Exploration of Cardiology

Table 1. Comparison of diagnostic modalities for ICI-associated myocarditis.

Modality	Key findings	Sensitivity	Limitations	Role	References
High-sensitivity troponin (I or T)	Elevated in myocardial injury; may precede symptoms	High	Not specific to myocarditis; may be elevated in other conditions	Screening and monitoring; every 1% troponin rise associated with worse outcomes	[33–35]
NT-proBNP/BNP	Elevated with myocardial stress and heart failure	Moderate	Nonspecific; elevated in many cardiac and non-cardiac conditions	Adjunctive biomarker	[33, 36]
ECG	Conduction abnormalities (prolonged QRS, bundle branch block, AV block), atrial/ventricular ectopy, ST-T wave changes; QRS prolongation independently predicts MACE	Moderate	Nonspecific; may be normal early	Baseline and serial monitoring	[19, 24]
Echocardiography with GLS	Reduced LVEF, wall motion abnormalities, pericardial effusion; GLS detects subclinical dysfunction	Moderate for LVEF; higher for GLS	LVEF may be preserved in early/mild myocarditis	Initial imaging; GLS superior to LVEF for early detection	[33, 36, 37]
Cardiac MRI	T1/T2 mapping, LGE in non-ischemic pattern; 95% meet non-ischemic injury criteria	High	Limited availability; contraindicated with some devices; may miss early disease	Confirmatory imaging	[33, 36, 38]
Endomyocardial biopsy	CD8+ T-cell infiltrate, CD163+, PD-L1+ staining	Gold standard	Invasive; sampling error; procedural risk	Reserved for uncertain diagnosis or refractory cases	[19, 31, 33, 39, 40]

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ICI: immune checkpoint inhibitor; NT-proBNP/BNP: N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide; ECG: electrocardiogram; AV: atrioventricular; MACE: major adverse cardiac events; GLS: global longitudinal strain; LVEF: left ventricular ejection fraction; LGE: late gadolinium enhancement; PD-L1: programmed death ligand 1.

Declarations

Acknowledgments

Artificial intelligence–based tools (including large language models) were used to assist with drafting, language refinement, and organization of this manuscript. Open Evidence was used for literature search assistance while Claude (Anthropic) AI was used for writing support. All scientific content, interpretations, and conclusions were generated, verified, and approved by the author, who assumes full responsibility for the work.

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JV: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. The author has read and approved the submitted version.

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