Song Wenhua, Zhang Nan, Lv Tonglian, Zhao Yang, Li Guangping, Tse Gary, Liu Tong
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University Tianjin China.
Department of Radiology Second Hospital of Tianjin Medical University Tianjin China.
Cancer Innov. 2024 Apr 15;3(3):e109. doi: 10.1002/cai2.109. eCollection 2024 Jun.
Immune checkpoint inhibitors (ICI) are increasingly used in the first-line treatment of malignant tumors. There is increasing recognition of their cardiotoxicity and, in particular, their potential to lead to myocarditis. Cardiovascular magnetic resonance (CMR) can quantify pathological changes, such as myocardial edema and fibrosis. The purpose of this systematic review and meta-analysis was to examine the evidence for the roles of CMR in predicting prognosis in ICI-associated myocarditis.
PubMed, Cochrane Library, and Web of Science databases were searched until October 2023 for published works investigating the relationship between CMR parameters and adverse events in patients with ICI-associated myocarditis. The analysis included studies reporting the incidence of late gadolinium enhancement (LGE), T1 values, T2 values, and CMR-derived left ventricular ejection fraction (LVEF). Odds ratios (OR) and weighted mean differences (WMD) were combined for binary and continuous data, respectively. Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies.
Five cohort studies were included (average age 65-68 years; 25.4% female). Of these, four studies were included in the meta-analysis of LGE-related findings. Patients with major adverse cardiovascular events (MACE) had a higher incidence of LGE compared with patients without MACE (OR = 4.18, 95% CI: 1.72-10.19, = 0.002). A meta-analysis, incorporating data from two studies, showed that patients who developed MACE exhibited significantly higher T1 value (WMD = 36.16 ms, 95% CI: 21.43-50.89, < 0.001) and lower LVEF (WMD = - 8.00%, 95% CI: -13.60 to -2.40, = 0.005). Notably, T2 value (WMD = -0.23 ms, 95% CI: -1.86 to -1.39, = 0.779) was not associated with MACE in patients with ICI-related myocarditis.
LGE, T1 value, and LVEF measured by CMR imaging have potential prognostic value for long-term adverse events in patients with ICI-related myocarditis.
免疫检查点抑制剂（ICI）越来越多地用于恶性肿瘤的一线治疗。人们越来越认识到其心脏毒性，尤其是导致心肌炎的可能性。心血管磁共振（CMR）可以量化病理变化，如心肌水肿和纤维化。本系统评价和荟萃分析的目的是检验CMR在预测ICI相关性心肌炎预后中作用的证据。
检索PubMed、Cochrane图书馆和Web of Science数据库至2023年10月，以查找关于ICI相关性心肌炎患者CMR参数与不良事件之间关系的已发表研究。分析包括报告钆延迟强化（LGE）发生率、T1值、T2值和CMR衍生的左心室射血分数（LVEF）的研究。分别对二分类和连续性数据合并比值比（OR）和加权平均差（WMD）。采用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。
纳入5项队列研究（平均年龄65 - 68岁；女性占25.4%）。其中，4项研究纳入了LGE相关结果的荟萃分析。与无主要不良心血管事件（MACE）的患者相比，发生MACE的患者LGE发生率更高（OR = 4.18，95%CI：1.72 - 10.19，P = 0.002）。一项纳入两项研究数据的荟萃分析显示，发生MACE的患者T1值显著更高（WMD = 36.16 ms，95%CI：21.43 - 50.89，P < 0.001）且LVEF更低（WMD = -8.00%，95%CI：-13.60至-2.40，P = 0.005）。值得注意的是，ICI相关性心肌炎患者的T2值（WMD = -0.23 ms，95%CI：-1.86至-1.39，P = 0.779）与MACE无关。
CMR成像测量的LGE、T1值和LVEF对ICI相关性心肌炎患者的长期不良事件具有潜在的预后价值。
