and to determine whether the addition of other criteria to this definition would improve its performance.</p></div><div><h3>Method</h3><p>Between May 2017 and November 2021, all patients with suspected ICI-M were consecutively included in a multicenter cohort. The final diagnosis was the one recorded in the patient's electronic medical record, established within one month of hospital discharge by the expert cardio-oncology team that managed the patient.</p></div><div><h3>Results</h3><p>Of the 68 patients included, 45 patients presented with ICI-M. The sensitivity, specificity, and positive and negative likelihood ratios of the IC-OS definition were 93% (95% CI: 82%–99%), 70% (95% CI: 47%–87%), 3.1 (95% CI: 1.7–5.7), and 0.1 (95% CI: 0–0.3), respectively. A delay in the onset of the first events < 3 months after the introduction of ICIs was the only variable that was both significantly associated with the final diagnosis of ICI-M and did not already meet the criteria of the IC-OS definition (72% vs. 52%, <em>P</em> <!-->=<!--> <!-->0.03). By including this variable as a new minor criterion and increasing the number of minor criteria for defining ICI-M to 3, the specificity increased from 70% to 83% (<em>P</em> <!-->=<!--> <!-->0.08), and the sensitivity remained unchanged (93%).</p></div><div><h3>Conclusion</h3><p>The IC-OS definition for the diagnosis of ICI-M showed excellent sensitivity and moderate specificity. The latter could be increased by a modified definition including the time of the onset of the first events < 3 months after the introduction of ICIs (<span>Fig. 1</span>).</p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S187864802300160X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S187864802300160X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Diagnostic value of the International Society of Cardio-Oncology (IC-OS) definition for suspected immune checkpoint inhibitor-associated myocarditis
Introduction
The diagnosis of immune checkpoint inhibitor-associated myocarditis (ICI-M) is challenging. Recently, the International Society of Cardio-Oncology (IC-OS) proposed an empirical definition of ICI-M; however, this definition has never been validated. We aimed to assess the diagnostic value at admission of the IC-OS definition in a cohort of patients with suspected ICI-M and to determine whether the addition of other criteria to this definition would improve its performance.
Method
Between May 2017 and November 2021, all patients with suspected ICI-M were consecutively included in a multicenter cohort. The final diagnosis was the one recorded in the patient's electronic medical record, established within one month of hospital discharge by the expert cardio-oncology team that managed the patient.
Results
Of the 68 patients included, 45 patients presented with ICI-M. The sensitivity, specificity, and positive and negative likelihood ratios of the IC-OS definition were 93% (95% CI: 82%–99%), 70% (95% CI: 47%–87%), 3.1 (95% CI: 1.7–5.7), and 0.1 (95% CI: 0–0.3), respectively. A delay in the onset of the first events < 3 months after the introduction of ICIs was the only variable that was both significantly associated with the final diagnosis of ICI-M and did not already meet the criteria of the IC-OS definition (72% vs. 52%, P = 0.03). By including this variable as a new minor criterion and increasing the number of minor criteria for defining ICI-M to 3, the specificity increased from 70% to 83% (P = 0.08), and the sensitivity remained unchanged (93%).
Conclusion
The IC-OS definition for the diagnosis of ICI-M showed excellent sensitivity and moderate specificity. The latter could be increased by a modified definition including the time of the onset of the first events < 3 months after the introduction of ICIs (Fig. 1).
期刊介绍:
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.