Immune Checkpoint Inhibitor-Related Myocarditis: Recognition Surveillance, and Management

BACKGROUND: Immune checkpoint inhibitor (ICI) therapy is an effective treatment for many patients. Although rare, immune-mediated cardiovascular adverse events can occur, including myocarditis. OBJECTIVES: This article provides an overview of the incidence, proposed pathophysiology, and current surveillance for myocarditis in patients receiving ICI therapy. METHODS: A literature search was conducted using PubMed (R), CINAHL (R), and Scopus (R) for articles published from 2016 through 2021 to evaluate current recognition, surveillance, and management protocols for ICI-related myocarditis. A case study illustrates the challenges in managing patients experiencing ICI-related cardiac adverse events. FINDINGS: The incidence of myocarditis in patients treated with ICI therapy is 0.04%-1.14%, but it carries a high mortality rate of 25%-50%. A baseline cardiac evaluation and scheduled surveillance throughout therapy is recommended, particularly for patients with cardiovascular risk factors. Through continuing education and proper training, clinicians and nursing staff can recognize and promptly diagnose immune-related cardiac adverse events.