# Predictors of Immune-Related Cardiac Adverse Events in Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Cohort Study

## TL;DR

This study identifies cardiovascular conditions as risk factors for heart-related side effects in cancer patients treated with immune checkpoint inhibitors.

## Contribution

The study reveals that cardiovascular comorbidities are independent predictors of immune-related cardiac adverse events in ICI-treated patients.

## Key findings

- Hypercholesterolemia and pre-existing cardiovascular disease are independent predictors of cardiac irAEs.
- Cardiac irAEs were not significantly associated with non-cardiac irAEs.
- The predictive model showed high specificity but moderate sensitivity for cardiac toxicity.

## Abstract

Background/Objectives: Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs), including cardiac toxicities, which may have significant clinical impact. Data regarding predictors of immune-mediated cardiac toxicity remain limited. The aim of this study was to evaluate the association between cardiovascular comorbidities and the development of cardiac irAEs, as well as to assess their potential role in predicting non-cardiac irAEs. Methods: We conducted a retrospective observational study including oncological patients treated with immune checkpoint inhibitors at Colțea Clinical Hospital. Patients with complete clinical data and documented cardiac and non-cardiac irAEs were included. Demographic characteristics, prior oncological treatments, cardiovascular comorbidities, and relevant clinical parameters were analyzed. Univariate and multivariate logistic regression analyses were performed to identify predictors of immune-related adverse events. Results: Hypercholesterolemia, atrial fibrillation, history of acute coronary syndrome, and heart failure were significantly associated with the development of cardiac irAEs. In multivariate analysis, hypercholesterolemia and pre-existing cardiovascular disease remained independent predictors of cardiac toxicity. No significant association was observed between non-cardiac irAEs and cardiac irAEs. The predictive model demonstrated high specificity but moderate sensitivity. Conclusions: Cardiovascular comorbidities play a significant role in the development of immune-related cardiac toxicities. Identification of these risk factors may improve patient stratification and support individualized monitoring strategies in patients receiving immune checkpoint inhibitors.