免疫检查点抑制剂相关心肌炎患者的磁共振心肌 T1 和 T2 mapping
Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor-Associated Myocarditis.
机构信息
Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
出版信息
J Am Coll Cardiol. 2021 Mar 30;77(12):1503-1516. doi: 10.1016/j.jacc.2021.01.050.
BACKGROUND
Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited.
OBJECTIVES
This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis.
METHODS
In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block.
RESULTS
Of 136 patients with ICI myocarditis with a CMR, 86 (63%) had T1 maps and 79 (58%) also had T2 maps. Among the 86 patients (66.3 ± 13.1 years of age), 36 (41.9%) had a left ventricular ejection fraction <55%. Across all patients, mean z-scores for T1 and T2 values were 2.9 ± 1.9 (p < 0.001) and 2.2 ± 2.1 (p < 0.001), respectively. On Siemens 1.5-T scanner (n = 67), native T1 (1,079.0 ± 55.5 ms vs. 1,000.3 ± 22.1 ms; p < 0.001) and T2 (56.2 ± 4.9 ms vs. 49.8 ± 2.2 ms; p < 0.001) values were elevated compared with reference values. Abnormal T1 and T2 values were seen in 78% and 43% of the patients, respectively. Applying the modified Lake Louise Criteria, 95% met the nonischemic myocardial injury criteria and 53% met the myocardial edema criteria. Native T1 values had excellent discriminatory value for subsequent MACE, with an area under the curve of 0.91 (95% confidence interval: 0.84 to 0.98). Native T1 values (for every 1-unit increase in z-score, hazard ratio: 1.44; 95% confidence interval: 1.12 to 1.84; p = 0.004) but not T2 values were independently associated with subsequent MACE.
CONCLUSIONS
The use of T1 mapping and application of the modified Lake Louise Criteria provides important diagnostic value, and T1 mapping provides prognostic value in patients with ICI myocarditis.
背景
心肌炎是免疫检查点抑制剂（ICI）治疗的潜在致命并发症。心血管磁共振（CMR）T1 和 T2 映射在 ICI 心肌炎中的应用数据有限。
目的
本研究旨在评估 CMR T1 和 T2 映射在 ICI 心肌炎患者中的价值。
方法
这是一项来自国际 ICI 心肌炎患者注册研究的回顾性研究，收集了临床和 CMR 发现（包括 T1 和 T2 图谱）。异常 T1 和 T2 定义为超过 2 个标准差（特定于站点/场强的参考值），并为每位患者计算 z 分数。主要不良心血管事件（MACE）是心血管死亡、心源性休克、心脏骤停和完全性心脏阻滞的复合事件。
结果
在 136 例接受 CMR 的 ICI 心肌炎患者中，86 例（63%）有 T1 图谱，79 例（58%）也有 T2 图谱。在 86 例患者（66.3±13.1 岁）中，36 例（41.9%）左心室射血分数<55%。在所有患者中，T1 和 T2 值的平均 z 分数分别为 2.9±1.9（p<0.001）和 2.2±2.1（p<0.001）。在西门子 1.5-T 扫描仪上（n=67），本征 T1（1079.0±55.5 ms 与 1000.3±22.1 ms；p<0.001）和 T2（56.2±4.9 ms 与 49.8±2.2 ms；p<0.001）值升高与参考值相比。分别有 78%和 43%的患者出现异常 T1 和 T2 值。应用改良的 Lake Louise 标准，95%的患者符合非缺血性心肌损伤标准，53%的患者符合心肌水肿标准。本征 T1 值对随后的 MACE 具有极好的判别价值，曲线下面积为 0.91（95%置信区间：0.84 至 0.98）。本征 T1 值（z 分数每增加 1 单位，风险比：1.44；95%置信区间：1.12 至 1.84；p=0.004）而不是 T2 值与随后的 MACE 独立相关。
结论
T1 映射的应用和改良的 Lake Louise 标准的应用提供了重要的诊断价值，T1 映射为 ICI 心肌炎患者提供了预后价值。
Zotero 插件