Background

Immune checkpoint inhibitors (ICIs) for cancer treatment are associated with a spectrum of immune-related adverse events, including ICI-induced myocarditis; however, the extent of subclinical acute cardiac effects related to ICI treatment is unclear.

Purpose

To explore the extent of cardiac injury and inflammation related to ICI therapy that can be detected with use of cardiac MRI.

Materials and Methods

In this prospective study from November 2019 to April 2021, oncologic participants, without known underlying structural heart disease or cardiac symptoms, underwent multiparametric cardiac MRI before planned ICI therapy (baseline) and 3 months after starting ICI therapy (follow-up). The cardiac MRI protocol incorporated assessment of cardiac function, including systolic myocardial strain, myocardial edema, late gadolinium enhancement (LGE), T1 and T2 relaxation times, and extracellular volume fraction. The paired t test, Wilcoxon signed-rank test, and McNemar test were used for intraindividual comparisons.

Results

Twenty-two participants (mean age ± standard deviation, 65 years ± 14; 13 men) were evaluated, receiving a median of four infusions of ICI therapy (interquartile range, four to six infusions). Compared with baseline MRI, participants displayed increased markers of diffuse myocardial edema at follow-up (T1 relaxation time, 972 msec ± 26 vs 1006 msec ± 36 [P < .001]; T2 relaxation time, 54 msec ± 3 vs 58 msec ± 4 [P < .001]; T2 signal intensity ratio, 1.5 ± 0.3 vs 1.7 ± 0.3 [P = .03]). Left ventricular average systolic longitudinal strain had decreased at follow-up MRI (–23.4% ± 4.8 vs –19.6% ± 5.1, respectively; P = .005). New nonischemic LGE lesions were prevalent in two of 22 participants (9%). Compared with baseline, small pericardial effusions were more evident at follow-up (one of 22 participants [5%] vs 10 of 22 [45%]; P = .004).

Conclusion

In participants who received immune checkpoint inhibitor therapy for cancer treatment, follow-up cardiac MRI scans showed signs of systolic dysfunction and increased parameters of myocardial edema and inflammation.

© RSNA, 2021

Online supplemental material is available for this article.

中文翻译：

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心脏 MRI 描绘免疫检查点抑制剂诱发的心肌炎：一项前瞻性研究

背景

用于癌症治疗的免疫检查点抑制剂 (ICI) 与一系列免疫相关不良事件有关，包括 ICI 诱发的心肌炎；然而，与 ICI 治疗相关的亚临床急性心脏效应的程度尚不清楚。

目的

探讨可使用心脏 MRI 检测到的与 ICI 治疗相关的心脏损伤和炎症的程度。

材料和方法

在这项从 2019 年 11 月到 2021 年 4 月的前瞻性研究中，没有已知潜在结构性心脏病或心脏症状的肿瘤参与者在计划的 ICI 治疗前（基线）和开始 ICI 治疗后 3 个月（随访）接受了多参数心脏 MRI。心脏 MRI 协议包括对心脏功能的评估，包括收缩心肌应变、心肌水肿、钆延迟增强 (​​LGE)、T1 和 T2 弛豫时间以及细胞外体积分数。配对t检验、Wilcoxon 符号秩检验和 McNemar 检验用于个体内比较。

结果

22 名参与者（平均年龄 ± 标准差，65 岁 ± 14 岁；13 名男性）接受了中位数的四次 ICI 治疗（四分位距，四到六次输注）的评估。与基线 MRI 相比，参与者在随访时显示出更多的弥漫性心肌水肿标志物（T1 弛豫时间，972 毫秒 ± 26 对 1006 毫秒 ± 36 [ P < .001]；T2 弛豫时间，54 毫秒 ± 3 对 58 毫秒 ± 4 [ P < .001]；T2 信号强度比，1.5 ± 0.3 与 1.7 ± 0.3 [ P = .03]）。随访 MRI 时左心室平均收缩纵向应变降低（分别为 –23.4% ± 4.8 和 –19.6% ± 5.1；P= .005）。22 名参与者中有 2 名 (9%) 普遍存在新的非缺血性 LGE 病变。与基线相比，小的心包积液在随访时更为明显（22 名参与者之一 [5%] 对 22 名参与者中的 10 名 [45%]；P = .004）。

结论

在接受免疫检查点抑制剂治疗癌症治疗的参与者中，后续心脏 MRI 扫描显示收缩功能障碍的迹象以及心肌水肿和炎症参数增加。

©北美放射学会，2021

本文提供了在线补充材料。