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Background: Immune checkpoint inhibitors (ICIs) have markedly improved outcome in various types of cancer. ICI-associated myocarditis is one of the most severe immune-related adverse events. In particular, high concentrations of cardiac troponin T (cTnT) are associated with a high risk of death and early detection and vigorous therapy with high-dose steroids may improve survival. However, chronic skeletal muscle disorders have been suggested as a non-cardiac source of elevated high-sensitivity cardiac troponin T (hs-cTnT) concentrations., Case Summary: Here, we present the case of a 72-year-old patient with metastatic melanoma treated with nivolumab and ipilimumab, who developed symptomatic myositis [creatine kinase (CK) max. 3113 U/L]. Due to substantially elevated concentrations of hs-cTnT (max. 1128 ng/L, normal <14 ng/L, Elecsys), the patient was referred to the cardio-oncology unit for evaluation of concomitant myocarditis. The patient did not report any cardiac symptoms and there were no clinical signs of congestion or rhythm abnormalities. Concentrations of NT-proBNP were within the normal range. Echocardiography showed normal cardiac dimensions and normal systolic and diastolic function. Cardiac magnetic resonance imaging confirmed these findings and also showed no evidence of acute or post-inflammatory myocardial tissue changes. Absence of relevant cardiomyocyte injury was supported by determination of normal levels of cardiac troponin I concentrations and made endomyocardial biopsy in this severely ill patient unnecessary., Discussion: Our observation documents ICI-induced myositis as an alternative non-cardiac cause of hs-cTnT elevation. A global cardiologic approach employing clinical and cardiac magnetic resonance imaging data as well as NT-proBNP and cardiac troponin I helps to identify false positive hs-TnT elevation under ICI therapy., Competing Interests: Conflict of interest: C.M. has received research support from Abbott, Astra Zeneca, Beckman Coulter, Biomerieux, Brahms, Novartis, Ortho Clinical Diagnostics, Quidel, Roche, Sanofi, Siemens, Singulex, and Sphingotec, as well as speaker honoraria/consulting honoraria from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS, Brahms, Idorsia, Novartis, Roche, Sanofi, Siemens, Singulex, and Vifor. O.P. has received research support from Sanofi and consulting honoraria from Novartis, Vifor, and MSD. S.I.R. has received research funding from AbbVie, Amgen, Astra-Zeneca, BMS, Boehringer-Ingelheim, Foundation Medicine, Merck and Roche Pharma. S.I.R. serves as consultant and advisor for AbbVie, Amgen, Astellas, Astra-Zeneca, Bayer, BMS, Boehringer-Ingelheim, Eisai, Eli Lilly, Janssen, Merck Serono, MSD, Novartis, Otsuka, Pfizer, PharmaMar, Roche Pharma, Roche Diagnostics, Sanofi Aventis, Takeda (payment of honoraria to the institution) and he is elected member of the Federal Drug Commission of the Federal Office of Public Health in Switzerland and Vice President of the Swiss Group for Clinical Cancer Research (SAKK)., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: We aimed to determine the association of a comprehensive healthy lifestyle with heart rate variability (HRV), a validated measure of autonomic function., Design: This was a prospective cohort study., Methods: A population-based sample of 2079 individuals aged 25-41 years without prevalent cardiovascular disease was investigated. The standard deviation of all normal RR intervals (SDNN) during 24-hour electrocardiography was used as main HRV marker. Healthy lifestyle metrics were summed to a validated lifestyle-score ranging from 0 = most unhealthy to 7 = most healthy. One point was given for each of the following items: never smoking cigarettes; consuming a healthy diet; performing moderate (≥150 min/week) or vigorous (≥75 min/week) physical activity; body mass index (BMI)<25 kg/m(2); total cholesterol<200 mg/dl; glycated haemoglobin A1c<5.7%; and blood pressure<120 (systolic) and <80 mm Hg (diastolic)., Results: Median age of the participants (47% males) was 37 years. Mean SDNN was 153 ms and median lifestyle-score was four. A score of 0/1 or 6/7 was found in 5.2% and 11.0%, respectively. In multivariable linear regression analysis with SDNN as the outcome variable, the β-estimate (95% confidence interval (CI)) for a one-point increase of the lifestyle-score was 0.14 (0.11-0.17), p < 0.0001. This relationship was attenuated but remained significant after additional adjustment for resting heart rate (HR) (β-estimate (95% CI) 0.07 (0.07-0.10), p < 0.0001) or 24-hour HR (0.04 (0.01-0.07), p = 0.003)., Conclusions: Few individuals adopted a healthy lifestyle in this large contemporary cohort of young adults from the general population. Adopting a healthy lifestyle has an important effect on autonomic function., (© The European Society of Cardiology 2015.)