Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis.
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Zhang Lili, Awadalla Magid, Mahmood Syed S, Nohria Anju, Hassan Malek Z O, Thuny Franck, Zlotoff Daniel A, Murphy Sean P, Stone James R, Golden Doll Lauren Alexandra, Alvi Raza M, Rokicki Adam, Jones-O'Connor Maeve, Cohen Justine V, Heinzerling Lucie M, Mulligan Connor, Armanious Merna, Barac Ana, Forrestal Brian J, Sullivan Ryan J, Kwong Raymond Y, Yang Eric H, Damrongwatanasuk Rongras, Chen Carol L, Gupta Dipti, Kirchberger Michael C, Moslehi Javid J, Coelho-Filho Otavio R, Ganatra Sarju, Rizvi Muhammad A, Sahni Gagan, Tocchetti Carlo G, Mercurio Valentina, Mahmoudi Michael, Lawrence Donald P, Reynolds Kerry L, Weinsaft Jonathan W, Baksi A John, Ederhy Stephane, Groarke John D, Lyon Alexander R, Fradley Michael G, Thavendiranathan Paaladinesh, Neilan Tomas G
Аннотация
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.