{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:36:28Z","timestamp":1792791388438,"version":"4.5.0"},"reference-count":82,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Immune checkpoint inhibitors (ICIs), such as anti-programmed death (PD)-1 and anti-cytotoxic T-lymphocyte-associated protein (CTLA)-4 agents, have revolutionized oncology but are associated with immune-related adverse events (irAEs). Among these, ICI-associated myocarditis (ICI-M) is a rare but life-threatening complication, with mortality rates ranging from 27% to 50%. Objective: This narrative review summarizes the pathogenesis, epidemiology, clinical presentation, diagnostic methods, and management strategies for ICI-induced myocarditis, specifically highlighting emerging biomarkers and immunosuppressive therapeutic approaches. Results and Discussion: ICI-M typically presents within the first 65 days of treatment and is significantly more frequent with combination therapies. Pathologically, it is characterized by myocyte necrosis and massive infiltration of cluster of differentiation (CD)4+ and CD8+ T-cells, often overlapping with myositis (irM\/M). Diagnosis relies on a multimodal approach. Management requires immediate ICI cessation and initiation of high-dose corticosteroids as first-line therapy. For steroid-refractory cases, second-line options include mycophenolate mofetil (MMF), intravenous immunoglobulin (IVIG), and emerging therapies like abatacept and ruxolitinib. Rechallenge with ICIs after high-grade ICI-M must be approached with extreme caution by the multidisciplinary team (MDT). Emerging biomarkers and omics techniques hold promise for earlier diagnosis and risk stratification. Conclusions: ICI-M is a rare yet highly lethal cardiac complication demanding high clinical vigilance and timely diagnosis. Management hinges on an aggressive multidisciplinary approach, aiming to minimize toxicity while balancing oncological efficacy.<\/jats:p>","DOI":"10.3390\/jcm15020814","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:24:34Z","timestamp":1768901074000},"page":"814","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Immune Checkpoint Inhibitor-Associated Myocarditis: Risk, Diagnosis, and Clinical Impact"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7060-6938","authenticated-orcid":false,"given":"Alfredo","family":"Mauriello","sequence":"first","affiliation":[{"name":"S.C. Cardiology, Institute National Cancer, IRCCS, Foundation \u201cG. Pascale\u201d, Via M. Semmola 52, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Correra","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedali Riuniti University Hospital, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Chiara","family":"Maratea","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease, ASL Napoli 1 Centro, Via Comunale del Principe, 13\/a, 80145 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2137-0188","authenticated-orcid":false,"given":"Valeria","family":"Cetoretta","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital \u201cOspedali Riuniti\u201d, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5660-6162","authenticated-orcid":false,"given":"Giovanni","family":"Benfari","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of Verona, P.le L.A. Scuro 10, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-5093","authenticated-orcid":false,"given":"Federica","family":"Ilardi","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosangela","family":"Cocchia","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4591-2030","authenticated-orcid":false,"given":"Matteo","family":"Lisi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease\u2014AUSL Romagna, Division of Cardiology, Ospedale \u201cS. Maria delle Croci\u201d, Viale Randi 5, 48121 Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9119-4311","authenticated-orcid":false,"given":"Alessandro","family":"Malagoli","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Nephro-Cardiovascular Department, \u201cBaggiovara\u201d Hospital, Via P. Giardini 1355, 41100 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia Elena","family":"Mandoli","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Concetta","family":"Pastore","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Sperlongano","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Medical and Translational Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, \u201cI Policlinico\u201d Hospital, Piazza Luigi Miraglia 2, 80100 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Russo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Medical and Translational Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, \u201cV. 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