C31 NEXT GENERATION MYOCARDITIS

Abstract A 75–year–old overweight man, affected by hypertension, diabetes mellitus and atrial fibrillation since 2020. After 3 unsuccessful attempts of electrical cardioversion it was opted for a strategy rate control with beta blocker anticoagulant therapy Rivaroxaban 20 mg. Following episodes rectal bleeding; adenocarcinoma the colon diagnosed. The patient underwent hemicolectomy started Pembrolizumab. replaced Edoxaban 60 In August 2022, he admitted to emergency department severe signs symptoms heart failure. On ECG, 90 bpm non–specific changes in ventricular repolarization. echocardiogram showed reduction ejection fraction (FE 30%), which not present at previous controls. blood tests, troponins were negative BNP increased. coronarography significant lesions, failure prescribed. Three months later came our cardio–oncology outpatient clinic; we repeated recovery 45% planned cardiac MRI. Cardiac MRI (CMR) global left hypokinesia 42%) late subepicardial gadoline enhancement basal segment inferior wall transmural lateral without oedema. Report described as compatible myocarditis. case discussed collegially radiologists oncologists, decided discontinue immunotherapy (ICI). Myocarditis is most common cardiovascular adverse events ICI therapy, although has very low incidence. Generally, myocarditis related high mortality requires discontinuation ICI. addition, CMR may have lower sensitivity this setting. There also possibility developing dysfunction associated absence increase troponin active myocardial inflammation CMR. Although been defined myocarditis, presents some unclear aspects due part early non–diagnosis complication therapy. cancer patients taking expanded considerably recent years, evidence on complications scarce unknown clinical cardiologist.