Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis.

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Citation: Jacc: Cardiovascular Imaging. 15(11):1883-1896, 2022 Nov.PMID: 36357131Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Myocarditis | Aged | Aged, 80 and over | Humans | Immune Checkpoint Inhibitors | Male | Middle Aged | Myocarditis/ci [Chemically Induced] | Myocarditis/co [Complications] | Myocarditis/dg [Diagnostic Imaging] | Predictive Value of Tests | Retrospective Studies | Stroke Volume | Troponin T | Ventricular Function, LeftYear: 2022ISSN:
  • 1876-7591
Name of journal: JACC. Cardiovascular imagingAbstract: BACKGROUND: Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS.CONCLUSIONS: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance. Copyright © 2022 American College of Cardiology Foundation. All rights reserved.METHODS: In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death.OBJECTIVES: This study aimed to detail the role of GCS and GRS in ICI myocarditis.RESULTS: Cases and controls were similar in age (66 +/- 15 years vs 63 +/- 12 years; P = 0.20), sex (male: 73% vs 61%; P = 0.20) and cancer type (P = 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% +/- 3.4% vs 23.5% +/- 3.8%; P = 0.14; GRS: 45.5% +/- 6.2% vs 43.6% +/- 8.8%; P = 0.24). Overall, 56% (n = 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% +/- 4.2% vs 23.6% +/- 3.0%; P < 0.001; GRS: 28.6% +/- 6.7% vs 47.0% +/- 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P = 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P = 0.008) below the median was associated with an increased event rate. In receiver-operating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56-0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P = 0.04) and GCS over cTnT (P = 0.002).All authors: Afilalo J, Awadalla M, Barac A, Cabral M, Calles A, Chen CL, Coelho-Filho OR, Devereux R, Drobni ZD, Ederhy S, Fernandez-Aviles F, Fradley MG, Ganatra S, Garcia de Yebenes Castro M, Gavira JJ, Gilman HK, Gongora C, Gonzalez NS, Gupta D, Hassan MZO, Heinzerling LM, Hung J, Lyon AR, Mahmood SS, Mahmoudi M, Mandawat A, Mansilla AG, Michel C, Neilan TG, Nikolaidou S, Nohria A, Picard MH, Quinaglia T, Reynolds KL, Rizvi MA, Sahni G, Sama S, Suero-Abreu GA, Sullivan R, Thavendiranathan P, Thuny F, Yang EH, Zafar A, Zatarain-Nicolas E, Zhang L, Zlotoff DA, Zubiri LFiscal year: FY2023Digital Object Identifier: Date added to catalog: 2022-12-13
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Journal Article MedStar Authors Catalog Article 36357131 Available 36357131

BACKGROUND: Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS.

CONCLUSIONS: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance. Copyright © 2022 American College of Cardiology Foundation. All rights reserved.

METHODS: In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death.

OBJECTIVES: This study aimed to detail the role of GCS and GRS in ICI myocarditis.

RESULTS: Cases and controls were similar in age (66 +/- 15 years vs 63 +/- 12 years; P = 0.20), sex (male: 73% vs 61%; P = 0.20) and cancer type (P = 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% +/- 3.4% vs 23.5% +/- 3.8%; P = 0.14; GRS: 45.5% +/- 6.2% vs 43.6% +/- 8.8%; P = 0.24). Overall, 56% (n = 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% +/- 4.2% vs 23.6% +/- 3.0%; P < 0.001; GRS: 28.6% +/- 6.7% vs 47.0% +/- 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P = 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P = 0.008) below the median was associated with an increased event rate. In receiver-operating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56-0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P = 0.04) and GCS over cTnT (P = 0.002).

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