Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor-Associated Myocarditis.

Autor:	Thavendiranathan P; Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: dinesh.thavendiranathan@uhn.ca., Zhang L; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA., Zafar A; Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA., Drobni ZD; Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Mahmood SS; Cardiology Division, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA., Cabral M; Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada., Awadalla M; Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Nohria A; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Zlotoff DA; Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Thuny F; University Mediterranean Center of Cardio-Oncology, Nord Hospital, Aix-Marseille University, Marseille, France; Groupe Méditerranéen de Cardio-Oncologie, Marseille, France; Center for CardioVascular and Nutrition Research, INRA 1260, INSERM 1263, Aix-Marseille University, Marseille, France., Heinzerling LM; Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany., Barac A; Cardio-Oncology Program, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA., Sullivan RJ; Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Chen CL; Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA., Gupta D; Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA., Kirchberger MC; Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany., Hartmann SE; Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA., Weinsaft JW; Cardiology Division, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA; Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA., Gilman HK; Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA., Rizvi MA; Division of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA., Kovacina B; Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada., Michel C; Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada., Sahni G; Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA., González-Mansilla A; Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain., Calles A; Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain., Fernández-Avilés F; Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain., Mahmoudi M; Faculty of Medicine, University of Southampton, Southampton, United Kingdom., Reynolds KL; Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Ganatra S; Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA., Gavira JJ; Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain., González NS; Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain., García de Yébenes Castro M; Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain., Kwong RY; Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Jerosch-Herold M; Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Coelho-Filho OR; Cardiology Division, State University of Campinas, Campinas, Brazil., Afilalo J; Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada., Zataraín-Nicolás E; Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain., Baksi AJ; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom., Wintersperger BJ; Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada., Calvillo-Arguelles O; Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada., Ederhy S; Cardio-Oncology Program, Division of Cardiology, Hôpitaux Universitaires Est Parisien, Paris, France., Yang EH; UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA., Lyon AR; Cardio-Oncology Program, Royal Brompton Hospital, Imperial College London, London, United Kingdom., Fradley MG; Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Neilan TG; Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: tneilan@mgh.harvard.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2021 Mar 30; Vol. 77 (12), pp. 1503-1516.
DOI:	10.1016/j.jacc.2021.01.050
Abstrakt:	Background: Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited. Objectives: This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis. Methods: In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. Results: Of 136 patients with ICI myocarditis with a CMR, 86 (63%) had T1 maps and 79 (58%) also had T2 maps. Among the 86 patients (66.3 ± 13.1 years of age), 36 (41.9%) had a left ventricular ejection fraction <55%. Across all patients, mean z-scores for T1 and T2 values were 2.9 ± 1.9 (p < 0.001) and 2.2 ± 2.1 (p < 0.001), respectively. On Siemens 1.5-T scanner (n = 67), native T1 (1,079.0 ± 55.5 ms vs. 1,000.3 ± 22.1 ms; p < 0.001) and T2 (56.2 ± 4.9 ms vs. 49.8 ± 2.2 ms; p < 0.001) values were elevated compared with reference values. Abnormal T1 and T2 values were seen in 78% and 43% of the patients, respectively. Applying the modified Lake Louise Criteria, 95% met the nonischemic myocardial injury criteria and 53% met the myocardial edema criteria. Native T1 values had excellent discriminatory value for subsequent MACE, with an area under the curve of 0.91 (95% confidence interval: 0.84 to 0.98). Native T1 values (for every 1-unit increase in z-score, hazard ratio: 1.44; 95% confidence interval: 1.12 to 1.84; p = 0.004) but not T2 values were independently associated with subsequent MACE. Conclusions: The use of T1 mapping and application of the modified Lake Louise Criteria provides important diagnostic value, and T1 mapping provides prognostic value in patients with ICI myocarditis. Competing Interests: Funding Support and Author Disclosures Dr. Thavendiranathan was supported, in part, through the Canadian Institutes of Health Research New Investigator Award (FRN 147814) and a Canada Research Chair in Cardio-Oncology. This work is supported by the New York Academy of Medicine's Glorney-Raisbeck Award to Dr. Mahmood. Dr. Sullivan was supported, in part, through the National Institutes of Health (NIH)/National Cancer Institute (RO1CA229851, UH2CA207355, RO1CA193970). Dr. C.L. Chen, and Dr. D. Gupta were supported, in part, through the NIH/National Cancer Institute P30CA008748. Dr. Neilan was supported, in part, through the Kohlberg Foundation, the NIH/National Heart, Lung, and Blood Institute (RO1HL130539, RO1HL137562, and K24HL150238), and the NIH/Harvard Center for AIDS Research (P30 AI060354). Dr. Thavendiranathan has received Speakers Bureau fees from Amgen, Takeda, and BI. Dr. Mahmood has received consulting fees from OMR Globus, Alpha Detail, and Opinion Research Team. Dr. Nohria has received research grant support from Amgen; and has served a consultant for Takeda Oncology. Dr. Heinzerling has received consulting, advisory board, and speaker fees from MSD, BMS, Roche, Novartis, Amgen, and Curevac. Dr. Sullivan has served as a consultant for Merck and Novartis. Dr. Groarke has received research support from Amgen. Dr. Neilan has received advisory fees from Parexel, BMS, H3 Biomedicine, AbbVie, and Intrinsic Imaging. Dr. Neilan has received grant support from AstraZeneca. Dr. Wintersperger has received research support and speaker honoraria from Siemens Healthineers (the University Health Network has a master research agreement with Siemens Healthineers); and is an inventor of the IG fitting method owned by the University Health Network (US10314548B2). Dr. Yang has received research funding from CSL Behring. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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