Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis.

Abstract:

AIMS: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. METHODS AND RESULTS: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. CONCLUSION:These data suggest caution in reliance on LGE or a qualitative T2-STIR-only approach for the exclusion of ICI-associated myocarditis.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Zhang L,Awadalla M,Mahmood SS,Nohria A,Hassan MZO,Thuny F,Zlotoff DA,Murphy SP,Stone JR,Golden DLA,Alvi RM,Rokicki A,Jones-O'Connor M,Cohen JV,Heinzerling LM,Mulligan C,Armanious M,Barac A,Forrestal BJ,Sullivan RJ,

doi

10.1093/eurheartj/ehaa051

subject

Has Abstract

pub_date

2020-05-07 00:00:00

pages

1733-1743

issue

18

eissn

0195-668X

issn

1522-9645

pii

5762637

journal_volume

41

pub_type

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