TY - JOUR T1 - Electrocardiographic features of immune checkpoint inhibitor associated myocarditis JF - Journal for ImmunoTherapy of Cancer JO - J Immunother Cancer DO - 10.1136/jitc-2020-002007 VL - 9 IS - 3 SP - e002007 AU - Daniel A Zlotoff AU - Malek Z O Hassan AU - Amna Zafar AU - Raza M Alvi AU - Magid Awadalla AU - Syed S Mahmood AU - Lili Zhang AU - Carol L Chen AU - Stephane Ederhy AU - Ana Barac AU - Dahlia Banerji AU - Maeve Jones-O'Connor AU - Sean P Murphy AU - Merna Armanious AU - Brian J Forrestal AU - Michael C Kirchberger AU - Otavio R Coelho-Filho AU - Muhammad A Rizvi AU - Gagan Sahni AU - Anant Mandawat AU - Carlo G Tocchetti AU - Sarah Hartmann AU - Hannah K Gilman AU - Eduardo Zatarain-Nicolás AU - Michael Mahmoudi AU - Dipti Gupta AU - Ryan Sullivan AU - Sarju Ganatra AU - Eric H Yang AU - Lucie M Heinzerling AU - Franck Thuny AU - Leyre Zubiri AU - Kerry L Reynolds AU - Justine V Cohen AU - Alexander R Lyon AU - John Groarke AU - Paaladinesh Thavendiranathan AU - Anju Nohria AU - Michael G Fradley AU - Tomas G Neilan Y1 - 2021/03/01 UR - http://jitc.bmj.com/content/9/3/e002007.abstract N2 - Background Myocarditis is a highly morbid complication of immune checkpoint inhibitor (ICI) use that remains inadequately characterized. The QRS duration and the QTc interval are standardized electrocardiographic measures that are prolonged in other cardiac conditions; however, there are no data on their utility in ICI myocarditis.Methods From an international registry, ECG parameters were compared between 140 myocarditis cases and 179 controls across multiple time points (pre-ICI, on ICI prior to myocarditis, and at the time of myocarditis). The association between ECG values and major adverse cardiac events (MACE) was also tested.Results Both the QRS duration and QTc interval were similar between cases and controls prior to myocarditis. When compared with controls on an ICI (93±19 ms) or to baseline prior to myocarditis (97±19 ms), the QRS duration prolonged with myocarditis (110±22 ms, p<0.001 and p=0.009, respectively). In contrast, the QTc interval at the time of myocarditis (435±39 ms) was not increased compared with pre-myocarditis baseline (422±27 ms, p=0.42). A prolonged QRS duration conferred an increased risk of subsequent MACE (HR 3.28, 95% CI 1.98 to 5.62, p<0.001). After adjustment, each 10 ms increase in the QRS duration conferred a 1.3-fold increase in the odds of MACE (95% CI 1.07 to 1.61, p=0.011). Conversely, there was no association between the QTc interval and MACE among men (HR 1.33, 95% CI 0.70 to 2.53, p=0.38) or women (HR 1.48, 95% CI 0.61 to 3.58, p=0.39).Conclusions The QRS duration is increased in ICI myocarditis and is associated with increased MACE risk. Use of this widely available ECG parameter may aid in ICI myocarditis diagnosis and risk-stratification. ER -