Troponin for surveillance of immune checkpoint inhibitor–associated myocarditis and post-therapy cardiovascular risk stratification: a systematic review and meta-analysis - Report - MDSpire

Troponin for surveillance of immune checkpoint inhibitor–associated myocarditis and post-therapy cardiovascular risk stratification: a systematic review and meta-analysis

  • By

  • Ahmed J. Alaraibi

  • Mustafa Alani

  • Layla Al-Nooh

  • Nairouz Quateen

  • Lulwa Al-Qallaf

  • Retaj Al-Azemi

  • Mohammed Taqi

  • Abdullatif Alfehaid

  • Paul Murray

  • June 26, 2026

  • 0 min

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Clinical Report: Utilizing Troponin for Monitoring Myocarditis Linked to ICIs

Overview

This comprehensive review and meta-analysis evaluates the role of cardiac troponin in identifying immune checkpoint inhibitor (ICI)-associated myocarditis.

Background

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but can lead to severe immune-related adverse events, including myocarditis. This condition, although rare, carries high morbidity and mortality and presents diagnostic challenges due to nonspecific symptoms. Understanding the role of cardiac troponin as a biomarker in this context is crucial for early detection.

Data Highlights

OutcomePooled Effect EstimateConfidence Interval
Troponin elevation and ICI-associated myocarditis4.142.80–5.48
Troponin elevation and MACE6.143.61–10.45
Troponin elevation and all-cause mortality1.951.36–2.81

Key Findings

  • Troponin elevation is significantly associated with confirmed ICI-associated myocarditis.
  • False-positive troponin elevations are common, leading to modest positive predictive value.
  • Elevated troponin levels correlate with increased risk of major adverse cardiovascular events (MACE).
  • Elevated troponin levels are associated with higher all-cause mortality.
  • Diagnostic performance of troponin varies by assay type, threshold, and timing.

Clinical Implications

Cardiac troponin serves as a biomarker for evaluation in patients receiving ICIs. Clinicians should be aware of false-positive results.

Conclusion

Troponin elevation in ICI-treated patients is linked to myocarditis and cardiovascular outcomes.

Related Resources & Content

  1. Frontiers | Troponin for Surveillance of Immune Checkpoint Inhibitor–Associated Myocarditis and Post-Therapy Cardiovascular Risk Stratification: A Systematic Review and Meta-Analysis
  2. 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee | JACC
  3. The ASCO Post — Early Myocarditis After Immune Checkpoint Inhibitors Signals Elevated Mortality Risk
  4. The ASCO Post — Studies Explore Cardiac Risks and Clinical Characteristics Associated With Immune Checkpoint Inhibitor–Related Myocarditis
  5. Frontiers in Immunology — Mechanisms and biomarkers of immune checkpoint inhibitor-associated myocarditis: from T cell imbalance to multicellular crosstalk
  6. Basic Research in Cardiology — Molecular Signatures of Cardiovascular Toxicity Linked to Immune Checkpoint Inhibitors
  7. 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee | JACC
  8. Frontiers | Troponin for Surveillance of Immune Checkpoint Inhibitor–Associated Myocarditis and Post-Therapy Cardiovascular Risk Stratification: A Systematic Review and Meta-Analysis
  9. Real-world analysis of cardiovascular adverse events and risk factors after immune checkpoint inhibitor therapy | Cardio-Oncology | Springer Nature Link

Original Source(s)

Troponin for surveillance of immune checkpoint inhibitor–associated myocarditis and post-therapy cardiovascular risk stratification: a systematic review and meta-analysis

  • by Ahmed J. Alaraibi, Mustafa Alani, Layla Al-Nooh, Nairouz Quateen, Lulwa Al-Qallaf, Retaj Al-Azemi, Mohammed Taqi, Abdullatif Alfehaid, Paul Murray

  • June 26, 2026

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