Articol susținut de S.N.O.M.R.

Ileana-Raluca Pătru^1,2, Andreea-Iuliana Ionescu^1,2,3,*, Alina Gabriela Negru⁴, Alexandra-Valentina Anghel², Maria Iordache^1,2, Oana Georgiana Becheru², Ilinca Arina Baranescu², Ioana Livia Barascu², Dimitrie Ionut Atasiei^2,5 and Ionut-Lucian Antone-Iordache^2,3

1. Medical Oncology Department, Coltea Clinical Hospital, 030167 Bucharest, Romania; ileana-raluca.patru@drd.umfcd.ro (I.-R.P.); maria.malai@drd.umfcd.ro (M.I.)
2. Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; alexandra-valentina.anghel@stud.umfcd.ro; oanageorgiana.becheru0720@stud.umfcd.ro; ilinca-arina.baranescu0720@stud.umfcd.ro; ioana-livia.barascu0720@stud.umfcd.ro; dimitrie-ionut.atasiei25@rez.umfcd.ro; ionut-lucian.antone-iordache@drd.umfcd.ro;
3. Radiotherapy Department, Coltea Clinical Hospital, 030167 Bucharest, Romania
4. Cardiology Department, University of Medicine and Pharmacy “Victor Babes” Timişoara, 300041 Timişoara, Romania;alinanegru@umft.ro
5. Neurosurgery Department, Emergency Clinical Hospital “Sf. Pantelimon”, 021659 Bucharest, Romania
* Correspondence: andreea-iuliana.ionescu@umfcd.ro; Tel.:0743893122

J. Clin. Med. - ISSN 2077-0383

DOI: https://doi.org/10.3390/jcm15051763

Abstract:
Background/Objectives: Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs), including cardiac toxicities, which may have significant clinical impact. Data regarding predictors of immune-mediated cardiac toxicity remain limited. The aim of this study was to evaluate the association between cardiovascular comorbidities and the development of cardiac irAEs, as well as to assess their potential role in predicting non-cardiac irAEs.
Methods:
We conducted a retrospective observational study including oncological patients treated with immune checkpoint inhibitors at Colt, ea Clinical Hospital. Patients with complete clinical data and documented cardiac and non-cardiac irAEs were included. Demographic characteristics, prior oncological treatments, cardiovascular comorbidities, and relevant clinical parameters were analyzed. Univariate and multivariate logistic regression analyses were performed to identify predictors of immune-related adverse events.
Results:
Hypercholesterolemia, atrial fibrillation, history of acute coronary syndrome, and heart failure were significantly associated with the devel-opment of cardiac irAEs. In multivariate analysis, hypercholesterolemia and pre-existing cardiovascular disease remained independent predictors of cardiac toxicity. No significant association was observed between non-cardiac irAEs and cardiac irAEs. The predictive model demonstrated high specificity but moderate sensitivity.
Conclusions:
This study provides evidence that pre-existing cardiovascular comorbidities play a significant role in the development of immune-related cardiac adverse events in patients treated with immune checkpoint inhibitors. Hypercholesterolemia, atrial fibrillation, prior acute coronary syndrome, and heart failure were identified as the main factors associated with an increased risk of cardiac irAEs, supporting the hypothesis that cardiac toxicity occurs preferentially in a previously vulnerable cardiovascular setting. The predictive model demonstrated high specificity, suggesting that patients without pre-existing cardiovascular disease are unlikely to develop immune-mediated cardiac toxicity. However, the modest sensitivity indicates that additional biological or clinical factors may contribute to the pathogenesis of cardiac irAEs and remain to be identified. Notably, non-cardiac irAEs were not associated with cardiac toxicity, supporting the concept that cardiac irAEs represent a distinct clinical entity rather than part of a generalized immune activation pattern. These findings underscore the importance of careful cardiovascular assessment prior to initiation of immunotherapy and support the need for tailored monitoring strategies in patients with known cardiovascular comorbidities. Further prospective studies and external validation cohorts are warranted to refine risk-stratification models and elucidate the mechanisms underlying immune-related cardiotoxicity.