The findings suggest that universal troponin screening offers limited benefit for unselected patients receiving immune checkpoint inhibitors. Instead, surveillance for cardiovascular immune-related toxicity may be better guided by baseline risk for ICI-associated cardiotoxicity and clinical symptoms rather than troponin levels alone. Further studies are needed to determine whether risk-adapted screening can improve outcomes while minimizing unnecessary treatment interruptions.
The study, published as an Original Investigation in JAMA Network Open by Imen Hamdi, Department of Cardiology, Institut Montsouris, Paris, France, and colleagues, evaluated whether routine troponin monitoring could reduce the risk of major cardiovascular events or death among patients with advanced solid tumors receiving ICIs.
Immune checkpoint inhibitors have transformed cancer treatment but can occasionally trigger immune-related cardiovascular complications, including myocarditis. While current recommendations support troponin testing for the early detection of ICI-associated myocarditis, its value as a universal screening strategy for all patients remains uncertain.
To evaluate this, researchers conducted a retrospective multicenter cohort study of 859 adults treated with immune checkpoint inhibitors between 2017 and 2022. Patients who underwent routine troponin monitoring during the first three months of therapy were compared with those receiving standard care without scheduled screening. The primary outcome was major adverse cardiovascular events, including ICI-associated myocarditis, acute coronary syndrome, heart failure hospitalization, sudden cardiac death, and cardiovascular death.
Key Findings:
- The study included 859 patients with a mean age of 70.1 years, of whom 60.2% were men, and 68.1% had lung cancer.
- Over a median follow-up of 3.3 months, 40 patients (4.7%) experienced a MACE, including six cases (0.7%) of ICI-associated myocarditis.
- A total of 484 patients (56.3%) died during follow-up, with more than 90% of deaths attributed to cancer progression.
- Multivariable analysis initially linked routine troponin screening with a lower combined risk of mortality and major cardiovascular events.
- However, this association was no longer significant after competing-risk analysis accounting for cancer-related deaths and after propensity score matching.
- Overall, systematic troponin monitoring did not significantly reduce adjudicated major cardiovascular events in patients receiving immune checkpoint inhibitors.
The researchers noted limitations including the retrospective design, potential residual confounding, the low incidence of myocarditis, lack of routine cardiac MRI to detect subclinical disease, and non-standardized troponin assays across centers. They added that the findings may not be generalizable to patients at lower cardiovascular risk or those at high risk of ICI-associated myocarditis.
Overall, the findings suggest that routine troponin screening offers limited benefit in unselected patients receiving immune checkpoint inhibitors. The researchers recommend reserving troponin testing for patients with suspected cardiovascular toxicity or a high risk of ICI-associated myocarditis and call for prospective studies to assess risk-adapted screening strategies.
Reference:
Hamdi I, El Bèze N, Henriquez S, et al. Troponin Screening and Major Cardiovascular Adverse Events During Immune Checkpoint Inhibitor Therapy. JAMA Netw Open. 2026;9(7):e2624168. doi:10.1001/jamanetworkopen.2026.24168
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