Publicaciones científicas
Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis
Thiago Quinaglia 1 , Carlos Gongora 2 , Magid Awadalla 2 , Malek Z O Hassan 2 , Amna Zafar 2 , Zsofia D Drobni 3 , Syed S Mahmood 4 , Lili Zhang 5 , Otavio R Coelho-Filho 6 , Giselle A Suero-Abreu 7 , Muhammad A Rizvi 8 , Gagan Sahni 9 , Anant Mandawat 10 , Eduardo Zatarain-Nicolás 11 , Michael Mahmoudi 12 , Ryan Sullivan 13 , Sarju Ganatra 14 , Lucie M Heinzerling 15 , Franck Thuny 16 , Stephane Ederhy 17 , Hannah K Gilman 2 , Supraja Sama 2 , Sofia Nikolaidou 2 , Ana González Mansilla 11 , Antonio Calles 11 , Marcella Cabral 18 , Francisco Fernández-Avilés 11 , Juan José Gavira 19 , Nahikari Salterain González 19 , Manuel García de Yébenes Castro 19 , Ana Barac 20 , Jonathan Afilalo 18 , Daniel A Zlotoff 21 , Leyre Zubiri 13 , Kerry L Reynolds 13 , Richard Devereux 22 , Judy Hung 23 , Michael H Picard 23 , Eric H Yang 24 , Dipti Gupta 4 , Caroline Michel 18 , Alexander R Lyon 25 , Carol L Chen 4 , Anju Nohria 26 , Michael G Fradley 27 , Paaladinesh Thavendiranathan 28 , Tomas G Neilan 29
Background: Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS.
Objectives: This study aimed to detail the role of GCS and GRS in ICI myocarditis.
Methods: In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death.
Results: Cases and controls were similar in age (66 ± 15 years vs 63 ± 12 years; P = 0.20), sex (male: 73% vs 61%; P = 0.20) and cancer type (P = 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% ± 3.4% vs 23.5% ± 3.8%; P = 0.14; GRS: 45.5% ± 6.2% vs 43.6% ± 8.8%; P = 0.24). Overall, 56% (n = 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% ± 4.2% vs 23.6% ± 3.0%; P < 0.001; GRS: 28.6% ± 6.7% vs 47.0% ± 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P = 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P = 0.008) below the median was associated with an increased event rate. In receiver-operating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56-0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P = 0.04) and GCS over cTnT (P = 0.002).
Conclusions: GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance.
CITA DEL ARTÍCULO JACC Cardiovasc Imaging. 2022 Nov;15(11):1883-1896. doi: 10.1016/j.jcmg.2022.06.014. Epub 2022 Sep 14.
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