Cardiovascular adverse effects of immune checkpoint inhibitors

Immune checkpoint inhibitors (ICI) are approved as first-line therapy for multiple cancers and significantly improve patients’ prognoses. However, they can also cause immune-related adverse events, among which cardiac adverse events are rare but highly lethal. Therefore, it is important to understand the spectrum of cardiac manifestations, because early detection and treatment are crucial to reduce the mortality. While myocarditis is the most common cardiac adverse event, other manifestations include takotsubo and dilated cardiomyopathy, pericarditis, pericardial effusion, cardiac tamponade, arrhythmia, giant cell arteritis, and atherosclerosis. Incidence ranges from 3.1% with monotherapy to 5.8% with combination therapy. Mortality reaches up to 50% in myocarditis and 26% in arrhythmia. Risk factors include older age, male gender, black race, and cardiovascular disease, but combination therapy is the most established predictor of cardiac adverse events. This article aims to present the spectrum of ICI cardiac adverse events and epidemiological data regarding those therapy complications.