Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis.

MedStar author(s):
Citation: European Heart Journal. 41(18):1733-1743, 2020 May 07.PMID: 32112560Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020Local holdings: Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006ISSN:
  • 0195-668X
Name of journal: European heart journalAbstract: 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.CONCLUSION: These data suggest caution in reliance on LGE or a qualitative T2-STIR-only approach for the exclusion of ICI-associated myocarditis. Copyright Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author(s) 2020. For permissions, please email: [email protected] 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.All authors: Alvi RM, Armanious M, Awadalla M, Baksi AJ, Barac A, Chen CL, Coelho-Filho OR, Cohen JV, Damrongwatanasuk R, Ederhy S, Forrestal BJ, Fradley MG, Ganatra S, Golden DLA, Groarke JD, Gupta D, Hassan MZO, Heinzerling LM, Jones-O'Connor M, Kirchberger MC, Kwong RY, Lawrence DP, Lyon AR, Mahmood SS, Mahmoudi M, Mercurio V, Moslehi JJ, Mulligan C, Murphy SP, Neilan TG, Nohria A, Reynolds KL, Rizvi MA, Rokicki A, Sahni G, Stone JR, Sullivan RJ, Thavendiranathan P, Thuny F, Tocchetti CG, Weinsaft JW, Yang EH, Zhang L, Zlotoff DAFiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32112560 Available 32112560

Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006

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.

CONCLUSION: These data suggest caution in reliance on LGE or a qualitative T2-STIR-only approach for the exclusion of ICI-associated myocarditis. Copyright Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author(s) 2020. For permissions, please email: [email protected].

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.

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