Key result
ICI myocarditis shows ~42% lower LV LGE frequency than non-ICI myocarditis despite similar CMR mapping.
Why the study?
Differentiating between immune checkpoint inhibitor (ICI) myocarditis and non-ICI myocarditis is clinically important, but the value of cardiovascular magnetic resonance (CMR) for distinguishing them remains unclear.
Does cardiovascular magnetic resonance differentiate between immune checkpoint inhibitor (ICI) myocarditis and non-ICI myocarditis?
Cohort (n=54)
No
Does cardiovascular magnetic resonance differentiate between immune checkpoint inhibitor (ICI) myocarditis and non-ICI myocarditis?
Quantitative parametric mapping by CMR may not reliably differentiate between ICI and non-ICI myocarditis, despite differences in LGE frequency.
Answers are grounded in this paper and cite their sources.
CMR parametric mapping may not differentiate ICI from non-ICI myocarditis; leaves open LGE frequency's diagnostic role in this cohort.
Background: Differentiating between immune checkpoint inhibitor (ICI) myocarditis and non-ICI myocarditis is clinically important. Cardiovascular magnetic resonance (CMR) is a well-established method for diagnosing acute myocarditis. The value of CMR for distinguishing ICI myocarditis from non-ICI myocarditis remains unclear, which this study sought to determine. Methods: A total of 54 patients (n = 26 ICI myocarditis; n = 28 non-ICI myocarditis) underwent clinical CMR for the assessment of cardiac function (cines), myocardial fibrosis (native T1-mapping, extracellular volume [ECV] fraction, late gadolinium enhancement [LGE]) and myocardial oedema (native T2-mapping). Results: ICI myocarditis patients were older than non-ICI myocarditis patients (75 years [71–78] vs. 39 years [30–64]; p < 0.001). Both groups had similar left ventricular (LV) ejection fraction (58 ± 11% vs. 58 ± 6%; p = 0.970). ICI myocarditis and non-ICI myocarditis patients also had similar native myocardial T1 values (1041 ± 84 ms vs. 1063 ± 60 ms; p = 0.281), native myocardial T2 values (59 ± 6 ms vs. 59 ± 6 ms; p = 0.943) and ECV (0.32 ± 0.07 vs. 0.31 ± 0.04; p = 0.403). Native myocardial T1 values (Rho = −0.553) and ECV (Rho = −0.502) were significantly associated with LVEF in non-ICI myocarditis patients (both p < 0.05). There was no significant association between myocardial T1 values, T2 values or ECV, with LVEF, in ICI myocarditis patients (all p < 0.05). Non-ICI myocarditis patients had a greater frequency of LGE in the LV compared to ICI myocarditis patients (89% vs. 52% p = 0.005). However, the pattern of LGE was similar between the two patient groups (mostly subepicardial and/or mid-wall). Conclusions: In this single centre retrospective cohort, the findings suggest that quantitative parametric mapping methods by CMR may not differentiate between ICI vs. non-ICI myocarditis. Further work is needed to assess the value of CMR for diagnosing standalone ICI myocarditis.
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Yip et al. (2025) conducted a cohort in Myocarditis (n=54). Immune checkpoint inhibitor (ICI) myocarditis vs. Non-ICI myocarditis was evaluated on Frequency of late gadolinium enhancement (LGE) in the left ventricle (p=0.005). Immune checkpoint inhibitor myocarditis exhibited similar CMR parametric mapping values to non-ICI myocarditis, but had a significantly lower frequency of left ventricular LGE (52% vs 89%; p=0.005).
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