{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:20Z","timestamp":1787008700263,"version":"build-2736575974"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) are increasingly used in oncology and can cause immune-related adverse events, including cardiotoxicity. Discrepancies between cardiac troponin T (cTnT) and cardiac troponin I (cTnI) have been described in ICI-associated myositis with otherwise normal cardiac findings and may help differentiate myositis from myocarditis. In this case, cTnT elevation was first detected on routine troponin testing performed because myocarditis is a recognized immune-related adverse event of nivolumab, despite the absence of typical cardiac symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 72-year-old man receiving nivolumab developed marked cTnT elevation. He was referred to cardiology for suspected ICI-related myocarditis. Cardiac MRI was unremarkable. Because of cardiovascular risk factors and unexplained troponinaemia, coronary angiography was performed and revealed an 80% stenosis of the LAD, which was treated with a drug-eluting stent. Post-intervention, cTnT continued to rise while cTnI remained normal on repeated measurements. Differential diagnoses included myositis, myocarditis, and in-stent thrombosis. Taken together, the clinical, imaging, and biomarker findings, in particular the troponin T\/I discrepancy, made a cardiac cause of cTnT elevation unlikely. Immune-mediated myositis was confirmed, and mycophenolate mofetil therapy led to clinical and biochemical improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case may expand current knowledge by showing that, in an ICI-treated patient, troponin T\/I discrepancy may not only help differentiate myositis from myocarditis but also assist in distinguishing skeletal muscle involvement from other cardiac causes, including ACS and in-stent thrombosis. Recognition of this pattern may improve diagnostic accuracy and guide appropriate therapeutic strategies in oncological patients presenting with troponinaemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag216","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T18:27:11Z","timestamp":1773858431000},"source":"Crossref","is-referenced-by-count":2,"title":["Troponin T\/I discordance in immune checkpoint inhibitor myositis in a patient with ischaemic cardiac disease: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5668-3600","authenticated-orcid":false,"given":"Ali","family":"El-Hisnawi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Vivantes Klinikum Neuk\u00f6lln , Rudower Stra\u00dfe 48, Berlin 12351 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-4521","authenticated-orcid":false,"given":"Giuseppe","family":"D'Ancona","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Vivantes Klinikum Am Urban , Dieffenbachstra\u00dfe 1, Berlin 10967 ,","place":["Germany"]},{"name":"Department of Cardiology, General Internal, Medicine and Conservative Intensive Care Medicine , Dieffenbachstra\u00dfe 1, 10967 Berlin-Kreuzberg ,","place":["Germany"]},{"name":"Department and Outpatient Clinic of Cardiology , Ernst-Heydemann-Stra\u00dfe 6, 18057 Rostock ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Heinze","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Vivantes Klinikum Neuk\u00f6lln , Rudower Stra\u00dfe 48, Berlin 12351 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Steinicke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Vivantes Klinikum Neuk\u00f6lln , Rudower Stra\u00dfe 48, Berlin 12351 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fcseyin","family":"Ince","sequence":"additional","affiliation":[{"name":"Vivantes Klinikum Neuk\u00f6lln Department of Cardiology, , Rudower Stra\u00dfe 48, Berlin 12351 ,","place":["Germany"]},{"name":"Department of Cardiology, General Internal, Medicine and Conservative Intensive Care Medicine , Dieffenbachstra\u00dfe 1, 10967 Berlin-Kreuzberg ,","place":["Germany"]},{"name":"Department and Outpatient Clinic of Cardiology , Ernst-Heydemann-Stra\u00dfe 6, 18057 Rostock ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026051107564860900_ytag216-B1","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1016\/j.jacc.2018.01.070","article-title":"Elevated cardiac troponin T in patients with skeletal myopathies","volume":"71","author":"Schmid","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026051107564860900_ytag216-B2","doi-asserted-by":"crossref","first-page":"102462","DOI":"10.1016\/j.jaccas.2024.102462","article-title":"Elevated troponin T in immune-checkpoint inhibitor myositis: a case of mistaken myocarditis","volume":"29","author":"Beaulieu","year":"2024","journal-title":"JACC Case Rep"},{"key":"2026051107564860900_ytag216-B3","doi-asserted-by":"crossref","first-page":"6634","DOI":"10.1038\/s41598-024-57185-w","article-title":"Troponin T is elevated in a relevant proportion of patients with 5q-associated spinal muscular atrophy","volume":"14","author":"Lapp","year":"2024","journal-title":"Sci Rep"},{"key":"2026051107564860900_ytag216-B4","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1242\/dev.110.2.547","article-title":"Cardiac troponin T in developing, regenerating and denervated rat skeletal muscle","volume":"110","author":"Saggin","year":"1990","journal-title":"Development"},{"key":"2026051107564860900_ytag216-B5","doi-asserted-by":"crossref","first-page":"1197364","DOI":"10.3389\/fimmu.2023.1197364","article-title":"Immune-related adverse effects of checkpoint immunotherapy and implications for the treatment of patients with cancer and autoimmune diseases","volume":"14","author":"Ibis","year":"2023","journal-title":"Front Immunol"},{"key":"2026051107564860900_ytag216-B6","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3390\/diagnostics12020399","article-title":"Cardiovascular magnetic resonance in myocarditis","volume":"12","author":"Polte","year":"2022","journal-title":"Diagnostics"}],"container-title":["European Heart Journal - 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