Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis

Zhang L, Awadalla M, Mahmood SS, Nohria A, Hassan MZ, Thuny F, Zlotoff DA, Murphy SP, Stone JR, Golden DLA, Alvi RM, Rokicki A, Jones-O'Connor M, Cohen JV, Heinzerling L, Mulligan C, Armanious M, Barac A, Forrestal BJ, Sullivan RJ, Kwong RY, Yang EH, Damrongwatanasuk R, Chen CL, Gupta D, Kirchberger M, Moslehi JJ, Coelho-Filho OR, Ganatra S, Rizvi MA, Sahni G, Tocchetti CG, Mercurio V, Mahmoudi M, Lawrence DP, Reynolds KL, Weinsaft JW, Baksi AJ, Ederhy S, Groarke JD, Lyon AR, Fradley MG, Thavendiranathan P, Neilan TG (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Book Volume: 41

Pages Range: 1733-1743

Journal Issue: 18

DOI: 10.1093/eurheartj/ehaa051

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.

Authors with CRIS profile

Involved external institutions

H. Lee Moffitt Cancer Center & Research Institute United States (USA) (US) Royal Brompton Hospital United Kingdom (GB) Massachusetts General Hospital United States (USA) (US) Brigham and Women's Hospital (BWH) United States (USA) (US) Weill Cornell Medicine United States (USA) (US) Hôpital Saint-Antoine France (FR) Mount Sinai Hospital United States (USA) (US) Memorial Sloan Kettering Cancer Center United States (USA) (US) Università degli Studi di Napoli Federico II Italy (IT) Georgetown University United States (USA) (US) Veterans Affairs Healthcare System Boston and Harvard Medical School United States (USA) (US) Aix-Marseille University / Aix-Marseille Université France (FR) University of Southampton United Kingdom (GB) Lehigh Valley Health Network United States (USA) (US) University of Toronto Canada (CA) Lahey Hospital & Medical Center United States (USA) (US) University of California Los Angeles (UCLA) United States (USA) (US) Universidade Estadual de Campinas (UNICAMP) / University of Campinas Brazil (BR) Vanderbilt University United States (USA) (US)

How to cite

APA:

Zhang, L., Awadalla, M., Mahmood, S.S., Nohria, A., Hassan, M.Z., Thuny, F.,... Neilan, T.G. (2020). Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis. European Heart Journal, 41(18), 1733-1743. https://doi.org/10.1093/eurheartj/ehaa051

MLA:

Zhang, Lili, et al. "Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis." European Heart Journal 41.18 (2020): 1733-1743.

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