Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis

Quinaglia T, Gongora C, Awadalla M, Hassan MZ, Zafar A, Drobni ZD, Mahmood SS, Zhang L, Coelho-Filho OR, Suero-Abreu GA, Rizvi MA, Sahni G, Mandawat A, Zatarain-Nicolás E, Mahmoudi M, Sullivan R, Ganatra S, Heinzerling L, Thuny F, Ederhy S, Gilman HK, Sama S, Nikolaidou S, Mansilla AG, Calles A, Cabral M, Fernández-Avilés F, Gavira JJ, González NS, García de Yébenes Castro M, Barac A, Afilalo J, Zlotoff DA, Zubiri L, Reynolds KL, Devereux R, Hung J, Picard MH, Yang EH, Gupta D, Michel C, Lyon AR, Chen CL, Nohria A, Fradley MG, Thavendiranathan P, Neilan TG (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 15

Pages Range: 1883-1896

Journal Issue: 11

DOI: 10.1016/j.jcmg.2022.06.014

Abstract

Background: Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS. Objectives: This study aimed to detail the role of GCS and GRS in ICI myocarditis. Methods: In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death. Results: Cases and controls were similar in age (66 ± 15 years vs 63 ± 12 years; P = 0.20), sex (male: 73% vs 61%; P = 0.20) and cancer type (P = 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% ± 3.4% vs 23.5% ± 3.8%; P = 0.14; GRS: 45.5% ± 6.2% vs 43.6% ± 8.8%; P = 0.24). Overall, 56% (n = 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% ± 4.2% vs 23.6% ± 3.0%; P < 0.001; GRS: 28.6% ± 6.7% vs 47.0% ± 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P = 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P = 0.008) below the median was associated with an increased event rate. In receiver-operating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56-0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P = 0.04) and GCS over cTnT (P = 0.002). Conclusions: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.

Authors with CRIS profile

Involved external institutions

Massachusetts General Hospital United States (USA) (US) Weill Cornell Medicine United States (USA) (US) Albert Einstein College of Medicine United States (USA) (US) Universidade Estadual de Campinas (UNICAMP) / University of Campinas Brazil (BR) The State University of New Jersey (Rutgers) United States (USA) (US) Lehigh Valley Health Network United States (USA) (US) Mount Sinai Hospital United States (USA) (US) Emory University United States (USA) (US) Hospital General Universitario Gregorio Marañón Spain (ES) University of Southampton United Kingdom (GB) Lahey Hospital & Medical Center United States (USA) (US) Aix-Marseille University / Aix-Marseille Université France (FR) Hôpital Armand-Trousseau (AP-HP) France (FR) Jewish General Hospital Canada (CA) Universidad de Navarra Spain (ES) MedStar Washington Hospital Center United States (USA) (US) Veterans Affairs Healthcare System Boston and Harvard Medical School United States (USA) (US) University of California Los Angeles (UCLA) United States (USA) (US) Royal Brompton Hospital United Kingdom (GB) Brigham and Women's Hospital (BWH) United States (USA) (US) Perelman School of Medicine University of Pennsylvania United States (USA) (US) University of Toronto Canada (CA)

How to cite

APA:

Quinaglia, T., Gongora, C., Awadalla, M., Hassan, M.Z., Zafar, A., Drobni, Z.D.,... Neilan, T.G. (2022). Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis. Journal of the American College of Cardiology : Cardiovascular imaging, 15(11), 1883-1896. https://dx.doi.org/10.1016/j.jcmg.2022.06.014

MLA:

Quinaglia, Thiago, et al. "Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis." Journal of the American College of Cardiology : Cardiovascular imaging 15.11 (2022): 1883-1896.

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