Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis.
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Quinaglia Thiago, Gongora Carlos, Awadalla Magid, Hassan Malek Z O, Zafar Amna, Drobni Zsofia D, Mahmood Syed S, Zhang Lili, Coelho-Filho Otavio R, Suero-Abreu Giselle A, Rizvi Muhammad A, Sahni Gagan, Mandawat Anant, Zatarain-Nicolás Eduardo, Mahmoudi Michael, Sullivan Ryan, Ganatra Sarju, Heinzerling Lucie M, Thuny Franck, Ederhy Stephane, Gilman Hannah K, Sama Supraja, Nikolaidou Sofia, Mansilla Ana González, Calles Antonio, Cabral Marcella, Fernández-Avilés Francisco, Gavira Juan José, González Nahikari Salterain, García de Yébenes Castro Manuel, Barac Ana, Afilalo Jonathan, Zlotoff Daniel A, Zubiri Leyre, Reynolds Kerry L, Devereux Richard, Hung Judy, Picard Michael H, Yang Eric H, Gupta Dipti, Michel Caroline, Lyon Alexander R, Chen Carol L, Nohria Anju, Fradley Michael G, Thavendiranathan Paaladinesh, Neilan Tomas G
Аннотация
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.