Citation: ; Journal of the American College of Cardiology. 75(5):467-478, 2020 02 11..Journal: Journal of the American College of Cardiology.Published: ; 2020; ISSN: 0735-1097.Full author list: 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 DA.UI/PMID: 32029128.Subject(s): Aged | Retrospective Studies | *Myocarditis/dg [Diagnostic Imaging] | Myocarditis/co [Complications] | Myocarditis/ci [Chemically Induced] | Middle Aged | Melanoma/dt [Drug Therapy] | Male | Lung Neoplasms/dt [Drug Therapy] | Humans | Female | *Echocardiography | *Antineoplastic Agents/ae [Adverse Effects] | Aged, 80 and overInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1016/j.jacc.2019.11.049 (Click here)Abbreviated citation: ; J Am Coll Cardiol. 75(5):467-478, 2020 02 11.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: OBJECTIVES: This study sought to evaluate the role of GLS and assess its association with cardiac events among patients with ICI myocarditis.Abstract: 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).