Myocardial T1 and T2 mapping by magnetic resonance in patients with immune checkpoint inhibitor–associated myocarditis Journal Article
| Authors: | Thavendiranathan, P.; Zhang, L.; Zafar, A.; Drobni, Z. D.; 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. |
| Article Title: | Myocardial T1 and T2 mapping by magnetic resonance in patients with immune checkpoint inhibitor–associated myocarditis |
| Abstract: | 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 |
| Keywords: | myocarditis; immune checkpoint inhibitor; cardiovascular magnetic resonance; lake louise criteria; major adverse cardiovascular event; t1 mapping; t2 mapping |
| Journal Title: | Journal of the American College of Cardiology |
| Volume: | 77 |
| Issue: | 12 |
| ISSN: | 0735-1097 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2021-03-30 |
| Start Page: | 1503 |
| End Page: | 1516 |
| Language: | English |
| DOI: | 10.1016/j.jacc.2021.01.050 |
| PROVIDER: | scopus |
| PUBMED: | 33766256 |
| PMCID: | PMC8442989 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2021 -- Source: Scopus |
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