Cardiac MRI Features and Prognostic Value in Immune Checkpoint Inhibitor–induced Myocarditis

Farah Cadour (1) , Jennifer Cautela (2) , Stanislas Rapacchi , Arthur Varoquaux (3) , Paul Habert (1) , François Arnaud (1) , Alexis Jacquier (1) , Alexandra Meilhac , Franck Paganelli (2) , Nathalie Lalevee (2) , Ugo Scemama (4) , Franck Thuny (2)

1 TIMONE - Hôpital de la Timone [CHU - APHM]
2 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
3 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
4 Hôpital Saint-Joseph [Marseille]

Background: Cardiac MRI features are not well-defined in immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M), a severe complication of ICI therapy in patients with cancer. Purpose: To analyze the cardiac MRI features of ICI-M and to explore their prognostic value in major adverse cardiovascular events (MACE). Materials and Methods: In this retrospective study from May 2017 to January 2020, cardiac MRI findings (including late gadolinium enhancement [LGE], T1 and T2 mapping, and extracellular volume fraction [ECV] z scores) of patients with ICI-M were compared with those of patients with cancer scheduled to receive ICI therapy (pre-ICI group) and patients with viral myocarditis. As a secondary objective, the potential value of cardiac MRI for predicting MACE in patients with ICI-M by using Cox proportional hazards models was explored. Results: Thirty-three patients with ICI-M (mean age +/- standard deviation, 68 years +/- 14; 23 men) were compared with 21 patients scheduled to receive to ICI therapy (mean age, 65 years +/- 14; 14 men) and 85 patients with viral myocarditis (mean age, 32 years +/- 13; 67 men). Compared with the pre-ICI group, patients with ICI-M showed higher global native T1, ECV, and T2 z scores (0.03 +/- 0.85 vs 1.79 +/- 1.93 [P < .001]; 1.34 +/- 0.57 vs 2.59 +/- 1.97 [P = .03]; and -0.76 +/- 1.41 vs 0.88 +/- 1.96 [P = .002], respectively), and LGE was more frequently observed (27 of 33 patients [82%] vs two of 21 [10%]; P < .001). LGE was less frequent in patients with ICI-M than those with viral myocarditis (27 of 33 patients [82%] vs 85 of 85 [100%]; P < .001) but was more likely to involve the septal segments (16 of 33 patients [48%] vs 25 of 85 [29%]; P < .001) and midwall layer (11 of 33 patients [33%] vs two of 85 [2%]; P < .001). Septal LGE was the only cardiac MRI predictor of MACE at 1 year even after adjustment for peak troponin (adjusted hazard ratio, 2.7 [95% CI: 1.1, 6.7]; P = .03). Conclusion: Cardiac MRI features of immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) seem to differ from those in patients scheduled to receive ICIs and patients with viral myocarditis. Septal late gadolinium enhancement might be a predictor of major cardiovascular events in patients with ICI-M.

Domains: Humanities and Social Sciences

Farah Cadour, Jennifer Cautela, Stanislas Rapacchi, Arthur Varoquaux, Paul Habert, et al.. Cardiac MRI Features and Prognostic Value in Immune Checkpoint Inhibitor–induced Myocarditis. Radiology, 2022, 303 (3), pp.512-521. ⟨10.1148/radiol.211765⟩. ⟨hal-03666700⟩