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Peer-reviewedCC BY-NC-NDCirculation reports

Troponin I Surveillance to Risk-Stratify Early Events After Immune Checkpoint Inhibitor Initiation.

  • Hiroyuki Fujii1,2
  • Yuichi Tamura1,2,3
  • Masao Daimon1
  • Yudai Tamura2
  • Sarasa Isobe1,2,3
  • Yukihiro Yamaguchi1
  • Jin Iwasawa1
  • Shigeki Kimura1
  • Masahiko Goya1,3
  • Shinsuke Aida4
  • Issei Komuro3
4 affiliations
  1. 1Cardiovascular Center, International University of Health and Welfare Mita Hospital Tokyo Japan.
  2. 2Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan.
  3. 3Department of Cardiology, International University of Health and Welfare School of Medicine Chiba Japan.
  4. 4Department of Pathology, International University of Health and Welfare Mita Hospital Tokyo Japan.
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Abstract

Background

Troponin surveillance may facilitate early detection of immune checkpoint inhibitor (ICI)-associated myocarditis, but mild elevations and baseline abnormalities complicate interpretation. We assessed early post-ICI troponin I (TnI) dynamics and the performance characteristics of clinically applicable peak TnI thresholds within 3 months of ICI initiation.Methods and results

We analyzed 281 participants from a cardio-oncology surveillance program. TnI was measured at predefined intervals. Using peak TnI levels within 3 months, we evaluated the performance characteristics of candidate TnI thresholds for identifying adjudicated clinically significant TnI elevation associated with clinically meaningful conditions (e.g., ICI-associated myocarditis) at cut-offs of 50, 100, and 500 pg/mL. Eleven (3.9%) patients had elevated baseline TnI. Within 3 months, clinically significant TnI elevation occurred in 5 (1.8%) patients: ICI-associated myocarditis (n=2); immune-related myositis (n=1); pulmonary embolism (n=1); and seizures (n=1). A 50 pg/mL cut-off yielded 100% sensitivity, 96.0% specificity, 31.3% positive predictive value, and 100% negative predictive value. A 100 pg/mL cut-off demonstrated 100% sensitivity, 99.6% specificity, 83.3% positive predictive value, and 100% negative predictive value. A 500 pg/mL cut-off yielded 40.0% sensitivity and 100% specificity.Conclusions

In this exploratory study, a peak TnI threshold of 100 pg/mL within 3 months identified all clinically significant events with high specificity. This threshold may serve as a pragmatic trigger for expedited evaluation of myocarditis and alternative etiologies.

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Cite

BibTeXRIS
BibTeX
@article{fujii2026troponin,
  title = {{Troponin I Surveillance to Risk-Stratify Early Events After Immune Checkpoint Inhibitor Initiation.}},
  author = {Hiroyuki Fujii and Yuichi Tamura and Masao Daimon and Yudai Tamura and Sarasa Isobe and Yukihiro Yamaguchi and Jin Iwasawa and Shigeki Kimura and Masahiko Goya and Shinsuke Aida and Issei Komuro},
  journal = {Circulation reports},
  year = {2026},
  month = sep,
  doi = {10.1253/circrep.cr-26-0251},
  url = {https://europepmc.org/article/MED/43010971},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Troponin I Surveillance to Risk-Stratify Early Events After Immune Checkpoint Inhibitor Initiation.
AU  - Hiroyuki Fujii
AU  - Yuichi Tamura
AU  - Masao Daimon
AU  - Yudai Tamura
AU  - Sarasa Isobe
AU  - Yukihiro Yamaguchi
AU  - Jin Iwasawa
AU  - Shigeki Kimura
AU  - Masahiko Goya
AU  - Shinsuke Aida
AU  - Issei Komuro
PY  - 2026
DA  - 2026/09/15
JO  - Circulation reports
DO  - 10.1253/circrep.cr-26-0251
UR  - https://europepmc.org/article/MED/43010971
AB  - Background  Troponin surveillance may facilitate early detection of immune checkpoint inhibitor (ICI)-associated myocarditis, but mild elevations and baseline abnormalities complicate interpretation. We assessed early post-ICI troponin I (TnI) dynamics and the performance characteristics of clinically applicable peak TnI thresholds within 3 months of ICI initiation.Methods and results  We analyzed 281 participants from a cardio-oncology surveillance program. TnI was measured at predefined intervals. Using peak TnI levels within 3 months, we evaluated the performance characteristics of candidate TnI thresholds for identifying adjudicated clinically significant TnI elevation associated with clinically meaningful conditions (e.g., ICI-associated myocarditis) at cut-offs of 50, 100, and 500 pg/mL. Eleven (3.9%) patients had elevated baseline TnI. Within 3 months, clinically significant TnI elevation occurred in 5 (1.8%) patients: ICI-associated myocarditis (n=2); immune-related myositis (n=1); pulmonary embolism (n=1); and seizures (n=1). A 50 pg/mL cut-off yielded 100% sensitivity, 96.0% specificity, 31.3% positive predictive value, and 100% negative predictive value. A 100 pg/mL cut-off demonstrated 100% sensitivity, 99.6% specificity, 83.3% positive predictive value, and 100% negative predictive value. A 500 pg/mL cut-off yielded 40.0% sensitivity and 100% specificity.Conclusions  In this exploratory study, a peak TnI threshold of 100 pg/mL within 3 months identified all clinically significant events with high specificity. This threshold may serve as a pragmatic trigger for expedited evaluation of myocarditis and alternative etiologies.
SN  - 2434-0790
ER  -