Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor–Associated Myocarditis

Thavendiranathan, P. ✉; Zhang, L.*; Zafar, A.; Drobni, Z.D. [Drobni, Zsófia (kardiológia), szerző] Városmajori Szív- és Érgyógyászati Klinika (SE / AOK / K); Kardiológia Központ - Kardiológiai Tanszék (SE / AOK / K); Mahmood, S.S.; Cabral, M.; Awadalla, M.; Nohria, A.; Zlotoff, D.A.; Thuny, F.; Heinzerling, L.M.; Barac, A.; Sullivan, R.J.; Chen, C.L.; Gupta, D.; Kirchberger, M.C.; Hartmann, S.E.; Weinsaft, J.W.; Gilman, H.K.; Rizvi, M.A.; Kovacina, B.; Michel, C.; Sahni, G.; González-Mansilla, A.; Calles, A.; Fernández-Avilés, F.; Mahmoudi, M.; Reynolds, K.L.; Ganatra, S.; Gavira, J.J.; González, N.S.; García, de Yébenes Castro M.; Kwong, R.Y.; Jerosch-Herold, M.; Coelho-Filho, O.R.; Afilalo, J.; Zataraín-Nicolás, E.; Baksi, A.J.; Wintersperger, B.J.; Calvillo-Arguelles, O.; Ederhy, S.; Yang, E.H.; Lyon, A.R.; Fradley, M.G.; Neilan, T.G. ✉

Angol nyelvű Sokszerzős vagy csoportos szerzőségű szakcikk (Folyóiratcikk) Tudományos
  • SJR Scopus - Cardiology and Cardiovascular Medicine: D1
Background: Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited. Objectives: This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis. Methods: In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. Results: Of 136 patients with ICI myocarditis with a CMR, 86 (63%) had T1 maps and 79 (58%) also had T2 maps. Among the 86 patients (66.3 ± 13.1 years of age), 36 (41.9%) had a left ventricular ejection fraction <55%. Across all patients, mean z-scores for T1 and T2 values were 2.9 ± 1.9 (p < 0.001) and 2.2 ± 2.1 (p < 0.001), respectively. On Siemens 1.5-T scanner (n = 67), native T1 (1,079.0 ± 55.5 ms vs. 1,000.3 ± 22.1 ms; p < 0.001) and T2 (56.2 ± 4.9 ms vs. 49.8 ± 2.2 ms; p < 0.001) values were elevated compared with reference values. Abnormal T1 and T2 values were seen in 78% and 43% of the patients, respectively. Applying the modified Lake Louise Criteria, 95% met the nonischemic myocardial injury criteria and 53% met the myocardial edema criteria. Native T1 values had excellent discriminatory value for subsequent MACE, with an area under the curve of 0.91 (95% confidence interval: 0.84 to 0.98). Native T1 values (for every 1-unit increase in z-score, hazard ratio: 1.44; 95% confidence interval: 1.12 to 1.84; p = 0.004) but not T2 values were independently associated with subsequent MACE. Conclusions: The use of T1 mapping and application of the modified Lake Louise Criteria provides important diagnostic value, and T1 mapping provides prognostic value in patients with ICI myocarditis. © 2021 American College of Cardiology Foundation
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2024-07-17 15:44