Heart failure & cardiomyopathies
Cardiac Magnetic Resonance-Based Layer-Specific Strain in Immune Checkpoint Inhibitor-Associated Myocarditis
Authors' conclusion
CR and CS ICIaM demonstrated different functional and morphological characteristics in different myocardial layers. An impaired GLSendo could be a helpful parameter in early identifying corticosteroid-refractory individuals in the ICIaM population.
Study context
- Population
- Patients with immune checkpoint inhibitor-associated myocarditis (ICIaM), all non-fulminant at presentation; Cardiac magnetic resonance (CMR) within 2 days of suspicion35 ICIaM, 30 controls
- Participants
- 15 / 20 / 30
- Exposure
- Corticosteroid-refractory vs corticosteroid-sensitive ICIaM
- Corticosteroid-refractory (CR) ICIaMn = 15
- Corticosteroid-sensitive (CS) ICIaMn = 20reference
- Controlsn = 30
- Outcome
- GLSendo and GLSepi (CMR feature tracking)
Methodological detailsage and gender-matched controls
- Age and gender-matched controls
Main finding
As reported in the abstract
| Group | GLSendo | GLSepi |
|---|---|---|
| CR ICIaM | −14.61 ± 2.67 | −14.75 ± 2.53 |
| CS ICIaM | −18.50 ± 2.53 | −16.68 ± 2.05 |
| Controls | −19.31 ± 1.80 |
GLSendo
CR ICIaM−14.61 ± 2.67
CS ICIaM−18.50 ± 2.53
Controls— not stated in the abstract
GLSepi
CR ICIaM−14.75 ± 2.53
CS ICIaM−16.68 ± 2.05
Controls−19.31 ± 1.80
- CR ICIaM vs CS ICIaM: P < 0.001 — GLSendo
- CR ICIaM vs CS ICIaM: P < 0.001 — GLSepi
- CS ICIaM vs Controls: P < 0.001 — GLSepi impaired; GLSendo preserved
Observational data: associations, not effects.
Further findings
Independent predictor of CR ICIaM (multivariate: Left ventricular ejection fraction (LVEF), GLSendo, GLSepi)
| OR (95% CI) | P value | ||
|---|---|---|---|
| GLSendoOnly GLSendo remained independent | 2.170 (1.189–3.962) | P = 0.012 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Values |
|---|---|
| GLSendo ≥−17.10% for predicting CR ICIaM | GLSendo ≥−17.10% Sensitivity 86.7% · Specificity 80.0% · AUC 0.860 |
| LGE in ICIaM | ICIaM 62.86% |
- GLSendo ≥−17.10% for predicting CR ICIaM: P < 0.001
CV adverse events, impaired (≥−17.10%) vs preserved GLSendo
- Cardiovascular adverse events (CAEs) occurred much earlier with impaired GLSendo (log-rank)
- P = 0.017
Late gadolinium enhancement (LGE) in ICIaM
- No difference in CMR parameters between LGE-positive and negative
LVEF
- LVEF decreased in CR ICIaM vs CS and controls
Original publication
Cardiac Magnetic Resonance-Based Layer-Specific Strain in Immune Checkpoint Inhibitor-Associated Myocarditis. ESC Heart Fail. Published 19 January 2024. doi:10.
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