TY - JOUR
T1 - Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor–Associated Myocarditis
AU - Thavendiranathan, Paaladinesh
AU - Zhang, Lili
AU - Zafar, Amna
AU - Drobni, Zsofia D.
AU - Mahmood, Syed S.
AU - Cabral, Marcella
AU - Awadalla, Magid
AU - Nohria, Anju
AU - Zlotoff, Daniel A.
AU - Thuny, Franck
AU - Heinzerling, Lucie M.
AU - Barac, Ana
AU - Sullivan, Ryan J.
AU - Chen, Carol L.
AU - Gupta, Dipti
AU - Kirchberger, Michael C.
AU - Hartmann, Sarah E.
AU - Weinsaft, Jonathan W.
AU - Gilman, Hannah K.
AU - Rizvi, Muhammad A.
AU - Kovacina, Bojan
AU - Michel, Caroline
AU - Sahni, Gagan
AU - González-Mansilla, Ana
AU - Calles, Antonio
AU - Fernández-Avilés, Francisco
AU - Mahmoudi, Michael
AU - Reynolds, Kerry L.
AU - Ganatra, Sarju
AU - Gavira, Juan José
AU - González, Nahikari Salterain
AU - García de Yébenes Castro, Manuel
AU - Kwong, Raymond Y.
AU - Jerosch-Herold, Michael
AU - Coelho-Filho, Otavio R.
AU - Afilalo, Jonathan
AU - Zataraín-Nicolás, Eduardo
AU - Baksi, A. John
AU - Wintersperger, Bernd J.
AU - Calvillo-Arguelles, Oscar
AU - Ederhy, Stephane
AU - Yang, Eric H.
AU - Lyon, Alexander R.
AU - Fradley, Michael G.
AU - Neilan, Tomas G.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/3/30
Y1 - 2021/3/30
N2 - 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.
AB - 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.
KW - Lake Louise Criteria
KW - T1 mapping
KW - T2 mapping
KW - cardiovascular magnetic resonance
KW - immune checkpoint inhibitor
KW - major adverse cardiovascular event
KW - myocarditis
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U2 - 10.1016/j.jacc.2021.01.050
DO - 10.1016/j.jacc.2021.01.050
M3 - Article
C2 - 33766256
AN - SCOPUS:85102580658
SN - 0735-1097
VL - 77
SP - 1503
EP - 1516
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -