# Utility of echocardiographic parameters in predicting cardiac immune-related adverse events in Japanese patients undergoing immune checkpoint inhibitor therapy

## TL;DR

This study shows that heart function measurements can help predict heart-related side effects in cancer patients receiving a specific type of therapy.

## Contribution

The study identifies baseline echocardiographic parameters as predictors of cardiac immune-related adverse events in Japanese patients undergoing immune checkpoint inhibitor therapy.

## Key findings

- Patients who developed cardiac irAEs had significantly lower ejection fractions before treatment.
- Left ventricular end-systolic diameters and ejection fractions showed moderate predictive value for cardiac irAEs.
- Early echocardiographic evaluation can help stratify risk and improve monitoring for cardiac irAEs.

## Abstract

Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but are associated with immune-related adverse events, including cardiac immune-related adverse events (cardiac irAEs). Early identification of patients at risk for cardiac irAEs is crucial, and echocardiographic parameters may serve as valuable predictors. This study aimed to evaluate the predictive utility of echocardiographic indices in assessing cardiac irAE risk in Japanese patients receiving ICI therapy.

This retrospective study analyzed patients treated with ICIs at the University of Fukui Hospital between November 2015 and October 2018. Cardiac irAEs were defined according to the ESC guidelines.

Among 73 patients, six (8%) developed cardiac irAEs, with no fatalities. Echocardiographic assessment before ICI initiation revealed that patients who later developed cardiac irAEs had significantly lower ejection fractions (EFs) (p < 0.05). Receiver operating characteristic analysis demonstrated that left ventricular end-systolic diameters (LVDs) (area under the curve: AUC = 0.660) and EFs (AUC = 0.797) had moderate predictive value for cardiac irAEs. Kaplan–Meier analysis showed a higher probability of cardiac irAEs in patients with LVDs and EFs beyond specific thresholds (p < 0.01). Poisson regression analysis indicated a decreasing risk of cardiac irAEs over time after ICI initiation.

Baseline echocardiographic parameters, particularly LVDs and EFs, can be useful predictors of cardiac irAEs in patients receiving ICI therapy. Early echocardiographic evaluation may facilitate risk stratification and improve monitoring strategies for cardiac irAEs.

UMIN000023840.

The online version contains supplementary material available at 10.1007/s12574-025-00698-8.