Publicaciones científicas
Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor-Associated Myocarditis
Paaladinesh Thavendiranathan 1 , Lili Zhang 2 , Amna Zafar 3 , Zsofia D Drobni 4 , Syed S Mahmood 5 , Marcella Cabral 6 , Magid Awadalla 7 , Anju Nohria 8 , Daniel A Zlotoff 7 , Franck Thuny 9 , Lucie M Heinzerling 10 , Ana Barac 11 , Ryan J Sullivan 12 , Carol L Chen 13 , Dipti Gupta 13 , Michael C Kirchberger 14 , Sarah E Hartmann 3 , Jonathan W Weinsaft 15 , Hannah K Gilman 3 , Muhammad A Rizvi 16 , Bojan Kovacina 6 , Caroline Michel 6 , Gagan Sahni 17 , Ana González-Mansilla 18 , Antonio Calles 18 , Francisco Fernández-Avilés 18 , Michael Mahmoudi 19 , Kerry L Reynolds 12 , Sarju Ganatra 20 , Juan José Gavira 21 , Nahikari Salterain González 21 , Manuel García de Yébenes Castro 21 , Raymond Y Kwong 22 , Michael Jerosch-Herold 22 , Otavio R Coelho-Filho 23 , Jonathan Afilalo 6 , Eduardo Zataraín-Nicolás 18 , A John Baksi 24 , Bernd J Wintersperger 25 , Oscar Calvillo-Arguelles 26 , Stephane Ederhy 27 , Eric H Yang 28 , Alexander R Lyon 29 , Michael G Fradley 30 , Tomas G Neilan 31
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.
CITA DEL ARTÍCULO J Am Coll Cardiol. 2021 Mar 30;77(12):1503-1516. doi: 10.1016/j.jacc.2021.01.050
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