Francesco Cribari: Not Every Patient With Elevated Troponin on ICIs Needs a Hospital Bed
Francesco Cribari, Cardiologist and Cardio-oncologist at Immaculate Conception Dermatological Institute, shared a post on LinkedIn about a recent article he and his colleagues co-authored:
“Not every patient with elevated troponin on immune checkpoint inhibitors (ICIs) needs a hospital bed.
Traditionally, ICI-myocarditis has been perceived as a rare but fulminant condition with a 50% mortality rate.
We’re proud to share our newly published work The FAST TRACK ICI: In our prospective study of 175 referrals — most triggered by mild symptoms or biomarker elevation — we found that:
- Most cases were low-risk and manageable without hospital admission
- No cardiovascular deaths occurred at 30 days
- Over 80% were safely managed through outpatient evaluation
- ICI-myocarditis often presents as a smoldering, indolent form — not requiring immediate, aggressive treatment
Our triage algorithm relied on simple clinical parameters:
- Absence of CV symptoms
- Normal ECG
- No history of CV or autoimmune disease
- No double ICI therapy
Our criteria supported a pragmatic, stepwise approach to suspected ICI-related cardiotoxicity balancing safety, diagnostic precision, and system adaptability and overall allowing safe outpatient evaluation with advanced diagnostics (e.g., CMR, biopsy) performed within days, rather than emergently.
Thank you to the dedicated teams and all the authors at Institut Mutualiste Montsouris, Institut Curie, and Georges Pompidou European Hospital for their collaboration.”
Title: Cardiovascular safety of a standardized outpatient triage and diagnostic approach for suspected cardiovascular immune-related adverse events of immune checkpoint inhibitors
Authors: Francesco Cribari, Imen Hamdi, Soledad Henriquez, Marie-Liesse Joulia, Pierre Charles, Raphael Colle, Delphine Loirat, Nicolas Girard, Agnes Lillo-Le Louet, Christophe Caussin, Mariana Mirabel
Read the Full Article on Archives of Cardiovascular Diseases
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