Troponin for surveillance of immune checkpoint inhibitor–associated myocarditis and post-therapy cardiovascular risk stratification: a systematic review and meta-analysis - Summary - MDSpire
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Troponin for surveillance of immune checkpoint inhibitor–associated myocarditis and post-therapy cardiovascular risk stratification: a systematic review and meta-analysis
To evaluate the performance of cardiac troponin in the surveillance and identification of ICI-associated myocarditis and to assess its prognostic value for major adverse cardiovascular events (MACE) and mortality.
Approach:
Systematic Review and Meta-Analysis: Conducted in accordance with PRISMA 2020 guidelines, searching databases for studies evaluating troponin in adults receiving ICIs.
Key Findings:
Troponin elevation was associated with confirmed ICI-associated myocarditis (pooled log OR 4.14, 95% CI 2.80–5.48).
False-positive troponin elevations were common, leading to modest positive predictive value despite high sensitivity.
Elevated troponin levels were linked to increased risk of MACE (pooled HR 6.14, 95% CI 3.61–10.45) and all-cause mortality (pooled HR 1.95, 95% CI 1.36–2.81).
Interpretation:
Troponin elevation is associated with ICI-related myocarditis and increased risk of adverse cardiovascular outcomes and mortality.
Limitations:
Common false-positive elevations in troponin.
Diagnostic performance varies by assay type, threshold, and timing.
Need for prospective studies to define optimal troponin-guided surveillance strategies.
Conclusion:
Troponin should not be interpreted as a standalone diagnostic test due to variability in performance and the prevalence of false positives.
