Cardiac MRI Features and Prognostic Value in Immune Checkpoint Inhibitor-induced Myocarditis
Farah Cadour1, Jennifer Cautela1, Stanislas Rapacchi1
1From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.).
Immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) shows distinct cardiac MRI features compared to other conditions. Septal late gadolinium enhancement on cardiac MRI may predict major adverse cardiovascular events in patients with ICI-M.
Area of Science:
- Cardiology
- Radiology
- Oncology
Background:
- Cardiac Magnetic Resonance Imaging (CMR) features of immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) are not well-defined.
- ICI-M is a severe complication of cancer immunotherapy with immune checkpoint inhibitors (ICIs).
Purpose of the Study:
- To analyze the cardiac MRI features of ICI-M.
- To explore the prognostic value of these features for major adverse cardiovascular events (MACE).
Main Methods:
- Retrospective study comparing CMR findings (LGE, T1/T2 mapping, ECV) in patients with ICI-M, pre-ICI therapy, and viral myocarditis.
- Cox proportional hazards models were used to assess MACE prediction.
Main Results:
- Patients with ICI-M exhibited higher global native T1, ECV, and T2 z-scores compared to the pre-ICI group.
- Late gadolinium enhancement (LGE) was more frequent in ICI-M than pre-ICI groups but less frequent than in viral myocarditis.
- Septal LGE was more common in ICI-M and identified as the sole cardiac MRI predictor of MACE at 1 year.
Conclusions:
- Cardiac MRI features in ICI-M differ from those in patients receiving ICIs and those with viral myocarditis.
- Septal LGE may serve as a valuable predictor of cardiovascular events in ICI-M patients.
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