Key result
CMR in immune checkpoint inhibitor myocarditis shows mostly preserved LVEF, with LGE seen in up to ~83%.
Why the study?
Several studies have investigated CMR in patients with ICI-myocarditis, but the available evidence on CMR findings had not been systematically summarized.
What are the characteristic cardiac magnetic resonance imaging findings and their prognostic value in patients with immune checkpoint inhibitor myocarditis?
Systematic Review (n=252)
What are the characteristic cardiac magnetic resonance imaging findings and their prognostic value in patients with immune checkpoint inhibitor myocarditis?
CMR in immune checkpoint inhibitor myocarditis demonstrates myocardial dysfunction, edema, and fibrosis, with native T1 mapping offering high concordance with biopsy and significant prognostic value.
Answers are grounded in this paper and cite their sources.
May guide noninvasive evaluation and risk stratification in ICI myocarditis; extends evidence for native T1 mapping's diagnostic and prognostic utility.
Immune checkpoint inhibitors (ICIs) are a family of anticancer drugs in which the immune response elicited against the tumor may involve other organs, including the heart. Cardiac magnetic resonance (CMR) imaging is increasingly used in the diagnostic work-up of myocardial inflammation; recently, several studies investigated the use of CMR in patients with ICI-myocarditis (ICI-M). The aim of the present systematic review is to summarize the available evidence on CMR findings in ICI-M. We searched electronic databases for relevant publications; after screening, six studies were selected, including 166 patients from five cohorts, and further 86 patients from a sub-analysis that were targeted for a tissue mapping assessment. CMR revealed mostly preserved left ventricular ejection fraction; edema prevalence ranged from 9% to 60%; late gadolinium enhancement (LGE) prevalence ranged from 23% to 83%. T1 and T2 mapping assessment were performed in 108 and 104 patients, respectively. When available, the comparison of CMR with endomyocardial biopsy revealed partial agreement between techniques and was higher for native T1 mapping amongst imaging biomarkers. The prognostic assessment was inconsistently assessed; CMR variables independently associated with the outcome included decreasing LVEF and increasing native T1. In conclusion, CMR findings in ICI-M include myocardial dysfunction, edema and fibrosis, though less evident than in more classic forms of myocarditis; native T1 mapping retained the higher concordance with EMB and significant prognostic value.
No takes yet. Share an insight, caveat, or question.
Arcari et al. (2022) conducted a systematic review in Immune Check-Point Inhibitor Myocarditis (n=252). Cardiac magnetic resonance imaging was evaluated on CMR findings including edema and late gadolinium enhancement prevalence. Cardiac magnetic resonance imaging in immune checkpoint inhibitor myocarditis revealed mostly preserved ejection fraction, with edema prevalence ranging from 9% to 60% and LGE from 23% to 83%.
Synapse has enriched 10 related papers. Consider them for comparative context: