Myocardial T1 and T2 Mapping by Cardiovascular Magnetic Resonance in Immune Checkpoint Inhibitor-Associated Myocarditis

Thavendiranathan, Paaladinesh; Zhang, Lili; Zafar, Amna; Mahmood, Syed; Cabral, Marcella; Nohria, Anju; Thuny, Franck; Gupta, Dipti; Hartmann, Sarah; Weinsaft, Jonathan W.; Gilman, Hannah; Kovacina, Bojan; Michel, Caroline; Mahmoudi, Michael; Castro, Manuel García de Yébenes; Kwong, Raymond; Coelho‐Filho, Otávio R.; Afilalo, Jonathan; Nicolás, Eduardo; Baksi, A. John; Wintersperger, Bernd J.; Yang, Eric H.; Lyon, Alexander R.; Fradley, Michael G.; Neilan, Tomas G.

doi:10.1016/s0735-1097(21)04410-7

Cited by 10 publications

(9 citation statements)

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“…A retrospective study was conducted using an international registry to assess the value of CMR T1 and T2 mapping in individuals with ICI myocarditis. Abnormal T1 and T2 values were observed in 78% and 43% of cases, respectively 14. When applying the modified Lake Louise Criteria, 95% of cases met the non-ischaemic myocardial injury criteria, and 53% met the myocardial oedema criteria 14.…”

Section: Discussionmentioning

confidence: 98%

Immune checkpoint inhibitor-induced myopericarditis

Alrayyashi,

Uddin,

Bdiwi

et al. 2024

BMJ Case Rep

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A woman in her 30s with a medical history of metastatic rectal adenocarcinoma, currently on pembrolizumab, which started a few weeks ago, was admitted for abdominal pain. During the hospital stay, she experienced sharp chest pain. Troponin was 1885 ng/mL which peaked at 7338 ng/mL. ECG was unremarkable. The echocardiogram showed an Ejection fraction (EF) of 55%–60% and basal-inferior wall hypokinesis. Left heart catheterisation showed no coronary abnormalities. Cardiac MRI showed a non-coronary area of focal T1 and T2 hyperintense signal and transmural delayed gadolinium enhancement in the mid-basal inferior/inferoseptal wall consistent with myocardial damage. Pericardium showed increased thickness and adhesions at the right ventricular outflow tract consistent with pericarditis. Steroid therapy was initiated, and a marked clinical response was achieved. Immune checkpoint inhibitor-induced myocarditis and pericarditis is a rare complication associated with a high mortality rate, if untreated. Diagnosis requires a multidisciplinary approach, and early detection is critical to preventing a fatal outcome.

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Section: Discussionmentioning

confidence: 98%

Immune checkpoint inhibitor-induced myopericarditis

Alrayyashi,

Uddin,

Bdiwi

et al. 2024

BMJ Case Rep

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“…59 Other important adverse prognostic MRI markers in myocarditis include global systolic dysfunction (LVEF <40%) and higher T1 and ECV. 57,60 In patients with acute myocarditis with evidence of myocardial edema and/or left ventricular dysfunction, follow-up cardiac MRI may be considered approximately 3-6 months after the baseline study to assess for resolution of edema, functional recovery, and residual fibrosis.…”

Section: Myocarditis and Pericarditismentioning

confidence: 99%

“…This is most likely due to the fact that LGE without associated edema typically reflects fibrosis, which is irreversible, while LGE in the context of edema confers the possibility of recovery as edema improves over time 59 . Other important adverse prognostic MRI markers in myocarditis include global systolic dysfunction (LVEF <40%) and higher T1 and ECV 57,60 . In patients with acute myocarditis with evidence of myocardial edema and/or left ventricular dysfunction, follow‐up cardiac MRI may be considered approximately 3–6 months after the baseline study to assess for resolution of edema, functional recovery, and residual fibrosis.…”

Section: Imaging Acute Covid‐19 Cardiovascular Sequelamentioning

confidence: 99%

Magnetic Resonance Imaging of Cardiovascular Manifestations Following COVID‐19

Tijmes

Marschner

Thavendiranathan

et al. 2023

Magnetic Resonance Imaging

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Globally, over 650 million people have had COVID‐19 due to infection with the SARS‐Cov‐2 virus. Cardiac complications in the acute infectious and early recovery phase were recognized early in the pandemic, including myocardial injury and inflammation. With a decrease in the number of acute COVID‐19 related deaths, there has been increased interest in postacute sequela of COVID‐19 (PASC) and other longer‐term cardiovascular complications. A proportion of patients recovered from COVID‐19 have persistent cardiac symptoms and are at risk of cardiovascular disease. Cardiovascular imaging, including MRI, plays an important role in the detection of cardiovascular manifestations of COVID‐19 in both the acute and longer‐term phases after COVID‐19. The purpose of this review is to highlight the role of cardiovascular imaging in the diagnosis and risk stratification of patients with acute and chronic cardiovascular manifestations of COVID‐19 with a focus on cardiac MRI. Evidence Level 4. Technical Efficacy Stage 3.

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“…One approach to combining data is to convert T1 and T2 values to z-scores using site-specific reference values. 10 Additional data are needed on longitudinal imaging changes, baseline risk factors, and long-term prognosis in patients with myocarditis after COVID-19 vaccination. Understanding the pattern and extent of myocardial injury and its implications will allow for improved care of these patients and may help to address vaccine hesitancy.…”

mentioning

confidence: 99%

“…Importantly, parametric mapping values vary substantially depending on the technique (including the specific sequence and field strength), and therefore pooling multi‐site data is of limited value. One approach to combining data is to convert T1 and T2 values to z‐scores using site‐specific reference values 10 …”

mentioning

confidence: 99%