Global circumferential and radial strain among patients with immune checkpoint inhibitor myocarditis Journal Article
| Authors: | 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.; Ederhy, S.; Gilman, H. K.; Sama, S.; Nikolaidou, S.; Mansilla, A. G.; Calles, A.; Cabral, M.; Fernández-Avilés, F.; Gavira, J. J.; González, N. S.; García de Yébenes Castro, M.; Barac, A.; Afilalo, J.; Zlotoff, D. A.; Zubiri, L.; Reynolds, K. L.; Devereux, R.; Hung, J.; Picard, M. H.; Yang, E. H.; Gupta, D.; Michel, C.; Lyon, A. R.; Chen, C. L.; Nohria, A.; Fradley, M. G.; Thavendiranathan, P.; Neilan, T. G. |
| Article 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. © 2022 American College of Cardiology Foundation |
| Keywords: | controlled study; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; hepatitis; gadolinium; follow up; ipilimumab; ticilimumab; diagnostic imaging; retrospective study; age; pneumonia; acetylsalicylic acid; cardiovascular disease; predictive value of tests; colitis; dermatitis; heart left ventricle ejection fraction; neurologic disease; beta adrenergic receptor blocking agent; calcium channel blocking agent; hydroxymethylglutaryl coenzyme a reductase inhibitor; heart stroke volume; stroke volume; predictive value; receiver operating characteristic; ventricular function, left; complication; hemodynamic parameters; hypophysitis; myositis; heart left ventricle function; vasculitis; nephritis; myocarditis; troponin t; adrenal disease; hypophysis disease; immune checkpoint inhibitor; nivolumab; very elderly; humans; human; male; female; article; pembrolizumab; durvalumab; immune checkpoint inhibitors; atezolizumab; avelumab; cardiovascular risk stratification; strain modalities survival analysis; core laboratory; global circumferential strain; global radial strain |
| Journal Title: | JACC: Cardiovascular Imaging |
| Volume: | 15 |
| Issue: | 11 |
| ISSN: | 1936-878X |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2022-11-01 |
| Start Page: | 1883 |
| End Page: | 1896 |
| Language: | English |
| DOI: | 10.1016/j.jcmg.2022.06.014 |
| PUBMED: | 36357131 |
| PROVIDER: | scopus |
| PMCID: | PMC10334352 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
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