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The prognostic value of global myocardium strain by CMR-feature tracking in immune checkpoint inhibitor–associated myocarditis

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Immune checkpoint inhibitor (ICI)–associated myocarditis is a potentially fatal complication. Sparse published researches evaluated the prognostic value of cardiovascular magnetic resonance feature tracking (CMR-FT) for ICI-associated myocarditis.

Methods

In the single-center retrospective study, 52 patients with ICI-associated myocarditis and CMR were included from August 2018 to July 2021. The ICI-associated myocarditis was diagnosed by using the clinical criteria of the European Society of Cardiology guidelines. Major adverse cardiovascular events (MACE) were comprised of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block.

Results

During a median follow-up of 171 days, 14 (27%) patients developed MACE. For patients with MACE, the global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), and left ventricular ejection fraction (LVEF) were significantly worse and native T1 values and late gadolinium enhancement (LGE) extent were significantly increased, compared with patients without MACE (p < 0.05). The GLS remained the independent factor associated with a higher risk of MACE (hazard ratio (HR): 2.115; 95% confidence interval (CI): 1.379–3.246; p = 0.001) when adjusting for LVEF, LGE extent, age, sex, body mass index, steroid treatment, and prior cardiotoxic chemotherapy or radiation. After adjustment for LVEF, the GLS remained the independent risk factor associated with a higher rate of MACE among patients with a preserved LVEF (HR: 1.358; 95% CI: 1.007–1.830; p = 0.045).

Conclusions

GLS could provide independent prognostic value over GCS, GRS, traditional CMR features, and clinical features in patients with ICI-associated myocarditis.

Key Points

• The global circumferential strain (GCS), global radial strain (GRS), and global longitudinal strain (GLS) by cardiovascular magnetic resonance feature tracking were significantly impaired in patients with an immune checkpoint inhibitor (ICI)–associated myocarditis.

• GLS was still significantly impaired in patients with preserved left ventricular ejection fraction.

• The worse GLS was an independent risk factor over GCS, GRS, traditional CMR features, and clinical features for predicting major adverse cardiovascular events in patients with ICI-associated myocarditis.

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Abbreviations

CMR-FT:

Cardiovascular magnetic resonance feature tracking

EMB:

Endomyocardial biopsy

GCS:

Global circumferential strain;

GLS:

Global longitudinal strain

GRS:

Global radial strain

ICC:

Intraclass correlation coefficient

ICIs:

Immune checkpoint inhibitors

LGE:

Late gadolinium enhancement

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiac events

NT-proBNP:

N-terminal pro–B-type natriuretic peptide

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Funding

This study has received funding from the Science Foundation of Shanghai Municipal Health Commission (contract grant number: 202040349), Shanghai Science and Technology Committee (contract grant number: 18DZ1930102), and Shanghai Municipal Key Clinical Specialty (contract grant number: shslczdzk03202).

Author information

Author notes

  1. Shi-hai Zhao, Hong Yun and Cai-zhong Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai, 200032, China

    Shi-hai Zhao, Hong Yun, Cai-zhong Chen, Yin-yin Chen, Meng-su Zeng & Hang Jin

  2. Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China

    Shi-hai Zhao, Hong Yun, Cai-zhong Chen, Yin-yin Chen, Meng-su Zeng & Hang Jin

  3. Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China

    Shi-hai Zhao, Hong Yun, Cai-zhong Chen, Yin-yin Chen, Meng-su Zeng, Tian-shu Liu & Hang Jin

  4. Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China

    Jin-yi Lin

  5. Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China

    Tian-shu Liu

  6. Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China

    Cui-zhen Pan

Authors
  1. Shi-hai Zhao
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  2. Hong Yun
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  9. Hang Jin
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Corresponding authors

Correspondence to Meng-su Zeng, Cui-zhen Pan or Hang Jin.

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Guarantor

The scientific guarantor of this publication is Hang Jin, MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study

• performed at one institution

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Zhao, Sh., Yun, H., Chen, Cz. et al. The prognostic value of global myocardium strain by CMR-feature tracking in immune checkpoint inhibitor–associated myocarditis. Eur Radiol 32, 7657–7667 (2022). https://doi.org/10.1007/s00330-022-08844-x

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  • DOI: https://doi.org/10.1007/s00330-022-08844-x

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