1 | 72 | M | myocarditis and cardiomyopathy | week 22 | Clinical findings: edema, ascites, pleural effusion, dyspnea | diuresis, steroids (1 mg/kg), life vest | good regression of symptoms under steroid therapy; slight permanent decrease in EF | thyroiditis, hypophysitis | Ipilimumab 3 mg/kg x 4 | Nivolumab 1 mg/kg x 4 followed by 3 mg/kg x 6 | PR | 22 |
ECHO: EF from 50 % down to 15 % und up again to 40 %; dilatation of heart |
Stress MRI: DCM, EF 15-23 %, no signs for ischemia |
Cardiac catheterization: no signs for ischemia |
Endomyocardial biopsy: interstitial inflammation mainly with lymphocytes and interstitial fibrosis |
2 | 68 | M | cardiomyophathy | week 12 | Clinical findings: dyspnea, edema | diuresis | resolved | none | Ipilimumab 3 mg/kg x 4 | no | PD | 40+ |
Echo: decrease of EF to 46 %; mild LV dysfunction; increased pulmonary pressures with moderate tricuspid regurgitation |
Endomyocardial biopsy: Myocyte hypertrophy, interstitial and perivascular fibrosis, mild focal subendocardial myocyte vacuolization. Focal fibrous endocardial thickening. |
Transmission electron microscopy: mild perinuclear accumulation of lysosomes, consistent with lipofuscin pigment deposition; increase of cytoplasmic glycogen and the number of mitochondria, without anomalous forms. |
Cardiac catheterization: no evidence of coronary artery disease, however, measurements of his right heart pressures suggested an RA pressure of 16, RV pressure of 67/10, wedge of 23 and PA pressures of 68/39 |
3 | 61 | M | myocardial fibrosis | week 4 | Clinical findings: no cardiologic symptoms | steroids (2 mg/kg), intensive care unit | fatal; massive autoimmune side effects could not be overcome | autoimmune hepatitis | Ipilimumab 3 mg/kg x 2 | no | died of side effects | 3 |
Endomyocardial biopsy: myocardial fibrosis identified at autopsy |
4 | 81 | M | heart failure | week 22 | Clinical findings: dyspnea | diuresis | permanent decrease in EF | colitis, hypophysitis | Ipilimumab 3 mg/kg x 3 | no | PR | 22+ |
ECHO: moderately-to-severely reduced left ventricular EF at 35 %; mildly dilated left ventricle; global hypokinesis with regional variation; akinetic basal inferior and inferoseptal segments |
5 | 23 | M | myocarditis/CHF | week 31 | Clinical findings: cardiogenic shock requiring dopamine and dobutamine gtt | High dose steroids 2 mg/kg methylprednisolone per day converted to 80 mg prednisone/d with taper over 1 month, ACEi and beta blocker | resolved to baseline (NYHA C1) | uveitis | Ipilimumab 3 mg/kg x 4 | no | SD | 31 |
Endomyocardial biopsy: T cell infiltration without eosinophilia |
ECHO: drop of EF to 20 % |
Cardiac MRI: left ventricular dilation and moderate LV systolic dysfunction (LVEF 34 %); right ventricular dilation and moderate RV systolic dysfunction (RVEF 33 %); increased T2 signal in the mid-inferolateral wall, suggestive of underlying myocardial edema supportive of myocarditis. |
6 | 64 | M | myocarditis | week 5 | Clinical findings: fatigue, seizures, abdominal pain | dopamine and fentanyl | fatal | none | Ipilimumab 10 mg/kg x 2 | no | NA | died of side effects |
Cardiac catheterization and electrocardiogram: normal |
evidence of myocarditis and LV hypertrophy upon autopsy |
7 | 88 | M | cardiac arrest | week 20 | Clinical findings: collapse with cardiac arrest during shopping without any prodromi | AED with defibrillation, intensice care unit, catecholamines, steroids (125 mg i.v./d) | resolved | none | no | Pembrolizumab 2 mg/kg x 9 | PR | 8+ |
ECHO: akinesis of the apex |
Cardiac catheterization and electrocardiogram: coronary artery disease with no culprit stenosis, reduced LV function; similar to taktsubo cardiomyopathy |
8 | 80 | M | myocarditis | week 5 | Clinical findings: dyspnea, edema, arrhythmias | steroids (10 mg dexamethasone + 4 mg every 4 h), intensive care unit | fatal | autoimmune hepatitis | Ipilimumab 3 mg/kg x 2 | no | PR | died of side effects |
EKG: atrial fibrillation, right bundle-branch block |
Nuclear stress test: no stress-induced ischemia |
ECHO: drop of EF to 31 %, hypokinesis |
Endomyocardial biopsy: Multinucleated giant cells, lymphocytes, eosinophils |