Evaline Cheng, MD

All Publications

• Cardiac Troponin Screening and Clinical Outcomes in Patients Receiving Immunotherapy. JACC. CardioOncology Cheng, E., Ivanovic, M., Chan, A., Xu, S., Franquiz, M., Lee, C., You, J., Fazal, M., Le Guen, Y., Batchelder, R., Reddy, S. A., Katsumoto, T., Ramchandran, K., Colevas, A. D., Kahn, S., Fan, A., Wakelee, H., Cheng, P., Lewis, E. F., Wu, S. M., Witteles, R., Neal, J., Waliany, S., Zhu, H. 2025

  Abstract

  Immune checkpoint inhibitors (ICIs) are associated with cardiotoxicities such as myocarditis. However, data on the implementation and outcomes of cardiac biomarker screening remain limited.The aim of this study was to examine the impact of cardiac troponin I (cTnI) surveillance integrated with symptom-based triaging in patients receiving immunotherapy.A single-center retrospective cohort study was conducted among adults who underwent routine serial cTnI monitoring during immunotherapy between January 2019 and October 2021. For patients with elevated cTnI, clinical presentation, management, and outcomes were analyzed. Major adverse cardiac events included arrhythmia, myocarditis, heart failure, acute coronary syndrome, stroke, and pericardial effusion. Patients were followed for 24 months from their first ICI dose.Among 428 patients (mean age 67.1 ± 13.9 years, 60.3% men), 42 (9.8%) had elevated cTnI detected through monitoring. Compared with symptomatic patients, asymptomatic patients more often underwent outpatient evaluation (88.0% vs 17.6%; P < 0.001) and continued immunotherapy (68.0% vs 35.3%; P < 0.001), whereas symptomatic patients more often underwent myocarditis-specific diagnostics such as cardiac magnetic resonance imaging (58.8% vs 8.0%; P = 0.001) and received immunosuppression (47.1% vs 8.0%; P = 0.008). The cumulative incidence of major adverse cardiac events at 1.5 years following cTnI elevation was 19.0% (95% CI: 7.0%-31.1%) and was significantly higher in symptomatic vs asymptomatic patients (subdistribution HR: 18.9; 95% CI: 2.2-162.5; P = 0.008). Symptomatic patients had a significantly higher risk for all-cause mortality at 2-year follow-up (HR: 3.24; 95% CI: 1.06-9.94; P = 0.04). In total, 6 patients were diagnosed with myocarditis, with no cardiac-related deaths.cTnI surveillance integrated with symptom-based triaging can facilitate early intervention and treatment of cardiotoxicities such as myocarditis.

  View details for DOI 10.1016/j.jaccao.2025.06.009

  View details for PubMedID 40810717

• Immunotherapy-Associated Atherosclerosis: A Comprehensive Review of Recent Findings and Implications for Future Research. Current treatment options in cardiovascular medicine Chan, A., Torelli, S., Cheng, E., Batchelder, R., Waliany, S., Neal, J., Witteles, R., Nguyen, P., Cheng, P., Zhu, H. 2023; 25 (12): 715-735

  Abstract

  Even as immune checkpoint inhibitors (ICIs) have transformed the lifespan of many patients, they may also trigger acceleration of long-term cardiovascular disease. Our review aims to examine the current landscape of research on ICI-mediated atherosclerosis and address key questions regarding its pathogenesis and impact on patient management.Preclinical mouse models suggest that T cell dysregulation and proatherogenic cytokine production are key contributors to plaque development after checkpoint inhibition. Clinical data also highlight the significant burden of atherosclerotic cardiovascular disease (ASCVD) in patients on immunotherapy, although the value of proactively preventing and treating ASCVD in this population remains an open area of inquiry. Current treatment options include dietary/lifestyle modification and traditional medications to manage hypertension, hyperlipidemia, and diabetes risk factors; no current targeted therapies exist.Early identification of high-risk patients is crucial for effective preventive strategies and timely intervention. Future research should focus on refining screening tools, elucidating targetable mechanisms driving ICI atherosclerosis, and evaluating long-term cardiovascular outcomes in cancer survivors who received immunotherapy. Moreover, close collaboration between oncologists and cardiologists is essential to optimize patient outcomes.

