SummaryIntroductionImmunotherapy has transformed cancer treatment, particularly with immune checkpoint inhibitors and chimeric antigen receptor T‐cell therapy. Despite their efficacy, these therapies can induce cardiotoxicity, presenting significant clinical challenges. Immune checkpoint inhibitors can cause myocarditis; pericarditis; arrhythmias; and myocardial infarction through immune‐mediated inflammation. Chimeric antigen receptor T‐cell therapy may result in cardiovascular complications due to cytokine release syndrome, including myocardial dysfunction, endothelial damage and arrhythmias.MethodsWe used PubMed, Embase and Google Scholar to search for peer‐reviewed articles in September 2024 without setting any date limits. Our selection criteria encompassed studies focusing on cardiotoxicity related to immune checkpoint inhibitors or chimeric antigen receptor T‐cell therapy, comprising original research, meta‐analyses, clinical trials and review articles. The findings were reported narratively.ResultsEarly diagnosis of cardiotoxicity is critical but challenging due to non‐specific symptoms. Diagnostic tools include ECG; cardiac biomarkers; echocardiography; cardiac magnetic resonance imaging; and endomyocardial biopsy. However, no single tool is definitive. High‐dose corticosteroids are the first‐line treatment for immune checkpoint inhibitor‐induced myocarditis, with additional immunosuppressive therapies for refractory cases. Standard heart failure management protocols should be followed in cases of heart failure. Tocilizumab and corticosteroids are utilised for chimeric antigen receptor T‐cell therapy‐induced cytokine release syndrome, alongside supportive care, including fluid resuscitation and vasopressors for severe cases.DiscussionAs the use of immunotherapy expands, understanding the mechanisms, risk factors and management strategies for cardiotoxicity is increasingly important. Collaborative efforts among oncologists, cardiologists and anaesthetists are essential to mitigate these risks, especially in peri‐operative settings. Ongoing research is vital to improve the safe and effective use of immunotherapeutic drugs while minimising cardiovascular adverse effects.

中文翻译：

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免疫检查点抑制剂和嵌合抗原受体 T 细胞疗法的心脏毒性和围手术期注意事项：叙述性回顾


摘要简介免疫疗法改变了癌症治疗，特别是免疫检查点抑制剂和嵌合抗原受体 T 细胞疗法。尽管这些疗法有效，但会诱发心脏毒性，带来重大的临床挑战。免疫检查点抑制剂可引起心肌炎;心包炎;心律 失常;和通过免疫介导的炎症引起的心肌梗死。嵌合抗原受体 T 细胞疗法可能因细胞因子释放综合征而导致心血管并发症，包括心肌功能障碍、内皮损伤和心律失常。方法我们使用 PubMed、Embase 和 Google Scholar 在 2024 年 9 月检索了同行评议的文章，没有设置任何日期限制。我们的纳入标准包括侧重于免疫检查点抑制剂或嵌合抗原受体 T 细胞疗法相关的心脏毒性的研究，包括原始研究、荟萃分析、临床试验和综述文章。研究结果以叙述方式报告。结果心脏毒性的早期诊断至关重要，但由于非特异性症状而具有挑战性。诊断工具包括心电图;心脏生物标志物;超声心动图;心脏磁共振成像;和心内膜心肌活检。但是，没有单一的工具是确定的。大剂量皮质类固醇是免疫检查点抑制剂诱导的心肌炎的一线治疗，难治性病例可进行额外的免疫抑制治疗。在心力衰竭的情况下，应遵循标准的心力衰竭管理方案。托珠单抗和皮质类固醇用于治疗嵌合抗原受体 T 细胞疗法诱导的细胞因子释放综合征，以及支持性治疗，包括液体复苏和严重病例的血管加压药。讨论随着免疫疗法的广泛应用，了解心脏毒性的机制、风险因素和管理策略变得越来越重要。肿瘤学家、心脏病专家和麻醉师之间的合作努力对于减轻这些风险至关重要，尤其是在围手术期环境中。正在进行的研究对于提高免疫治疗药物的安全和有效使用，同时最大限度地减少心血管不良反应至关重要。