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

Thiago Quinaglia; Carlos Gongora; Magid Awadalla; Malek Z.O. Hassan; Amna Zafar; Zsofia D. Drobni; Syed S. Mahmood; Lili Zhang; Otavio R. Coelho-Filho; Giselle A. Suero-Abreu; Muhammad A. Rizvi; Gagan Sahni; Anant Mandawat; Eduardo Zatarain-Nicolás; Michael Mahmoudi; Ryan Sullivan; Sarju Ganatra; Lucie M. Heinzerling; Franck Thuny; Stephane Ederhy; Hannah K. Gilman; Supraja Sama; Sofia Nikolaidou; Ana González Mansilla; Antonio Calles; Marcella Cabral; Francisco Fernández-Avilés; Juan José Gavira; Nahikari Salterain González; Manuel García de Yébenes Castro; Ana Barac; Jonathan Afilalo; Daniel A. Zlotoff; Leyre Zubiri; Kerry L. Reynolds; Richard Devereux; Judy Hung; Michael H. Picard; Eric H. Yang; Dipti Gupta; Caroline Michel; Alexander R. Lyon; Carol L. Chen; Anju Nohria; Michael G. Fradley; Paaladinesh Thavendiranathan; Tomas G. Neilan

doi:10.1016/j.jcmg.2022.06.014

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

Thiago Quinaglia, Carlos Gongora, Magid Awadalla, Malek Z.O. Hassan, Amna Zafar, Zsofia D. Drobni, Syed S. Mahmood, Lili Zhang, Otavio R. Coelho-Filho, Giselle A. Suero-Abreu, Muhammad A. Rizvi, Gagan Sahni, Anant Mandawat, Eduardo Zatarain-Nicolás, Michael Mahmoudi, Ryan Sullivan, Sarju Ganatra, Lucie M. Heinzerling, Franck Thuny, Stephane EderhyHannah K. Gilman, Supraja Sama, Sofia Nikolaidou, Ana González Mansilla, Antonio Calles, Marcella Cabral, Francisco Fernández-Avilés, Juan José Gavira, Nahikari Salterain González, Manuel García de Yébenes Castro, Ana Barac, Jonathan Afilalo, Daniel A. Zlotoff, Leyre Zubiri, Kerry L. Reynolds, Richard Devereux, Judy Hung, Michael H. Picard, Eric H. Yang, Dipti Gupta, Caroline Michel, Alexander R. Lyon, Carol L. Chen, Anju Nohria, Michael G. Fradley, Paaladinesh Thavendiranathan, Tomas G. Neilan

Medicine

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

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. Objectives: This study aimed to detail the role of GCS and GRS in ICI myocarditis. 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. 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). Conclusions: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.

Original language	English (US)
Pages (from-to)	1883-1896
Number of pages	14
Journal	JACC: Cardiovascular Imaging
Volume	15
Issue number	11
DOIs	https://doi.org/10.1016/j.jcmg.2022.06.014
State	Published - Nov 2022

Keywords

cardiovascular risk stratification
immune checkpoint inhibitors
myocarditis
strain modalities survival analysis

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcmg.2022.06.014

Cite this

Quinaglia, T., Gongora, C., Awadalla, M., Hassan, M. Z. O., Zafar, A., Drobni, Z. D., Mahmood, S. S., Zhang, L., Coelho-Filho, O. R., Suero-Abreu, G. A., Rizvi, M. A., Sahni, G., Mandawat, A., Zatarain-Nicolás, E., Mahmoudi, M., Sullivan, R., Ganatra, S., Heinzerling, L. M., Thuny, F., ... Neilan, T. G. (2022). Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis. JACC: Cardiovascular Imaging, 15(11), 1883-1896. https://doi.org/10.1016/j.jcmg.2022.06.014

Quinaglia, T, Gongora, C, Awadalla, M, Hassan, MZO, Zafar, A, Drobni, ZD, Mahmood, SS, Zhang, L, Coelho-Filho, OR, Suero-Abreu, GA, Rizvi, MA, Sahni, G, Mandawat, A, Zatarain-Nicolás, E, Mahmoudi, M, Sullivan, R, Ganatra, S, Heinzerling, LM, Thuny, F, Ederhy, S, Gilman, HK, Sama, S, Nikolaidou, S, Mansilla, AG, Calles, A, Cabral, M, Fernández-Avilés, F, Gavira, JJ, González, NS, García de Yébenes Castro, M, Barac, A, Afilalo, J, Zlotoff, DA, Zubiri, L, Reynolds, KL, Devereux, R, Hung, J, Picard, MH, Yang, EH, Gupta, D, Michel, C, Lyon, AR, Chen, CL, Nohria, A, Fradley, MG, Thavendiranathan, P & Neilan, TG 2022, 'Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis', JACC: Cardiovascular Imaging, vol. 15, no. 11, pp. 1883-1896. https://doi.org/10.1016/j.jcmg.2022.06.014

