免疫检查点抑制剂相关性心肌炎的心脏 MRI 特征和预后价值。
Cardiac MRI Features and Prognostic Value in Immune Checkpoint Inhibitor-induced Myocarditis.
机构信息
From the Aix-Marseille University, Department of Radiology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France (F.C., P.H., F.A., A.J.); Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique-Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Chemin des Bourrely, 13015 Marseille, France (J.C., A.M., F.P., N.L., F.T.); Aix-Marseille University, CNRS, CRMBM-Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, CEMEREM, Marseille, France (S.R.); Department of Radiology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France (A.V.); and Department of Radiology, Saint Joseph Hospital, Marseille, France (U.S.).
出版信息
Radiology. 2022 Jun;303(3):512-521. doi: 10.1148/radiol.211765. Epub 2022 Mar 1.
Background Cardiac MRI features are not well-defined in immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M), a severe complication of ICI therapy in patients with cancer. Purpose To analyze the cardiac MRI features of ICI-M and to explore their prognostic value in major adverse cardiovascular events (MACE). Materials and Methods In this retrospective study from May 2017 to January 2020, cardiac MRI findings (including late gadolinium enhancement [LGE], T1 and T2 mapping, and extracellular volume fraction [ECV] scores) of patients with ICI-M were compared with those of patients with cancer scheduled to receive ICI therapy (pre-ICI group) and patients with viral myocarditis. As a secondary objective, the potential value of cardiac MRI for predicting MACE in patients with ICI-M by using Cox proportional hazards models was explored. Results Thirty-three patients with ICI-M (mean age ± standard deviation, 68 years ± 14; 23 men) were compared with 21 patients scheduled to receive to ICI therapy (mean age, 65 years ± 14; 14 men) and 85 patients with viral myocarditis (mean age, 32 years ± 13; 67 men). Compared with the pre-ICI group, patients with ICI-M showed higher global native T1, ECV, and T2 scores (0.03 ± 0.85 vs 1.79 ± 1.93 [ < .001]; 1.34 ± 0.57 vs 2.59 ± 1.97 [ = .03]; and -0.76 ± 1.41 vs 0.88 ± 1.96 [ = .002], respectively), and LGE was more frequently observed (27 of 33 patients [82%] vs two of 21 [10%]; < .001). LGE was less frequent in patients with ICI-M than those with viral myocarditis (27 of 33 patients [82%] vs 85 of 85 [100%]; < .001) but was more likely to involve the septal segments (16 of 33 patients [48%] vs 25 of 85 [29%]; < .001) and midwall layer (11 of 33 patients [33%] vs two of 85 [2%]; < .001). Septal LGE was the only cardiac MRI predictor of MACE at 1 year even after adjustment for peak troponin (adjusted hazard ratio, 2.7 [95% CI: 1.1, 6.7]; = .03). Conclusion Cardiac MRI features of immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) seem to differ from those in patients scheduled to receive ICIs and patients with viral myocarditis. Septal late gadolinium enhancement might be a predictor of major cardiovascular events in patients with ICI-M. Clinical trial registration no. NCT03313544 © RSNA, 2022 See also the editorial by Edelman and Pursnani in this issue.
背景 免疫检查点抑制剂（ICI）诱导的心肌炎（ICI-M）是癌症患者接受 ICI 治疗后的一种严重并发症，其心脏 MRI 特征尚未明确。目的 分析 ICI-M 的心脏 MRI 特征，并探讨其在主要不良心血管事件（MACE）中的预后价值。材料与方法 本回顾性研究纳入了 2017 年 5 月至 2020 年 1 月期间接受 ICI-M 治疗的患者（33 例，平均年龄±标准差，68 岁±14 岁；23 例男性），并与接受 ICI 治疗计划（21 例，平均年龄 65 岁±14 岁；14 例男性）和病毒性心肌炎（85 例，平均年龄 32 岁±13 岁；67 例男性）患者进行了比较。作为次要目标，使用 Cox 比例风险模型探讨心脏 MRI 预测 ICI-M 患者 MACE 的潜在价值。结果 ICI-M 患者（33 例）与 ICI 治疗计划患者（21 例）和病毒性心肌炎患者（85 例）相比，表现出更高的全局 T1 本征、ECV 和 T2 评分（0.03±0.85 比 1.79±1.93[<0.001]；1.34±0.57 比 2.59±1.97[=0.03]；-0.76±1.41 比 0.88±1.96[=0.002]），且 LGE 更为常见（27/33[82%]比 2/21[10%]；<0.001）。与病毒性心肌炎患者相比，ICI-M 患者的 LGE 发生率较低（27/33[82%]比 85/85[100%]；<0.001），但更倾向于累及间隔段（16/33[48%]比 85/85[29%]；<0.001）和中层（11/33[33%]比 85/85[2%]；<0.001）。间隔 LGE 是 1 年时唯一与 MACE 相关的心脏 MRI 预测因素，即使在调整峰值肌钙蛋白后也是如此（调整后的危险比，2.7[95%CI：1.1，6.7]；=0.03）。结论 ICI-M 的心脏 MRI 特征似乎与接受 ICI 治疗和病毒性心肌炎的患者不同。间隔部晚期钆增强可能是预测 ICI-M 患者主要心血管事件的指标。临床试验注册号 NCT03313544 © RSNA，2022 请参见本期由 Edelman 和 Pursnani 撰写的社论。
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