Lerchner Tobias, Mincu Raluca I, Bühning Florian, Vogel Julia, Klingel Karin, Meetschen Mathias, Schlosser Thomas, Haubold Johannes, Umutlu Lale, Dobrev Dobromir, Totzeck Matthias, Rassaf Tienush, Michel Lars
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Germany.
Cardiopathology, Institute for Pathology and Neuropathology, Tübingen, Germany.
Int J Cardiol Heart Vasc. 2024 Dec 19;56:101581. doi: 10.1016/j.ijcha.2024.101581. eCollection 2025 Feb.
Cardiotoxicity from immune checkpoint inhibitor (ICI) therapy is a challenge in clinical practice, and the assessment of ICI-related myocarditis (ICI-M) is often complicated by a variable phenotype. Cardiac magnetic resonance imaging (CMR) is used frequently, but evidence is poor. Here, we aim to assess the role of CMR in the assessment of suspected ICI-M in a real-world clinical setting.
All patients receiving CMR at our centre for suspected ICI-M between September 2019 and January 2024 were included and retrospectively analysed. CMR parameters were correlated with clinical, laboratory and echocardiographic parameters and stratified for presence of myocarditis as per final diagnosis.
A total of 55 patients who received CMR for suspected ICI-M were analysed, including 25 patients with ICI-M and 30 patients with non-myocarditis cardiotoxicity (non-M). The mean age (ICI-M versus (vs.) non-M) was 65.7 ± 13.6 vs. 67.3 ± 9.9 (p = 0.61) years, 32.0 % vs. 26.7 % (p = 0.67) were female, and 40.0 % vs. 26.7 % (p = 0.29) had pre-existing coronary heart disease. Cardiac biomarkers and echocardiographic data did not differ between the groups. In CMR analysis, presence of LGE was associated with ICI-M (56.0 % in ICI-M vs. 26.7 % in non-M, p = 0.03). Myocardial oedema was generally rare and not associated with ICI-M.
In this real-life assessment of routine clinical practice, the diagnostic assessment of ICI-M is challenged by low sensitivity of common diagnostic measures, often requiring a multimodal approach. Presence of LGE in CMR is associated with ICI-M, but sensitivity and specificity are low. Prospective data to improve diagnostic criteria is needed.
免疫检查点抑制剂（ICI）治疗引起的心脏毒性是临床实践中的一项挑战，而ICI相关心肌炎（ICI-M）的评估常因表型多变而变得复杂。心脏磁共振成像（CMR）被频繁使用，但证据不足。在此，我们旨在评估CMR在真实临床环境中对疑似ICI-M评估中的作用。
纳入2019年9月至2024年1月期间在我们中心因疑似ICI-M接受CMR检查的所有患者，并进行回顾性分析。将CMR参数与临床、实验室及超声心动图参数进行关联，并根据最终诊断对心肌炎的存在情况进行分层。
共分析了55例因疑似ICI-M接受CMR检查的患者，其中25例为ICI-M患者，30例为非心肌炎性心脏毒性（非M）患者。平均年龄（ICI-M组与非M组）分别为65.7±13.6岁和67.3±9.9岁（p = 0.61），女性比例分别为32.0%和26.7%（p = 0.67），已有冠心病的比例分别为40.0%和26.7%（p = 0.29）。两组间心脏生物标志物和超声心动图数据无差异。在CMR分析中，延迟强化（LGE）的存在与ICI-M相关（ICI-M组为56.0%，非M组为26.7%，p = 0.03）。心肌水肿通常少见，且与ICI-M无关。
在本次对常规临床实践的实际评估中，ICI-M的诊断评估受到常见诊断措施低敏感性的挑战，通常需要多模式方法。CMR中LGE的存在与ICI-M相关，但敏感性和特异性较低。需要前瞻性数据来改进诊断标准。
