Chapra A, Ata F, Abdellatif A, Nofal M, Daniyal A, Mohammad Younus A, Shah JZ, Rasul K. Incidence and clinical course of immune checkpoint inhibitor-related cardiac adverse events: A descriptive study from the Middle East. World J Clin Cases 2026; 14(9): 118187 [DOI: 10.12998/wjcc.v14.i9.118187]
Corresponding Author of This Article
Fateen Ata, MD, MSc, Academic Fellow, Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Cleveland Clinic, Cleveland, OH 44118, United States. docfateenata@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 26, 2026 (publication date) through Mar 27, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Chapra A, Ata F, Abdellatif A, Nofal M, Daniyal A, Mohammad Younus A, Shah JZ, Rasul K. Incidence and clinical course of immune checkpoint inhibitor-related cardiac adverse events: A descriptive study from the Middle East. World J Clin Cases 2026; 14(9): 118187 [DOI: 10.12998/wjcc.v14.i9.118187]
World J Clin Cases. Mar 26, 2026; 14(9): 118187 Published online Mar 26, 2026. doi: 10.12998/wjcc.v14.i9.118187
Incidence and clinical course of immune checkpoint inhibitor-related cardiac adverse events: A descriptive study from the Middle East
Ammar Chapra, Fateen Ata, Amal Abdellatif, Mohammed Nofal, Ahmed Daniyal, Asma Mohammad Younus, Jassim Zaheen Shah, Kakil Rasul
Ammar Chapra, Jassim Zaheen Shah, Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha 00000, Qatar
Fateen Ata, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44118, United States
Amal Abdellatif, Department of Nephrology, Virginia Commonwealth University, Richmond, VA 842520, United States
Mohammed Nofal, Ahmed Daniyal, Department of Internal Medicine, Hamad Medical Corporation, Doha 00000, Qatar
Asma Mohammad Younus, Kakil Rasul, Department of Oncology, National Centre for Cancer Care and Research, Doha 00000, Qatar
Co-first authors: Ammar Chapra and Fateen Ata.
Author contributions: Chapra A and Ata F designed the project and they contributed equally to this manuscript as co-first authors; Chapra A, Ata F, Abdellatif A, Nofal M, Daniyal A, Younus AM, Shah JZ, and Rasul K did the literature review; Nofal M, Abdellatif A, Daniyal A, and Younus AM collected data; Ata F analyzed the data; Chapra A and Ata F wrote the paper; Shah JZ and Rasul K supervised the project. All authors have read and approved the final manuscript.
Institutional review board statement: This study has been approved by the Hamad Medical Corporation Institutional Review Board (approval No. MRC-01-24-488).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data sharing requires permission from the Ministry of Public Health, Qatar. Any request for datasets can be made to the Medical Research Center (MRC) Qatar at Hamad Medical Corporation, which will seek legal permission from the MOPH before data sharing. MRChelpdesk@hamad.qa. The corresponding author, Fateen Ata, can be contacted at docfateenata@gmail.com to initiate a data availability request.
Corresponding author: Fateen Ata, MD, MSc, Academic Fellow, Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Cleveland Clinic, Cleveland, OH 44118, United States. docfateenata@gmail.com
Received: December 26, 2025 Revised: January 23, 2026 Accepted: March 2, 2026 Published online: March 26, 2026 Processing time: 88 Days and 12.9 Hours
Abstract
BACKGROUND
Immune checkpoint inhibitors (ICIs) have transformed oncology by enhancing the immune response against tumor cells. Despite their ‘targeted’ action, these monoclonal antibodies are associated with several immune-mediated toxicities, including ICI-related cardiac adverse events (ICIRCAE). These range from myocarditis and pericarditis to various arrhythmias and exacerbation of pre-existing cardiomyopathies, often carrying a high morbidity and mortality risk. Despite the increasing global recognition of ICIRCAE, data from the Middle East remain scarce, necessitating regional studies to account for ethnic, genetic, environmental, and clinical variations.
AIM
To determine the incidence, clinical spectrum, and outcomes of ICIRCAE in a diverse Middle Eastern cohort of cancer patients receiving ICIs, providing critical insights into risk stratification, early recognition, and management strategies in this unique population.
METHODS
A retrospective observational study was conducted at an advanced oncology center, including all adult cancer patients who received at least one dose of an ICI from January 2015 to January 2023. Demographic, clinical, and echocardiographic data of patients who developed ICIRCAE were extracted. STATA 18 was used for statistical analysis, and ICIRCAE were classified based on clinical presentation and diagnostic findings. Continuous variables were reported as mean ± SD, and categorical variables as n (%).
RESULTS
During the eight-year study period, 14 patients (2.1%) out of 672 ICI recipients (mean age 54.2 ± 13.3 years; 70.5% male) experienced ICIRCAEs. The most commonly implicated drug was pembrolizumab (78.6%). With a median onset of 122 days after therapy, the most common complications were heart failure (42.9%), acute coronary syndrome (28.5%), and pericardial effusion (21.4%). Elevated pulmonary artery systolic pressure and reduced global longitudinal strain were among the salient echocardiographic changes observed in affected patients. Overall mortality was 42.9%, and 71.4% of cases had persistent permanent cardiac dysfunction.
CONCLUSION
Compared to Western cohorts, delayed-onset heart failure, rather than myocarditis, was the most frequent presentation in this first extensive Middle Eastern study of ICIRCAEs. To maximize ICI safety and predictability of risk profiles across diverse populations, these results emphasize the need for multicenter prospective studies, early surveillance, and regional risk-stratification tools.
Core Tip: Immune checkpoint inhibitors (ICIs) have revolutionized treatments and outcomes in oncology, but can cause serious ICI-related cardiac adverse events. This first comprehensive Middle Eastern study revealed that delayed-onset heart failure, rather than myocarditis, predominated among affected patients, with pembrolizumab being the most common implicated ICI. The 2.1% incidence and high mortality necessiates the need for early cardiac surveillance and risk stratification.
