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Noninvasive Assessment of Cardiac Abnormalities in Experimental Autoimmune Myocarditis by Magnetic Resonance Microscopy Imaging in the Mouse
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Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint
Jialian Li1, Yanwei Li1, Li Tao2
1Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China.
Insights
Immune checkpoint inhibitor (ICI) treatment alters cardiac function, increasing T1, T2, and global longitudinal strain (GLS), while decreasing global radial strain (GRS). This supports a rapid, non-contrast cardiac MRI protocol for cardio-oncology.
Area of Science:
- Cardio-oncology
- Cardiovascular imaging
- Immunotherapy
Background:
- Cardiac magnetic resonance (CMR) is complex and its parameters have uncertainty in diagnosing cardiotoxicity in patients on immune checkpoint inhibitors (ICI).
- Limited promotion of CMR in cardiac evaluation for ICI-treated patients due to complexity and parameter uncertainty.
Purpose of the Study:
- To evaluate the impact of ICI treatment on cardiac function using CMR parameters.
- To propose a streamlined, abbreviated CMR protocol for cardio-oncology.
Main Methods:
- Comprehensive literature search across major databases (PubMed, Web of Science, Embase, CNKI, Cochrane) up to September 28, 2024.
- Inclusion of 8 relevant articles for meta-analysis.
- Analysis of left ventricular global longitudinal strain (GLS), global radial strain (GRS), T1, and T2 values.
Main Results:
- ICI treatment significantly increased left ventricular GLS (WMD 2.33) and T1/T2 values (SMD 1.14/1.11).
- Global radial strain (GRS) significantly decreased (WMD -4.73) post-ICI.
- Elevated T2 was associated with increased major adverse cardiovascular events (MACE) (HR 1.36).
Conclusions:
- ICI administration leads to increased T1, T2, and GLS, with decreased GRS.
- A streamlined, abbreviated (non-contrast) CMR protocol under 15 minutes is proposed.
- This protocol aims to facilitate CMR integration in cardio-oncology for improved patient monitoring.
Background:
The complex process of cardiac magnetic resonance (CMR) and the uncertainty of each parameter in the diagnosis and prognosis of cardiotoxicity limit its promotion in the cardiac evaluation of patients treated with immune checkpoint inhibitors (ICI).
Methods:
A comprehensive search was conducted across PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Cochrane databases for relevant articles published up until September 28, 2024.
Results:
After screening, 8 articles were included in this study. The analysis revealed that following ICI treatment, the left ventricular global longitudinal strain (GLS) increased significantly [weighted mean difference (WMD) 2.33; 95% confidence interval (CI) 1.26, 3.41; p < 0.01], while the global radial strain (GRS) decreased [WMD -4.73; 95% CI -6.74, -2.71; p < 0.01]. Additionally, T1 and T2 values increased [standardized mean difference (SMD) 1.14; 95% CI 0.59, 1.68; p < 0.01] and [SMD 1.11; 95% CI 0.64, 1.58; p < 0.01], respectively. An elevated T2 was associated with a higher occurrence of major adverse cardiovascular events (MACE), with a hazard ratio of 1.36 (95% CI 1.12, 1.64).
Conclusions:
Our findings demonstrate that T1, T2, and GLS increase, while GRS decreases following ICI administration. By consolidating these critical metrics, we propose a streamlined, abbreviated (non-contrast) CMR protocol that can be completed within 15 minutes, thereby facilitating the integration of CMR in cardio-oncology.
The Prospero Registration:
CRD42023437238, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437238.
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