Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor–Associated Myocarditis

Thavendiranathan P, Zhang L, Zafar A, Drobni ZD, Mahmood SS, Cabral M, Awadalla M, Nohria A, Zlotoff DA, Thuny F, Heinzerling L, Barac A, Sullivan RJ, Chen CL, Gupta D, Kirchberger M, Hartmann SE, Weinsaft JW, Gilman HK, Rizvi MA, Kovacina B, Michel C, Sahni G, González-Mansilla A, Calles A, Fernández-Avilés F, Mahmoudi M, Reynolds KL, Ganatra S, Gavira JJ, González NS, García de Yébenes Castro M, Kwong RY, Jerosch-Herold M, Coelho-Filho OR, Afilalo J, Zataraín-Nicolás E, Baksi AJ, Wintersperger BJ, Calvillo-Arguelles O, Ederhy S, Yang EH, Lyon AR, Fradley MG, Neilan TG (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Book Volume: 77

Pages Range: 1503-1516

Journal Issue: 12

DOI: 10.1016/j.jacc.2021.01.050

Abstract

Background: Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited. Objectives: This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis. Methods: In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. Results: Of 136 patients with ICI myocarditis with a CMR, 86 (63%) had T1 maps and 79 (58%) also had T2 maps. Among the 86 patients (66.3 ± 13.1 years of age), 36 (41.9%) had a left ventricular ejection fraction <55%. Across all patients, mean z-scores for T1 and T2 values were 2.9 ± 1.9 (p < 0.001) and 2.2 ± 2.1 (p < 0.001), respectively. On Siemens 1.5-T scanner (n = 67), native T1 (1,079.0 ± 55.5 ms vs. 1,000.3 ± 22.1 ms; p < 0.001) and T2 (56.2 ± 4.9 ms vs. 49.8 ± 2.2 ms; p < 0.001) values were elevated compared with reference values. Abnormal T1 and T2 values were seen in 78% and 43% of the patients, respectively. Applying the modified Lake Louise Criteria, 95% met the nonischemic myocardial injury criteria and 53% met the myocardial edema criteria. Native T1 values had excellent discriminatory value for subsequent MACE, with an area under the curve of 0.91 (95% confidence interval: 0.84 to 0.98). Native T1 values (for every 1-unit increase in z-score, hazard ratio: 1.44; 95% confidence interval: 1.12 to 1.84; p = 0.004) but not T2 values were independently associated with subsequent MACE. Conclusions: The use of T1 mapping and application of the modified Lake Louise Criteria provides important diagnostic value, and T1 mapping provides prognostic value in patients with ICI myocarditis.

Authors with CRIS profile

Involved external institutions

Weill Cornell Medicine United States (USA) (US) Massachusetts General Hospital United States (USA) (US) Jewish General Hospital Canada (CA) Toronto General Hospital (TGH) Canada (CA) Royal Brompton Hospital United Kingdom (GB) Brigham and Women's Hospital (BWH) United States (USA) (US) University of California Los Angeles (UCLA) United States (USA) (US) Aix-Marseille University / Aix-Marseille Université France (FR) University of Toronto Canada (CA) Georgetown University United States (USA) (US) Hôpitaux Universitaires Paris-Ouest France (FR) Albert Einstein College of Medicine United States (USA) (US) Perelman School of Medicine University of Pennsylvania United States (USA) (US) Universidad de Navarra Spain (ES) Hospital General Universitario Gregorio Marañón Spain (ES) Lahey Hospital & Medical Center United States (USA) (US) Lehigh Valley Health Network United States (USA) (US) University of Southampton United Kingdom (GB) Mount Sinai Hospital United States (USA) (US) Universidade Estadual de Campinas (UNICAMP) / University of Campinas Brazil (BR)

How to cite

APA:

Thavendiranathan, P., Zhang, L., Zafar, A., Drobni, Z.D., Mahmood, S.S., Cabral, M.,... Neilan, T.G. (2021). Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor–Associated Myocarditis. Journal of the American College of Cardiology, 77(12), 1503-1516. https://doi.org/10.1016/j.jacc.2021.01.050

MLA:

Thavendiranathan, Paaladinesh, et al. "Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor–Associated Myocarditis." Journal of the American College of Cardiology 77.12 (2021): 1503-1516.

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