{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:00:03Z","timestamp":1789758003400,"version":"4.0.1"},"reference-count":25,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Associazione Italiana per la Ricerca sul Cancro","award":["IG Grant 24988"],"award-info":[{"award-number":["IG Grant 24988"]}]},{"name":"CRI Lloyd J. Old STAR","award":["CRI award 3914"],"award-info":[{"award-number":["CRI award 3914"]}]},{"name":"AIRC 5\u00d71000 program","award":["UniCanVax 22757"],"award-info":[{"award-number":["UniCanVax 22757"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2025,3,7]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) revolutionized cancer therapy, yet require management of immune-related adverse events (irAEs). Fulminant myocarditis is a rare irAE, but lower-severity cardiac events are being reported more frequently, leading to an unmet need for irAE prevention, early diagnosis, and treatment, especially for long-life-expectancy patients. We recruited 57 patients, stratified according to therapy regime (monotherapy (30%) or combination (33%) cohort) or history of cardiac disease or presence of at least two cardiovascular risk factors other than prior or active smoking (cardiovascular cohort (37%)). We performed a complete cardiological assessment with clinical visit, 12-lead ECG, multiparametric cardiac MRI as well as peripheral blood mononuclear cell immunophenotyping, prior to ICI initiation and around 2\u2009months later. ICI treatment was associated with a significant left ventricular ejection function (LVEF) reduction pre-ICI versus post-ICI treatment (60.1\u00b18%\u2009to 58.1\u00b18%, p=0.002, paired t-test) and more than 3% LVEF loss in a substantial proportion of patients (18; 32%). These patients also showed significantly higher T2 values (p=0.037, unpaired t-test), putative sign of cardiac edema. The loss of cardiac function did not differ among patients with different tumor types, therapy regimes or history of cardiac disease. Immunophenotyping analyses showed a reduction of programmed cell death protein 1 staining on both CD4<jats:sup>+<\/jats:sup> and CD8<jats:sup>+<\/jats:sup> T cells, and an upregulation of HLA-DR on CD8<jats:sup>+<\/jats:sup> T cells. Using a very sensitive and comprehensive approach in patients unselected for cardiac history, we found a subclinical but significant LVEF decrease. These findings may inform ongoing discussions on optimal management of cardiac irAEs in patients undergoing ICI treatment and warrant further evaluation.<\/jats:p>","DOI":"10.1136\/jitc-2024-010568","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T05:17:48Z","timestamp":1742534268000},"page":"e010568","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Cardiac MRI study of adverse events in patients treated with immune checkpoint inhibitors: a prospective cohort study of cardiac adverse events"],"prefix":"10.1136","volume":"13","author":[{"given":"Agnese","family":"Losurdo","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy"},{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), 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