Acute drops in ejection fraction in contemporary cardio-oncology: Old diagnosis, new offenders

Acute left ventricular (LV) dysfunction is a common manifestation of cardiotoxicity related to modern cancer treatment, including novel immunotherapies. As immune checkpoint inhibitor (ICI) therapy is increasingly used, different clinical forms of LV dysfunction are observed. Suspicion for ICI-induced cardiotoxicity prompts a complete cardiovascular evaluation, including transthoracic echocardiography and global longitudinal strain. We present 3 cases of ICI-induced cardiotoxicity with a common denominator, an acute drop in LV ejection fraction, but with 3 different etiologies: Takotsubo cardiomyopathy, ischemia, and myocarditis. Clinicians must be aware of the potential risk for immune-related adverse events, including the various forms of cardiotoxicity.