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The same autoimmune process that causes ICI myocarditis can manifest concurrent generalized myositis, myasthenia-like syndrome, and respiratory muscle failure. Prognostic factors for this \u2018cardiomyotoxicity\u2019 are lacking. The main aim of this study was to determine predictors and construct a risk score associated with negative outcomes in patients admitted for ICI myocarditis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicentre registry collected data retrospectively from 17 countries between 2014 and 2023. A multivariable Cox regression model was used to determine risk factors for the primary composite outcome: time to severe arrhythmia, heart failure, respiratory muscle failure, and\/or cardiomyotoxicity-related death. Covariates included demographics, comorbidities, cardiomuscular symptoms, diagnostics, and treatments. Time-dependent covariates were used, and missing data were imputed. A point-based prognostic risk score was derived and externally validated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 748 patients (67% male, age 23\u201394 years), 30-day incidence of the primary composite outcome, cardiomyotoxic death, and overall death were 33%, 13%, and 17%, respectively. By multivariable analysis, the primary composite outcome was associated with active thymoma (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7\u20137.7), presence of cardiomuscular symptoms (HR 2.6 [1.5\u20134.2]), low QRS voltage on presenting electrocardiogram (HR for \u22640.5\u2005mV vs &amp;gt;1\u2005mV 1.9 [1.1\u20133.1]), left ventricular ejection fraction (LVEF) &amp;lt; 50% (HR 1.7 [1.1\u20132.6]), and incremental troponin elevation (HR 1.8 [1.4\u20132.4], 2.9 [1.8\u20134.7], and 4.6 [2.3\u20139.3], for 20, 200, and 2000-fold above upper reference limit, respectively). A prognostic risk score developed using these parameters showed good performance; 30-day primary outcome incidence increased gradually from 4% (risk score = 0) to 81% (risk score \u2265 4). This risk score was externally validated in two independent French and US cohorts. This risk score was used prospectively in the external French cohort to identify low-risk patients who were managed with no immunosuppression resulting in no cardiomyotoxic events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ICI-associated myocarditis can manifest with high morbidity and mortality. Myocarditis severity is associated with magnitude of troponin, thymoma, low QRS voltage, depressed LVEF, and cardiomuscular symptoms. A risk score incorporating these features performed well.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>NCT04294771 and NCT05454527.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehaf315","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T06:29:08Z","timestamp":1745476148000},"page":"1050-1062","source":"Crossref","is-referenced-by-count":85,"title":["Immune checkpoint inhibitor-associated myocarditis: a novel risk score"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4254-4447","authenticated-orcid":false,"given":"John R","family":"Power","sequence":"first","affiliation":[{"name":"University of California San Diego 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