Immune Checkpoint Inhibitor-Induced Myocarditis vs. COVID-19 Vaccine-Induced Myocarditis—Same or Different?

• Published in: Life (Basel, Switzerland) Vol. 12; no. 9; p. 1366
• Main Authors: Zornitzki, Lior, Havakuk, Ofer, Rozenbaum, Zach, Viskin, Dana, Arbel, Yaron, Flint, Nir, Arnold, Joshua, Waissengein, Barliz, Wolf, Ido, Banai, Shmuel, Topilsky, Yan, Laufer-Perl, Michal
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01-09-2022; MDPI
• Subjects: Antigens; Calcium-binding protein; cardio-oncology; Coronaviruses; COVID-19; COVID-19 vaccines; Dyspnea; Electrocardiography; Fever; Flow velocity; Heart; Heart diseases; Heart failure; Hospitalization; ICIs; Immune checkpoint inhibitors; Immune system; Inhibitors; Laboratories; Myocarditis; Pain; Patients; Respiration; Software; speckle strain; Troponin; Troponin I; vaccine; Vaccines; Variables; Variance analysis; Ventricle; Viral diseases; Germany
• ISSN: 2075-1729; 2075-1729
• DOI: 10.3390/life12091366

Immune checkpoint inhibitor (ICI) and coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis possibly share common mechanisms secondary to overactivation of the immune system. We aimed to compare the presenting characteristics of ICIs and COVID-19 vaccine-induced myocarditis. We performed a retrospective analysis of characteristics of patients diagnosed with either ICIs or COVID-19 vaccine-induced myocarditis and compared the results to a control group of patients diagnosed with acute viral myocarditis. Eighteen patients diagnosed with ICIs (ICI group) or COVID-19 vaccine (COVID-19 vaccine group)-induced myocarditis, and 20 patients with acute viral myocarditis (Viral group) were included. The ICI group presented mainly with dyspnea vs. chest pain and fever among the COVID-19 vaccine and Viral groups. Peak median high sensitivity Troponin I was markedly lower in the ICI group (median 619 vs. 15,527 and 7388 ng/L, p = 0.004). While the median left ventricular (LV) ejection fraction was 60% among all groups, the ICI group had a lower absolute mean LV global longitudinal strain (13%) and left atrial conduit strain (17%), compared to the COVID-19 vaccine (17% and 30%) and Viral groups (18% and 37%), p = 0.016 and p = 0.001, respectively. Despite a probable similar mechanism, ICI-induced myocarditis’s presenting characteristics differed from COVID-19 vaccine-induced myocarditis.