Immune-checkpoint inhibitors (ICIs) have revolutionized oncology, with nearly 50% of all patients with cancer eligible for treatment with ICIs. However, patients on ICI therapy are at risk for immune-related toxicities that can affect any organ. Inflammation of the heart muscle, known as myocarditis, resulting from ICI targeting cytotoxic T lymphocyte-associated antigen 4 (CTLA4), programmed cell death protein 1 (PD1) and PD1 ligand 1 (PDL1) is an infrequent but potentially fatal complication. ICI-mediated myocarditis (ICI-myocarditis) is a growing clinical entity given the widespread use of ICIs, its increased clinical recognition and growing use of combination ICI treatment, a well-documented risk factor for ICI-myocarditis. In this Review, we approach ICI-myocarditis from a basic and mechanistic perspective, synthesizing the recent data from both preclinical models and patient samples. We posit that mechanistic understanding of the fundamental biology of immune-checkpoint molecules may yield new insights into disease processes, which will enable improvement in diagnostic and therapeutic approaches. The syndrome of ICI-myocarditis is novel, and our understanding of immune checkpoints in the heart is in its nascency. Yet, investigations into the pathophysiology will inform better patient risk stratification, improved diagnostics and precision-based therapies for patients.

免疫检查点抑制剂 (ICIs) 彻底改变了肿瘤学，近 50% 的癌症患者适合接受 ICI 治疗。然而，接受 ICI 治疗的患者面临着免疫相关毒性的风险，这种毒性可能会影响任何器官。心肌炎症（称为心肌炎）是由针对细胞毒性 T 淋巴细胞相关抗原 4 (CTLA4)、程序性细胞死亡蛋白 1 (PD1) 和 PD1 配体 1 (PDL1) 的 ICI 引起的，是一种罕见但可能致命的并发症。鉴于 ICI 的广泛使用、其临床认知度的提高以及联合 ICI 治疗（ICI 心肌炎的一个有据可查的危险因素）的使用不断增加，ICI 介导的心肌炎（ICI-心肌炎）是一个不断增长的临床实体。在这篇综述中，我们从基础和机制的角度来研究 ICI 心肌炎，综合了临床前模型和患者样本的最新数据。我们认为，对免疫检查点分子的基本生物学机制的理解可能会对疾病过程产生新的见解，从而改进诊断和治疗方法。 ICI-心肌炎综合征是一种新疾病，我们对心脏免疫检查点的了解还处于起步阶段。然而，对病理生理学的研究将为更好的患者风险分层、改进的诊断和基于精确的患者治疗提供信息。