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Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis

Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis
Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis
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.
Cardiovascular magnetic resonance, Immune checkpoint inhibitor, Myocarditis
0195-668X
1733-1743
Zhang, Lili
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Awadalla, Magid
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Mahmood, Syed S.
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Nohria, Anju
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Hassan, Malek Z. O.
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Thuny, Franck
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Zlotoff, Daniel A.
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Murphy, Sean P.
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Stone, James R.
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Golden, Doll Lauren
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Alvi, Raza M.
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Rokicki, Adam
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Jones-O'Connor, Maev
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Cohen, Justine V.
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Heinzerling, Lucie M.
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Mulligan, Connor
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Armanious, Merna
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Barac, Ana
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Forrestal, Brian J.
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Sullivan, Ryan J.
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Kwong, Raymond Y.
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Yang, Eric H.
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Damrongwatanasuk, Rongras
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Chen, Carol L.
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Gupta, Dipti
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Kirchberger, Michael C.
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Moslehi, Javid J.
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Coelho-Filho, Otavio R.
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Ganatra, Sarju
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Rizvi, Muhammad A.
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Sahni, Gagan
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Tocchetti, Carlo G.
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Mercurio, Valentina
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Mahmoudi, Michael
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Lawrence, Donald P.
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Reynolds, Kerry L.
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Weinsaft, Jonathan W.
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Baksi, A. John
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Ederhy, Stephane
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Groarke, John D.
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Lyon, Alexander R.
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Fradley, Michael G.
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Thavendiranathan, Paaladinesh
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Neilan, Tomas G.
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Zhang, Lili
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Awadalla, Magid
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Mahmood, Syed S.
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Nohria, Anju
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Hassan, Malek Z. O.
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Thuny, Franck
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Zlotoff, Daniel A.
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Murphy, Sean P.
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Stone, James R.
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Golden, Doll Lauren
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Alvi, Raza M.
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Rokicki, Adam
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Jones-O'Connor, Maev
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Cohen, Justine V.
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Heinzerling, Lucie M.
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Mulligan, Connor
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Armanious, Merna
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Barac, Ana
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Forrestal, Brian J.
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Sullivan, Ryan J.
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Kwong, Raymond Y.
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Yang, Eric H.
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Damrongwatanasuk, Rongras
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Chen, Carol L.
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Gupta, Dipti
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Kirchberger, Michael C.
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Moslehi, Javid J.
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Coelho-Filho, Otavio R.
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Ganatra, Sarju
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Rizvi, Muhammad A.
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Sahni, Gagan
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Tocchetti, Carlo G.
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Mercurio, Valentina
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Mahmoudi, Michael
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Lawrence, Donald P.
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Reynolds, Kerry L.
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Weinsaft, Jonathan W.
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Baksi, A. John
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Ederhy, Stephane
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Groarke, John D.
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Lyon, Alexander R.
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Fradley, Michael G.
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Thavendiranathan, Paaladinesh
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Neilan, Tomas G.
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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, Alvi, Raza M., Rokicki, Adam, Jones-O'Connor, Maev, 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 and Neilan, Tomas G. (2020) Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis. European Heart Journal, 41 (18), 1733-1743. (doi:10.1093/eurheartj/ehaa051).

Record type: Article

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.

Text
ICI myocarditis and CMR Manuscript final - Accepted Manuscript
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More information

Accepted/In Press date: 21 January 2020
e-pub ahead of print date: 29 February 2020
Published date: 7 May 2020
Keywords: Cardiovascular magnetic resonance, Immune checkpoint inhibitor, Myocarditis

Identifiers

Local EPrints ID: 439234
URI: http://eprints.soton.ac.uk/id/eprint/439234
ISSN: 0195-668X
PURE UUID: 261f53bd-6b8d-4efb-a8c0-5b9fc53ed1a2
ORCID for Michael Mahmoudi: ORCID iD orcid.org/0000-0003-1293-8461

Catalogue record

Date deposited: 07 Apr 2020 16:31
Last modified: 28 Apr 2022 06:30

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Contributors

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

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