{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:31:32Z","timestamp":1753878692634,"version":"3.41.2"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001252","name":"Mount Zion Health Fund","doi-asserted-by":"publisher","award":["#20170788"],"award-info":[{"award-number":["#20170788"]}],"id":[{"id":"10.13039\/100001252","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Immune checkpoint inhibitor (ICI) anti\u2010tumor therapy is commonly associated with reports of significant fatigue. Whether ICI\u2010induced fatigue is linked to subclinical cardiac toxicity is not well understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a prospective observational study to monitor cardiac function following initiation of ICI in cancer patients. Rest and staged exercise stress transthoracic echocardiograms (TTE) were captured at baseline, 3 and 6 months after ICI initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen patients completed baseline testing, of whom 10 completed 3 month testing and 8 completed 6 month testing. Patients had elevated fatigue as per Common Terminology Criteria for Adverse Events (CTCAE) criteria and FACIT\u2010Fatigue subscale scores (47.5 [42.5\u201352] vs. 47 [38\u201348], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001). Among resting echocardiographic parameters, left ventricular (LV) outflow tract velocity time integral (VTI) was reduced at 6 months (22.6\u00a0cm [21.2\u201324.5] vs. 19.8\u00a0cm [17.2\u201321.2], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001), albeit still within normal range. Measures of biventricular size and systolic function, along with LV global longitudinal strain (GLS) and LA global strain, were not significantly changed. Among exercise parameters, peak heart rate was reduced at 6 months (143.4\u00a0bpm [128.5\u2013153.5] vs. 123.5 [110.2\u2013130.8], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.048); of those who completed 6 month testing, two (29%) were unable to achieve the previous peak stage of exercise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients starting ICI, statistically\u2010significant reductions in cardiac systolic function (LVOT VTI) and peak HR were observed, with nearly one\u2010third unable to achieve peak exercise at 6 months. This finding, combined with reported fatigue and lack of changes to biventricular systolic functional measures, suggests induced functional cardiac limitations are due to deconditioning, rather than cardiotoxicity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.70158","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T17:41:58Z","timestamp":1744134118000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Longitudinal Evaluation of Immune Checkpoint Inhibitor\u2010Induced Fatigue Syndrome by Rest, Stress, and Speckle\u2010Tracking Strain Echocardiography"],"prefix":"10.1111","volume":"42","author":[{"given":"Katy K.","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Hematology\/Oncology University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3009-6678","authenticated-orcid":false,"given":"Andrew Y.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Medicine Section of Cardiovascular Medicine Yale University  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane M.","family":"Abouzeid","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology University of Southern California  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandar A.","family":"Aras","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qizhi","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dwight","family":"Bibby","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leila","family":"Haghighat","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology University of California San Francisco  San Francisco California USA"},{"name":"Sutter Health Palo Alto Medical Foundation  Burlingame California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joan F.","family":"Hilton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adil I.","family":"Daud","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematology\/Oncology University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelson B.","family":"Schiller","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology University of California San Francisco  San Francisco California 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