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European Radiology
Published in: European Radiology 11/2022

14-05-2022 | Myocarditis | Cardiac

The prognostic value of global myocardium strain by CMR-feature tracking in immune checkpoint inhibitor–associated myocarditis

Authors: Shi-hai Zhao, Hong Yun, Cai-zhong Chen, Yin-yin Chen, Jin-yi Lin, Meng-su Zeng, Tian-shu Liu, Cui-zhen Pan, Hang Jin

Published in: European Radiology | Issue 11/2022

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Abstract

Objectives

Immune checkpoint inhibitor (ICI)–associated myocarditis is a potentially fatal complication. Sparse published researches evaluated the prognostic value of cardiovascular magnetic resonance feature tracking (CMR-FT) for ICI-associated myocarditis.

Methods

In the single-center retrospective study, 52 patients with ICI-associated myocarditis and CMR were included from August 2018 to July 2021. The ICI-associated myocarditis was diagnosed by using the clinical criteria of the European Society of Cardiology guidelines. Major adverse cardiovascular events (MACE) were comprised of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block.

Results

During a median follow-up of 171 days, 14 (27%) patients developed MACE. For patients with MACE, the global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), and left ventricular ejection fraction (LVEF) were significantly worse and native T1 values and late gadolinium enhancement (LGE) extent were significantly increased, compared with patients without MACE (p < 0.05). The GLS remained the independent factor associated with a higher risk of MACE (hazard ratio (HR): 2.115; 95% confidence interval (CI): 1.379–3.246; p = 0.001) when adjusting for LVEF, LGE extent, age, sex, body mass index, steroid treatment, and prior cardiotoxic chemotherapy or radiation. After adjustment for LVEF, the GLS remained the independent risk factor associated with a higher rate of MACE among patients with a preserved LVEF (HR: 1.358; 95% CI: 1.007–1.830; p = 0.045).

Conclusions

GLS could provide independent prognostic value over GCS, GRS, traditional CMR features, and clinical features in patients with ICI-associated myocarditis.

Key Points

• The global circumferential strain (GCS), global radial strain (GRS), and global longitudinal strain (GLS) by cardiovascular magnetic resonance feature tracking were significantly impaired in patients with an immune checkpoint inhibitor (ICI)–associated myocarditis.
• GLS was still significantly impaired in patients with preserved left ventricular ejection fraction.
• The worse GLS was an independent risk factor over GCS, GRS, traditional CMR features, and clinical features for predicting major adverse cardiovascular events in patients with ICI-associated myocarditis.
Appendix
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Metadata
Title
The prognostic value of global myocardium strain by CMR-feature tracking in immune checkpoint inhibitor–associated myocarditis
Authors
Shi-hai Zhao
Hong Yun
Cai-zhong Chen
Yin-yin Chen
Jin-yi Lin
Meng-su Zeng
Tian-shu Liu
Cui-zhen Pan
Hang Jin
Publication date
14-05-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08844-x

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