Key result
Following immune checkpoint inhibitor treatment, left ventricular global longitudinal strain significantly increased (WMD 2.33) and elevated T2 values were associated with a higher occurrence of major adverse cardiovascular events (HR 1.36).
Why the study?
The complex CMR process and uncertainty regarding parameters for diagnosing and predicting cardiotoxicity limit its clinical use in patients receiving immune checkpoint inhibitors.
Do cardiac magnetic resonance parameters change and predict major adverse cardiovascular events in patients treated with immune checkpoint inhibitors?
Meta-Analysis (n=368)
Do cardiac magnetic resonance parameters change and predict major adverse cardiovascular events in patients treated with immune checkpoint inhibitors?
Mean Difference: 2.33 (95% CI 1.26–3.41)
p-value: p=<0.01
CMR parameters including T1, T2, and GLS increase while GRS decreases following ICI administration, and elevated T2 is associated with higher MACE risk, supporting a streamlined non-contrast CMR protocol for cardio-oncology.
CMR strain and T1/T2 mapping changes may aid ICI cardiotoxicity monitoring; extends evidence for abbreviated non-contrast protocol in cardio-oncology.
Background: The complex process of cardiac magnetic resonance (CMR) and the uncertainty of each parameter in the diagnosis and prognosis of cardiotoxicity limit its promotion in the cardiac evaluation of patients treated with immune checkpoint inhibitors (ICI). Methods: A comprehensive search was conducted across PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Cochrane databases for relevant articles published up until September 28, 2024. Results: After screening, 8 articles were included in this study. The analysis revealed that following ICI treatment, the left ventricular global longitudinal strain (GLS) increased significantly [weighted mean difference (WMD) 2.33; 95% confidence interval (CI) 1.26, 3.41; p < 0.01], while the global radial strain (GRS) decreased [WMD –4.73; 95% CI –6.74, –2.71; p < 0.01]. Additionally, T1 and T2 values increased [standardized mean difference (SMD) 1.14; 95% CI 0.59, 1.68; p < 0.01] and [SMD 1.11; 95% CI 0.64, 1.58; p < 0.01], respectively. An elevated T2 was associated with a higher occurrence of major adverse cardiovascular events (MACE), with a hazard ratio of 1.36 (95% CI 1.12, 1.64). Conclusions: Our findings demonstrate that T1, T2, and GLS increase, while GRS decreases following ICI administration. By consolidating these critical metrics, we propose a streamlined, abbreviated (non-contrast) CMR protocol that can be completed within 15 minutes, thereby facilitating the integration of CMR in cardio-oncology. The PROSPERO registration: CRD42023437238, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437238.
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Li et al. (2025) conducted a meta-analysis in Immune checkpoint inhibitor-induced cardiotoxicity (n=368). Immune checkpoint inhibitors vs. Baseline levels or healthy controls was evaluated on Left ventricular global longitudinal strain (GLS) (WMD 2.33, 95% CI 1.26, 3.41, p=<0.01). Following immune checkpoint inhibitor treatment, left ventricular global longitudinal strain significantly increased (WMD 2.33) and elevated T2 values were associated with a higher occurrence of major adverse cardiovascular events (HR 1.36).
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