  View details for DOI 10.1007/s11936-023-01024-0

  View details for PubMedID 38213548

  View details for PubMedCentralID PMC10776491

• ACUTE CARDIOMYOPATHY AFTER INITIATION OF CABOZANTINIB, A MULTITYROSINE KINASE INHIBITOR Cheng, E., Zhu, H. ELSEVIER SCIENCE INC. 2023: 2670

  View details for Web of Science ID 000990866102681

• Taken to heart-arrhythmic potential of heart-leaf sida, a banned ephedrine alkaloid: a case report. European heart journal. Case reports Cheng, E., Hsiao, R., Feliciano, Z., Betancourt, J., Han, J. K. 2022; 6 (1): ytac023

  Abstract

  Ephedra and ephedrine alkaloids were commonly used in herbal supplements before being prohibited by the European Commission and US Food and Drug Administration. However, ongoing, unknowing use by consumers can lead to potential adverse cardiovascular effects, such as arrhythmias.A 65-year-old-man with a history of idiopathic pulmonary fibrosis status post-right single lung transplant was admitted for dizziness and resting tachycardia. Electrocardiogram showed a narrow complex, long R-P tachycardia with upright P-waves in lead V 1. An initial workup suggested an arrhythmia associated with the consumption of an herbal supplement containing heart-leaf sida, a banned botanical ephedrine alkaloid. After the supplement was discontinued, the patient's heart rate abruptly decreased without other intervention. Electrocardiogram showed a change in P-wave morphology in lead V 1 from upright to biphasic (+/-) after conversion to normal sinus rhythm. Thus, a diagnosis of atrial tachycardia originating at or near the donor right superior pulmonary vein was favoured.Atrial tachycardia can be precipitated by the proarrhythmic effects of ephedrine alkaloids, especially in patients with underlying risk factors and susceptible atrial anatomical substrate post-lung transplantation. Despite being banned by the European Union and the USA, ephedrine alkaloids continue to be used in over-the-counter herbal supplements and may go undetected by consumers. Ongoing vigilance for ephedrine alkaloids, more rigorous regulation, and active patient education can help reduce potential cardiovascular adverse events.

  View details for DOI 10.1093/ehjcr/ytac023

  View details for PubMedID 35106447

  View details for PubMedCentralID PMC8801050

• Bradyarrhythmias in Cardio-Oncology. South Asian journal of cancer Fonseca, M., Cheng, E., Do, D., Haldar, S., Kutty, S., Yang, E. H., Ghosh, A. K., Guha, A. 2021; 10 (3): 195-210

  Abstract

  The relationship between bradyarrhythmias and cancer therapies has not been well described but is increasingly recognized. There have been extensive advances in oncological pharmacotherapy, with several new classes of drugs available including targeted agents, immune checkpoint inhibitors and CAR T cell therapy. This increasing repertoire of available drugs has revolutionized overall prognosis and survival of cancer patients but the true extent of their cardiovascular toxicity is only beginning to be understood. Previous studies and published reviews have traditionally focused on conventional chemotherapies and in arrhythmias in general, particularly tachyarrhythmias. The number of patients with both cancer and cardiovascular problems is increasing globally and oncologists and cardiologists need to be adept at managing arrythmia based scenarios. Greater collaboration between the two specialties including studies with prospective data collection in Cardio-Oncology are much needed to fill in knowledge gaps in this arena. This case-based review summarizes current available evidence of cancer treatment-related bradyarrhythmia incidence (including its different subtypes), possible mechanisms and outcomes. Furthermore, we propose a stepwise surveillance and management protocol for patients with suspected bradyarrhythmia related to cancer treatment.

