TAKOTSUBO SYNDROME INDUCED BY IMMUNE CHECKPOINT INHIBITORS

Abstract

Introduction: Takotsubo syndrome (ST) is an acute cardiac syndrome characterized by typical regional wall motion abnormalities that reflect impaired myocardial contractility leading to acute heart failure in the absence of epicardial coronary artery disease. The exact etiology is not known, however, an apparent relationship is noted between the use of immune checkpoint inhibitors (ICIs) and the diagnosis of ST. Objective: To clarify the relationship between ICIs and ST, considering it to be an extremely important topic for health professionals. Materials and methods: The literature search was performed by consulting the PubMed electronic database, starting with "takotsubo syndrome" and "immune checkpoint inhibitor therapy". We delimited articles published between 2003 and 2022, with studies that answered the guiding question previously defined. After applying the inclusion and exclusion criteria, a final sample of 6 studies was obtained for the integrative review. Results and discussion: Immune checkpoint inhibitors are increasingly used to treat certain malignancies due to their greater efficacy compared to conventional chemotherapy. ICIs become toxic due to the removal of self-tolerance, which in turn induces autoimmune processes. Conclusion: In summary, this study makes it clear that, based on the currently available literature, one can conclude an association between ICIs and ST, especially when the ICI used is 5-fluorouracil.