Table 3 Comparison of Myocarditis cases with and without Flu vaccination (FV)
From: Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors
FV (n = 25) | No FV (n = 76) | P Value | |
|---|---|---|---|
Age at start of ICI, yrs | 69 ± 8 | 66 ± 20 | 0.60 |
Male | 17 (68) | 56 (74) | 0.58 |
CV risk factors | |||
Current or prior smoking | 10 (48) | 30 (47) | 0.95 |
Hypertension | 14 (58) | 45 (60) | 0.89 |
Diabetes mellitus | 7 (30) | 15 (21) | 0.36 |
No CV risk factors | 4 (16) | 19 (25) | 0.35 |
Coronary artery disease | 3 (15) | 9 (13) | 0.73 |
Stroke | 1 (5) | 6 (8) | 1.00 |
Heart failure | 1 (5) | 4 (6) | 1.00 |
COPD | 5 (28) | 7 (10) | 0.12 |
Obstructive sleep apnea | 0 | 6 (9) | 0.60 |
Chronic kidney diseasea | 2 (11) | 7 (10) | 1.00 |
Body mass index, kg/m2 | 28 ± 5 | 28 ± 7 | 0.90 |
Primary cancer type | |||
Head and neck | 0 | 5 (7) | 0.33 |
Hodgkin’s lymphoma | 0 | 2 (3) | 1.00 |
Melanoma | 12 (48) | 32 (42) | 0.61 |
Lung cancer | 6 (24) | 11 (14) | 0.35 |
Pancreatic | 2 (8) | 0 | 0.06 |
Renal cell carcinoma | 2 (8) | 4 (5) | 0.64 |
Glioblastoma | 0 | 2 (3) | 1.00 |
Other | 3 (12) | 20 (26) | 0.18 |
Prior chemotherapy or radiation | |||
Radiation | 4 (16) | 25 (33) | 0.11 |
Anthracyclines | 1 (4) | 5 (7) | 1.00 |
Cyclophosphamide | 1 (4) | 1 (1) | 0.44 |
Gemcitabine | 2 (8) | 3 (4) | 0.60 |
Taxanes | 2 (8) | 4 (5) | 0.64 |
Carboplatin | 2 (8) | 6 (8) | 1.00 |
VEGF Inhibitors | 0 | 1 (1) | 1.00 |
Single agent vs. combined ICI | |||
Combination | 8 (32) | 20 (26) | 0.61 |
Monotherapy | 17 (68) | 56 (74) | 0.61 |
Combined ICI | |||
Ipilimumab + nivolumab | 8 (32) | 16 (21) | 0.27 |
Ipilimumab + pembrolizumab | 0 | 1 (1) | 1.00 |
Tremelimumab + avelumab | 0 | 1 (1) | 1.00 |
Tremelimumab + durvalumab | 0 | 2 (3) | 1.00 |
Monotherapy ICI b | |||
Pembrolizumab (anti-PD1) | 7 (28) | 28 (37) | 0.42 |
Nivolumab (anti-PD1) | 7 (28) | 18 (24) | 0.66 |
Ipilimumab (anti-CTLA4) | 2 (8) | 4 (5) | 0.64 |
Tremelimumab (anti-CTLA4) | 1 (4) | 0 | 0.25 |
Atezolizumab (anti-PDL1) | 0 | 6 (8) | 0.33 |
Avelumab (anti-PDL1) | 0 | 0 | 1.00 |
Durvalumab (anti-PDL1) | 0 | 0 | 1.00 |
Overall types of ICI | |||
Any anti-PD1 | 22 (88) | 63 (83) | 0.75 |
Any anti-CTLA4 | 11 (44) | 24 (32) | 0.33 |
Any anti-PDL1 | 0 | 9 (12) | 0.11 |
Days of follow-up [IQR] | 223 [111, 324] | 162 [86, 364] | 0.32 |
Other immune side effects during treatment c | |||
No other immune side effects | 16 (64) | 34 (45) | 0.10 |
Hypophysitis/pituitary/adrenal | 1 (4) | 5 (7) | 1.00 |
Pneumonitis | 3 (12) | 26 (36) | 0.03 |
Hepatitis | 1 (4) | 7 (9) | 0.68 |
Colitis | 2 (8) | 7 (9) | 1.00 |
Dermatitis | 0 | 6 (8) | 0.33 |
Neurological | 1 (4) | 10 (13) | 0.28 |
Gastritis | 0 (0) | 3 (4) | 0.57 |
Myocarditis presentation c | |||
Chest pain | 15 (60) | 50 (66) | 0.60 |
Shortness of breath | 6 (25) | 21 (28) | 0.75 |
Orthopnea | 6 (26) | 18 (24) | 0.86 |
Paroxysmal nocturnal dyspnea | 2 (9) | 7 (9) | 1.00 |
Fatigue | 8 (40) | 27 (46) | 0.65 |
Admission examination | |||
Jugular venous distension | 8 (32) | 24 (32) | 1.00 |
Crackles on lung exam | 8 (32) | 36 (47) | 0.25 |
Admission vitals | |||
Heart rate, beats/min | 92 ± 16 | 89 ± 24 | 0.67 |
Systolic blood pressure, mmHg | 126 ± 17 | 126 ± 21 | 0.89 |
Diastolic blood pressure, mmHg | 70 ± 10 | 72 ± 11 | 0.48 |
Respiratory rate, rate, min | 19 ± 2 | 22 ± 14 | 0.38 |
Oxygen requirement and delivery d | |||
Room air | 13 (72) | 51 (75) | 0.61 |
Nasal cannula | 5 (28) | 13 (19) | 0.61 |
Intubated | 0 | 4 (6) | 0.61 |
Echocardiography, myocarditis admission | |||
LVEFe, % | 46 ± 15 | 50 ± 16 | 0.28 |
LVIDD, mm | 45 ± 11 | 48 ± 6 | 0.15 |
Admission cardiac enzymes | |||
Troponin T, ng/ml | 0.12 [0.02,0.47] | 0.40 [0.11,1.26] | 0.02 |
BNP or NT-pro BNP, pg/ml | 568 [421,987] | 600 [215,4275] | 0.82 |
Outcomes: MACE f | |||
Cumulative MACE | 6 (24) | 45 (59) | 0.002 |
Complete heart block | 2 (9) | 14 (19) | 0.35 |
Cardiogenic shock | 2 (9) | 15 (20) | 0.35 |
Cardiac arrest | 2 (9) | 13 (17) | 0.51 |
Cardiovascular death | 4 (36) | 28 (72) | 0.04 |