  View details for DOI 10.1055/s-0041-1731907

  View details for PubMedID 34966697

  View details for PubMedCentralID PMC8710146

• Long-term vs. recent-onset obesity: their contribution to cardiometabolic risk in adolescence. Pediatric research Burrows, R., Correa-Burrows, P., Rogan, J., Cheng, E., Blanco, E., Gahagan, S. 2019; 86 (6): 776-782

  Abstract

  The contribution of long-term vs. recent-onset obesity to cardiometabolic risk in adolescence remains controversial. Here, we aimed to investigate the association of time of onset and length of obesity with the cardiometabolic profile of adolescence.Prospective study in 678 16-year-olds. BMI was measured at birth-1-5-10-16 years and BMI trajectories were interpolated using cubic splines. BMI > 2 SD at <6 years was defined as early obesity. Waist circumference (WC), blood pressure, lipid and glucose profiles were measured at 16 years. A cardiometabolic risk score was computed (MetS_score). According to the BMI trajectory, four groups were defined: participants who were never obese (NOB), participants with obesity during adolescence (recent-onset obese (ROB)), participants who were obese in early childhood but transitioned to normal/overweight as preadolescents (formerly obese (FOB)), and participants who were obese in early childhood and remained obese (persistently obese (POB)).ROBs and POBs had significantly unhealthier cardiometabolic profile than NOBs. No differences were observed in the cardiometabolic profile of ROBs compared to POBs. Although FOBs had higher WC and MetS_score than NOBs, no differences were found in other biomarkers. FOBs were in healthier cardiometabolic condition than ROBs and POBs.Both long-term and recent-onset obesity increase the cardiometabolic risk in adolescents.

  View details for DOI 10.1038/s41390-019-0543-0

  View details for PubMedID 31426054

  View details for PubMedCentralID PMC6891158

• Light smoking is associated with metabolic syndrome risk factors in Chilean young adults. Acta diabetologica Cheng, E., Burrows, R., Correa, P., Güichapani, C. G., Blanco, E., Gahagan, S. 2019; 56 (4): 473-479

  Abstract

  Metabolic syndrome (MetS) is a cluster of risk factors for cardiometabolic diseases. While cigarette smoking is associated with MetS in adults, young adulthood is an under-studied, susceptible period for developing long-term morbidity from MetS. We examined associations between cigarette smoking and MetS risk factors.We studied 430 participants in Santiago, Chile who have been followed in a longitudinal cohort since infancy and assessed in adolescence for MetS. Participants were evaluated at 22 years from May 2015 to July 2017. Adiposity, blood pressure, and blood samples were measured. MetS was defined using International Diabetes Federation criteria. A continuous MetS score was calculated using z-scores. Participants self-reported cigarette and alcohol consumption using standardized questionnaires. We used multivariate regressions to examine associations between smoking and MetS risk factors, adjusting for sex, MetS in adolescence, alcohol consumption, and socioeconomic status.Thirteen percent of participants had MetS and 50% were current smokers. Among smokers, mean age of initiation was 14.9 years and consumption was 29 cigarettes weekly. Smokers had larger waist circumferences, higher BMIs, and lower high-density lipoprotein (HDL) cholesterol compared to non-smokers. Being a current smoker was significantly associated with higher waist circumference (β = 2.82; 95% CI 0.63, 5.02), lower HDL (β = - 3.62; 95% CI - 6.19, - 1.04), higher BMI (β = 1.22; 95% CI 0.16, 2.28), and higher MetS score (β = 0.13, 95% CI 0.02, 0.24).Cigarette smoking at light levels (mean < 30 cigarettes weekly) was associated with MetS risk factors in a sample of Chilean young adults.

  View details for DOI 10.1007/s00592-018-1264-2

  View details for PubMedID 30635716

  View details for PubMedCentralID PMC6420836

• 2018 Hope Babette Tang Humanism in Healthcare Essay Contest: Third Place Medical Student Essay. Academic medicine : journal of the Association of American Medical Colleges Cheng, E. 2018; 93 (10): 1482-1483

  View details for DOI 10.1097/ACM.0000000000002354

  View details for PubMedID 30252746