Cardiac magnetic resonance parameters associated with myocarditis in patients treated with immunotherapy: a scoping...

This scoping review, conducted in accordance with the PRISMA-ScR methodology, maps the available scientific evidence on cardiac magnetic resonance (CMR) abnormalities associated with immune checkpoint inhibitor-induced myocarditis (ICI-M). Twenty studies published between 2019 and 2025 were analysed, highlighting alterations in left ventricular function (left ventricular ejection fraction [LVEF]), myocardial oedema detected by T2-weighted sequences, and fibrosis identified as late gadolinium enhancement (LGE). Key diagnostic criteria included elevated extracellular volume (ECV), impaired global longitudinal strain (GLS), and abnormal T1 and T2 relaxation times. Of the included studies, most were retrospective, followed by case reports and prospective studies. The therapies most frequently associated with ICI-M involved combinations of anti-PD1 and anti-CTLA4 agents. Cardiac magnetic resonance (CMR) has proven to be a highly sensitive, non-invasive tool for detecting myocardial involvement, even before the elevation of biomarkers such as troponins. The importance of using advanced tools like CMR to assess cardiovascular complications associated with myocarditis is highlighted. Parameters such as LVEF, GLS, LGE, and ECV provide valuable information on ventricular function and structural alterations related to myocarditis. These findings allow us to identify knowledge gaps and guide future research on the use of CMR in myocarditis.