Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.

<h4>Background</h4>Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiot...

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Autores principales:	Angela Y Higgins, Amit Arbune, Aaron Soufer, Elio Ragheb, Jennifer M Kwan, Jerome Lamy, Mariana Henry, Jason R Cuomo, Ahmad Charifa, Cesia Gallegos, Sarah Hull, Jessica Shank Coviello, Anna S Bader, Dana C Peters, Steffen Huber, Hamid R Mojibian, Albert J Sinusas, Harriet Kluger, Lauren A Baldassarre
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d60485952e1846e2a5ebdde4efb2f722
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spelling	oai:doaj.org-article:d60485952e1846e2a5ebdde4efb2f7222021-12-02T20:11:27ZLeft ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.1932-620310.1371/journal.pone.0246764https://doaj.org/article/d60485952e1846e2a5ebdde4efb2f7222021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0246764https://doaj.org/toc/1932-6203<h4>Background</h4>Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity.<h4>Methods</h4>We identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis.<h4>Results</h4>Of the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of -9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at -12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = -0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = -0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment.<h4>Conclusion</h4>In patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.Angela Y HigginsAmit ArbuneAaron SouferElio RaghebJennifer M KwanJerome LamyMariana HenryJason R CuomoAhmad CharifaCesia GallegosSarah HullJessica Shank CovielloAnna S BaderDana C PetersSteffen HuberHamid R MojibianAlbert J SinusasHarriet KlugerLauren A BaldassarrePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 2, p e0246764 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Angela Y Higgins Amit Arbune Aaron Soufer Elio Ragheb Jennifer M Kwan Jerome Lamy Mariana Henry Jason R Cuomo Ahmad Charifa Cesia Gallegos Sarah Hull Jessica Shank Coviello Anna S Bader Dana C Peters Steffen Huber Hamid R Mojibian Albert J Sinusas Harriet Kluger Lauren A Baldassarre Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
description	<h4>Background</h4>Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity.<h4>Methods</h4>We identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis.<h4>Results</h4>Of the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of -9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at -12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = -0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = -0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment.<h4>Conclusion</h4>In patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.
format	article
author	Angela Y Higgins Amit Arbune Aaron Soufer Elio Ragheb Jennifer M Kwan Jerome Lamy Mariana Henry Jason R Cuomo Ahmad Charifa Cesia Gallegos Sarah Hull Jessica Shank Coviello Anna S Bader Dana C Peters Steffen Huber Hamid R Mojibian Albert J Sinusas Harriet Kluger Lauren A Baldassarre
author_facet	Angela Y Higgins Amit Arbune Aaron Soufer Elio Ragheb Jennifer M Kwan Jerome Lamy Mariana Henry Jason R Cuomo Ahmad Charifa Cesia Gallegos Sarah Hull Jessica Shank Coviello Anna S Bader Dana C Peters Steffen Huber Hamid R Mojibian Albert J Sinusas Harriet Kluger Lauren A Baldassarre
author_sort	Angela Y Higgins
title	Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
title_short	Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
title_full	Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
title_fullStr	Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
title_full_unstemmed	Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
title_sort	left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/d60485952e1846e2a5ebdde4efb2f722
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Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.

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