@article{c49ec84adae84ebb9c737c8c8a76b963,

title = "Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis",

abstract = "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. Objectives: This study aimed to detail the role of GCS and GRS in ICI myocarditis. 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. 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). Conclusions: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.",

keywords = "cardiovascular risk stratification, immune checkpoint inhibitors, myocarditis, strain modalities survival analysis",

author = "Thiago Quinaglia and Carlos Gongora and Magid Awadalla and Hassan, {Malek Z.O.} and Amna Zafar and Drobni, {Zsofia D.} and Mahmood, {Syed S.} and Lili Zhang and Coelho-Filho, {Otavio R.} and Suero-Abreu, {Giselle A.} and Rizvi, {Muhammad A.} and Gagan Sahni and Anant Mandawat and Eduardo Zatarain-Nicol{\'a}s and Michael Mahmoudi and Ryan Sullivan and Sarju Ganatra and Heinzerling, {Lucie M.} and Franck Thuny and Stephane Ederhy and Gilman, {Hannah K.} and Supraja Sama and Sofia Nikolaidou and Mansilla, {Ana Gonz{\'a}lez} and Antonio Calles and Marcella Cabral and Francisco Fern{\'a}ndez-Avil{\'e}s and Gavira, {Juan Jos{\'e}} and Gonz{\'a}lez, {Nahikari Salterain} and {Garc{\'i}a de Y{\'e}benes Castro}, Manuel and Ana Barac and Jonathan Afilalo and Zlotoff, {Daniel A.} and Leyre Zubiri and Reynolds, {Kerry L.} and Richard Devereux and Judy Hung and Picard, {Michael H.} and Yang, {Eric H.} and Dipti Gupta and Caroline Michel and Lyon, {Alexander R.} and Chen, {Carol L.} and Anju Nohria and Fradley, {Michael G.} and Paaladinesh Thavendiranathan and Neilan, {Tomas G.}",

note = "Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = nov,

doi = "10.1016/j.jcmg.2022.06.014",

language = "English (US)",

volume = "15",

pages = "1883--1896",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "11",

}

TY - JOUR

T1 - Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis

AU - Quinaglia, Thiago

AU - Gongora, Carlos

AU - Awadalla, Magid

AU - Hassan, Malek Z.O.

AU - Zafar, Amna

AU - Drobni, Zsofia D.

AU - Mahmood, Syed S.

AU - Zhang, Lili

AU - Coelho-Filho, Otavio R.

AU - Suero-Abreu, Giselle A.

AU - Rizvi, Muhammad A.

AU - Sahni, Gagan

AU - Mandawat, Anant

AU - Zatarain-Nicolás, Eduardo

AU - Mahmoudi, Michael

AU - Sullivan, Ryan

AU - Ganatra, Sarju

AU - Heinzerling, Lucie M.

AU - Thuny, Franck

AU - Ederhy, Stephane

AU - Gilman, Hannah K.

AU - Sama, Supraja

AU - Nikolaidou, Sofia

AU - Mansilla, Ana González

AU - Calles, Antonio

AU - Cabral, Marcella

AU - Fernández-Avilés, Francisco

AU - Gavira, Juan José

AU - González, Nahikari Salterain

AU - García de Yébenes Castro, Manuel

AU - Barac, Ana

AU - Afilalo, Jonathan

AU - Zlotoff, Daniel A.

AU - Zubiri, Leyre

AU - Reynolds, Kerry L.

AU - Devereux, Richard

AU - Hung, Judy

AU - Picard, Michael H.

AU - Yang, Eric H.

AU - Gupta, Dipti

AU - Michel, Caroline

AU - Lyon, Alexander R.

AU - Chen, Carol L.

AU - Nohria, Anju

AU - Fradley, Michael G.

AU - Thavendiranathan, Paaladinesh

AU - Neilan, Tomas G.

PY - 2022/11

Y1 - 2022/11

N2 - 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. Objectives: This study aimed to detail the role of GCS and GRS in ICI myocarditis. 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. 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). Conclusions: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.

AB - 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. Objectives: This study aimed to detail the role of GCS and GRS in ICI myocarditis. 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. 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). Conclusions: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.

KW - cardiovascular risk stratification

KW - immune checkpoint inhibitors

KW - myocarditis

KW - strain modalities survival analysis

UR - http://www.scopus.com/inward/record.url?scp=85140735559&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85140735559&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2022.06.014

DO - 10.1016/j.jcmg.2022.06.014

M3 - Article

C2 - 36357131

AN - SCOPUS:85140735559

SN - 1936-878X

VL - 15

SP - 1883

EP - 1896

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 11

ER -

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

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Keywords

ASJC Scopus subject areas

UN SDGs

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