- Main
Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis.
- Zhang, Lili;
- Awadalla, Magid;
- Mahmood, Syed S;
- Nohria, Anju;
- Hassan, Malek Z O;
- Thuny, Franck;
- Zlotoff, Daniel A;
- Murphy, Sean P;
- Stone, James R;
- Golden, Doll Lauren Alexandra;
- Alvi, Raza M;
- Rokicki, Adam;
- Jones-O'Connor, Maeve;
- Cohen, Justine V;
- Heinzerling, Lucie M;
- Mulligan, Connor;
- Armanious, Merna;
- Barac, Ana;
- Forrestal, Brian J;
- Sullivan, Ryan J;
- Kwong, Raymond Y;
- Yang, Eric H;
- Damrongwatanasuk, Rongras;
- Chen, Carol L;
- Gupta, Dipti;
- Kirchberger, Michael C;
- Moslehi, Javid J;
- Coelho-Filho, Otavio R;
- Ganatra, Sarju;
- Rizvi, Muhammad A;
- Sahni, Gagan;
- Tocchetti, Carlo G;
- Mercurio, Valentina;
- Mahmoudi, Michael;
- Lawrence, Donald P;
- Reynolds, Kerry L;
- Weinsaft, Jonathan W;
- Baksi, A John;
- Ederhy, Stephane;
- Groarke, John D;
- Lyon, Alexander R;
- Fradley, Michael G;
- Thavendiranathan, Paaladinesh;
- Neilan, Tomas G
Abstract
Myocarditis is a potentially fatal complication of immune checkpoint inhibitors (ICI). Sparse data exist on the use of cardiovascular magnetic resonance (CMR) in ICI-associated myocarditis. In this study, the CMR characteristics and the association between CMR features and cardiovascular events among patients with ICI-associated myocarditis are presented.
From an international registry of patients with ICI-associated myocarditis, clinical, CMR, and histopathological findings were collected. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. In 103 patients diagnosed with ICI-associated myocarditis who had a CMR, the mean left ventricular ejection fraction (LVEF) was 50%, and 61% of patients had an LVEF ≥50%. Late gadolinium enhancement (LGE) was present in 48% overall, 55% of the reduced EF, and 43% of the preserved EF cohort. Elevated T2-weighted short tau inversion recovery (STIR) was present in 28% overall, 30% of the reduced EF, and 26% of the preserved EF cohort. The presence of LGE increased from 21.6%, when CMR was performed within 4 days of admission to 72.0% when CMR was performed on Day 4 of admission or later. Fifty-six patients had cardiac pathology. Late gadolinium enhancement was present in 35% of patients with pathological fibrosis and elevated T2-weighted STIR signal was present in 26% with a lymphocytic infiltration. Forty-one patients (40%) had MACE over a follow-up time of 5 months. The presence of LGE, LGE pattern, or elevated T2-weighted STIR were not associated with MACE.
These data suggest caution in reliance on LGE or a qualitative T2-STIR-only approach for the exclusion of ICI-associated myocarditis.
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