{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T01:54:46Z","timestamp":1794275686853,"version":"4.9.0"},"reference-count":73,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"\n Importance<\/jats:title>\n The introduction of immune checkpoint inhibitor (ICI) therapy has improved cancer outcomes but at the cost of adverse events, mainly related to the immune system. Cardiovascular (CV) toxic effects, and especially myocarditis, are of particular concern and are the subject of this position statement by the International Cardio-Oncology Society with representation of experts from oncology, hematology, and cardiology.<\/jats:p>\n <\/jats:sec>\n \n Observations<\/jats:title>\n CV toxic effects of ICI therapies include inflammation-associated diseases, such as myocarditis, pericarditis, and vasculitis, as well as the aggravation of chronic inflammatory conditions, such as atherosclerosis with acute ischemic complications (myocardial infarction and stroke). Patients taking ICI therapies can also develop cardiac dysfunction, stress-induced cardiomyopathy (Takotsubo or apical ballooning syndrome), and heart failure without inflammatory cell infiltration of the myocardium. Atrial and ventricular arrhythmias can emerge in the setting of a systemic inflammatory milieu, myocarditis, or ischemia. Of all potential CV adverse effects, myocarditis remains of highest concern, although fatality rates have declined over time with a broadening spectrum of presentations ranging from troponin elevation of uncertain significance to smoldering, nonsevere, and severe or fulminant myocarditis.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Concerns for myocarditis continue to dominate the spectrum of CV toxic effects in patients receiving ICI therapy. Recommendations for management vary according to severity. Multidisciplinary collaborations remain key for managing acute toxic effects and future cancer treatment decisions, including ICI rechallenge. Ischemic heart disease constitutes the main differential diagnosis in these patients, while pericarditis can be concomitantly present, and atrial and ventricular arrhythmias can also complicate the clinical picture. Several gaps in knowledge are identified and require further research.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.4543","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T16:00:35Z","timestamp":1763049635000},"page":"90","source":"Crossref","is-referenced-by-count":53,"title":["Immune Checkpoint Inhibitor\u2013Associated Cardiovascular Toxic Effects"],"prefix":"10.1001","volume":"12","author":[{"given":"Joerg","family":"Herrmann","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Barac","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Inova Schar Heart and Vascular, Inova Health, Fairfax, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Carver","sequence":"additional","affiliation":[{"name":"Thalheimer Center for Cardio-Oncology at the Abramson Cancer Center, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard K.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Daniele","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Department, Roffo Institute, Buenos Aires University, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Dent","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Program, Division of Medical Oncology, Department of Medicine, University of Rochester, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Deych","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Center of Excellence, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Section, Division of Cardiovascular Disease, Department of Medicine, University of South Florida, Tampa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lenihan","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Center of Excellence, Saint Francis Healthcare, Cape Girardeau, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl P.","family":"Leong","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Liu","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Lopez-Fernandez","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Unit, Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Lyon","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Centre of Excellence, Royal Brompton Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fradley","sequence":"additional","affiliation":[{"name":"Thalheimer Center of Cardio-Oncology, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane V. 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