Mirza Jibran, Sunder Sunitha Shyam, Karthikeyan Badri, Kattel Sharma, Pokharel Saraswati, Quigley Brian, Sharma Umesh C
Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA.
Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA.
J Pers Med. 2022 Aug 19;12(8):1332. doi: 10.3390/jpm12081332.
Background: Immune checkpoint inhibitor (ICI)-induced cardiac side effects in cancer patients are increasingly being recognized and can be fatal. There is no standardized cardiac imaging test to examine the effects of ICIs in myocardial morphology and function. Objective: To study the utility of echocardiography and cardiac MRI in examining regional and global changes arising from ICI-induced myocarditis and cardiomyopathy in high-risk subjects suspected to have developed ICI cardiomyopathy. Methods: We studied eight consecutive patients referred for cardiac MRI (CMR) from a comprehensive cancer center for suspected ICI-induced myocarditis and compared the data with sixteen age-matched controls. Using newly developed strain analysis algorithms, we measured myocardial strain and strain rates using echocardiography and CMR. Then, we compared the mean longitudinal strain and strain rates derived from echocardiography and CMR in the same ICI-treated cohort of patients (n = 8). They underwent both of these imaging studies with images taken 24−48 h apart and followed up prospectively within the same hospital course. Results: All our cases had preserved ejection fraction (EF) > 50%. Echocardiogram showed reduced mean systolic longitudinal strain (LS, %) (ICI: −12.381 ± 4.161; control: −19.761 ± 1.925; p < 0.001), peak systolic strain rate (SRS, s−1) (ICI: −0.597 ± 0.218; control: −0.947 ± 0.135; p = 0.002) and early diastolic strain rate (SRE, s−1) (ICI: 0.562 ± 0.295; control: 1.073 ± 0.228; p = 0.002) in ICI-treated cases. Direct comparison between the echocardiogram vs. CMR obtained within the same hospital course demonstrated strong a correlation of LS scores (r = 0.83, p = 0.012) and SRS scores (r = 0.71, p = 0.048). The Bland−Altman plots showed that 95% of the data points fitted within the ±1.96 SD of the mean difference, suggesting an agreement among these two imaging modalities. Conclusion: In this feasibility cohort study, both echocardiography- and CMR-based strain indices illustrate changes in myocardial contractility and relaxation suggestive of ICI-induced cardiomyopathy. Our data, after validation in a larger cohort, can form the basis of myocardial imaging in cancer patients treated with ICIs.
癌症患者中免疫检查点抑制剂（ICI）引起的心脏副作用日益受到关注，且可能致命。目前尚无标准化的心脏成像检查来评估ICI对心肌形态和功能的影响。目的：研究超声心动图和心脏磁共振成像（CMR）在检查疑似发生ICI心肌病的高危受试者中ICI诱导的心肌炎和心肌病所引起的局部和整体变化方面的效用。方法：我们研究了一家综合癌症中心连续转诊来进行心脏磁共振成像（CMR）检查的8例疑似ICI诱导心肌炎的患者，并将数据与16例年龄匹配的对照组进行比较。使用新开发的应变分析算法，我们通过超声心动图和CMR测量心肌应变和应变率。然后，我们比较了同一组接受ICI治疗的患者（n = 8）中超声心动图和CMR得出的平均纵向应变和应变率。他们在同一次住院过程中相隔24 - 48小时接受了这两种成像检查，并进行了前瞻性随访。结果：我们所有病例的射血分数（EF）均保持> 50%。超声心动图显示，接受ICI治疗的病例中平均收缩期纵向应变（LS，%）降低（ICI组：−12.381 ± 4.161；对照组：−19.761 ± 1.925；p < 0.001），收缩期峰值应变率（SRS，s−1）降低（ICI组：−0.597 ± 0.218；对照组：−0.947 ± 0.135；p = 0.002），舒张早期应变率（SRE，s−1）降低（ICI组：0.562 ± 0.295；对照组：1.073 ± 0.228；p = 0.002）。在同一次住院过程中获得的超声心动图与CMR之间的直接比较显示，LS评分（r = 0.83，p = 0.012）和SRS评分（r = 0.71，p = 0.048）具有很强的相关性。Bland - Altman图显示，95%的数据点落在平均差异的±1.96 SD范围内，表明这两种成像方式之间具有一致性。结论：在这项可行性队列研究中，基于超声心动图和CMR的应变指标均显示出心肌收缩性和舒张性的变化，提示存在ICI诱导的心肌病。我们的数据在更大队列中得到验证后，可作为接受ICI治疗的癌症患者心肌成像的基础。
