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

F. Deharo, J. Cautela, F. Thuny, M. Gaubert, F. Paganelli, N. Resseguier, F. Cadour, J. Alexandre, C. Dolladille
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引用次数: 0

摘要

免疫检查点抑制剂相关性心肌炎(ICI-M)的诊断具有挑战性。最近,国际心脏肿瘤学会(IC-OS)提出了ICI-M的实证定义;然而,这一定义从未得到验证。我们的目的是评估一组疑似ci - m患者入院时采用IC-OS定义的诊断价值,并确定在此定义中加入其他标准是否会改善其表现。方法在2017年5月至2021年11月期间,将所有疑似ci - m患者连续纳入多中心队列。最终诊断记录在患者的电子病历中,由管理患者的心脏肿瘤学专家团队在出院后一个月内建立。结果纳入的68例患者中,45例出现ICI-M。IC-OS定义的敏感性、特异性和阳性和阴性似然比分别为93% (95% CI: 82%-99%)、70% (95% CI: 47%-87%)、3.1 (95% CI: 1.7-5.7)和0.1 (95% CI: 0-0.3)。最初事件发生的延迟<引入ici后3个月是唯一与ICI-M最终诊断显著相关且尚未达到IC-OS定义标准的变量(72%对52%,P = 0.03)。通过将该变量作为一个新的次要标准,并将定义ICI-M的次要标准增加到3个,特异性从70%提高到83% (P = 0.08),敏感性保持不变(93%)。结论IC-OS定义诊断ICI-M具有良好的敏感性和中等的特异性。后者可以通过包括第一事件发生时间的修改定义来增加;ICIs引入后3个月(图1)。
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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).

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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
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发文量
508
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.
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