Global Longitudinal Strain and Cardiac Events in Patients With Immune Checkpoint Inhibitor-Related Myocarditis.

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Citation: Journal of the American College of Cardiology. 75(5):467-478, 2020 02 11.PMID: 32029128Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Antineoplastic Agents/ae [Adverse Effects] | *Echocardiography | *Myocarditis/dg [Diagnostic Imaging] | Aged | Aged, 80 and over | Female | Humans | Lung Neoplasms/dt [Drug Therapy] | Male | Melanoma/dt [Drug Therapy] | Middle Aged | Myocarditis/ci [Chemically Induced] | Myocarditis/co [Complications] | Retrospective StudiesYear: 2020ISSN:
  • 0735-1097
Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: There is a need for improved methods for detection and risk stratification of myocarditis associated with immune checkpoint inhibitors (ICIs). Global longitudinal strain (GLS) is a sensitive marker of cardiac toxicity among patients receiving standard chemotherapy. There are no data on the use of GLS in ICI myocarditis.CONCLUSIONS: GLS decreases with ICI myocarditis and, compared with control subjects, was lower among cases presenting with either a preserved or reduced EF. Lower GLS was strongly associated with MACE in ICI myocarditis presenting with either a preserved or reduced EF. Crown Copyright (c) 2020. Published by Elsevier Inc. All rights reserved.METHODS: This study retrospectively compared echocardiographic GLS by speckle tracking at presentation with ICI myocarditis (cases, n = 101) to that from patients receiving an ICI who did not develop myocarditis (control subjects, n = 92). Where available, GLS was also measured pre-ICI in both groups. Major adverse cardiac events (MACE) were defined as a composite of cardiogenic shock, arrest, complete heart block, and cardiac death.OBJECTIVES: This study sought to evaluate the role of GLS and assess its association with cardiac events among patients with ICI myocarditis.RESULTS: Cases and control subjects were similar in age, sex, and cancer type. At presentation with myocarditis, 61 cases (60%) had a normal ejection fraction (EF). Pre-ICI, GLS was similar between cases and control subjects (20.3 +/- 2.6% vs. 20.6 +/- 2.0%; p = 0.60). There was no change in GLS among control subjects on an ICI without myocarditis (pre-ICI vs. on ICI, 20.6 +/- 2.0% vs. 20.5 +/- 1.9%; p = 0.41); in contrast, among cases, GLS decreased to 14.1 +/- 2.8% (p < 0.001). The GLS at presentation with myocarditis was lower among cases presenting with either a reduced (12.3 +/- 2.7%) or preserved EF (15.3 +/- 2.0%; p < 0.001). Over a median follow-up of 162 days, 51 (51%) experienced MACE. The risk of MACE was higher with a lower GLS among patients with either a reduced or preserved EF. After adjustment for EF, each percent reduction in GLS was associated with a 1.5-fold increase in MACE among patients with a reduced EF (hazard ratio: 1.5; 95% confidence interval: 1.2 to 1.8) and a 4.4-fold increase with a preserved EF (hazard ratio: 4.4; 95% confidence interval: 2.4 to 7.8).All authors: Alvi RM, Awadalla M, Bakar RB, Banerji D, Barac A, Chen CL, Cohen JV, Devereux RB, Ederhy S, Forrestal BJ, Fradley MG, Ganatra S, Groarke JD, Gupta D, Hassan MZO, Heinzerling LM, Hung J, Jones-O'Connor M, Kirchberger MC, Lawrence DP, Liu S, Lyon AR, Mahmood SS, Mahmoudi M, Mandawat A, Mercaldo ND, Mulligan CP, Murphy SP, Neilan TG, Nohria A, Picard MH, Reynolds KL, Rizvi MA, Rokicki A, Sahni G, Shah SP, Sullivan RJ, Thavendiranathan P, Thuny F, Tocchetti CG, Zhang L, Zlotoff DAOriginally published: Journal of the American College of Cardiology. 75(5):467-478, 2020 Feb 11.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-02-26
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Journal Article MedStar Authors Catalog Article 32029128 Available 32029128

BACKGROUND: There is a need for improved methods for detection and risk stratification of myocarditis associated with immune checkpoint inhibitors (ICIs). Global longitudinal strain (GLS) is a sensitive marker of cardiac toxicity among patients receiving standard chemotherapy. There are no data on the use of GLS in ICI myocarditis.

CONCLUSIONS: GLS decreases with ICI myocarditis and, compared with control subjects, was lower among cases presenting with either a preserved or reduced EF. Lower GLS was strongly associated with MACE in ICI myocarditis presenting with either a preserved or reduced EF. Crown Copyright (c) 2020. Published by Elsevier Inc. All rights reserved.

METHODS: This study retrospectively compared echocardiographic GLS by speckle tracking at presentation with ICI myocarditis (cases, n = 101) to that from patients receiving an ICI who did not develop myocarditis (control subjects, n = 92). Where available, GLS was also measured pre-ICI in both groups. Major adverse cardiac events (MACE) were defined as a composite of cardiogenic shock, arrest, complete heart block, and cardiac death.

OBJECTIVES: This study sought to evaluate the role of GLS and assess its association with cardiac events among patients with ICI myocarditis.

RESULTS: Cases and control subjects were similar in age, sex, and cancer type. At presentation with myocarditis, 61 cases (60%) had a normal ejection fraction (EF). Pre-ICI, GLS was similar between cases and control subjects (20.3 +/- 2.6% vs. 20.6 +/- 2.0%; p = 0.60). There was no change in GLS among control subjects on an ICI without myocarditis (pre-ICI vs. on ICI, 20.6 +/- 2.0% vs. 20.5 +/- 1.9%; p = 0.41); in contrast, among cases, GLS decreased to 14.1 +/- 2.8% (p < 0.001). The GLS at presentation with myocarditis was lower among cases presenting with either a reduced (12.3 +/- 2.7%) or preserved EF (15.3 +/- 2.0%; p < 0.001). Over a median follow-up of 162 days, 51 (51%) experienced MACE. The risk of MACE was higher with a lower GLS among patients with either a reduced or preserved EF. After adjustment for EF, each percent reduction in GLS was associated with a 1.5-fold increase in MACE among patients with a reduced EF (hazard ratio: 1.5; 95% confidence interval: 1.2 to 1.8) and a 4.4-fold increase with a preserved EF (hazard ratio: 4.4; 95% confidence interval: 2.4 to 7.8).

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