scholarly journals Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis

2020 ◽  
Vol 41 (18) ◽  
pp. 1733-1743 ◽  
Author(s):  
Lili Zhang ◽  
Magid Awadalla ◽  
Syed S Mahmood ◽  
Anju Nohria ◽  
Malek Z O Hassan ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Immune Checkpoint ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction

Abstract Aims Myocarditis is a potentially fatal complication of immune checkpoint inhibitors (ICI). Sparse data exist on the use of cardiovascular magnetic resonance (CMR) in ICI-associated myocarditis. In this study, the CMR characteristics and the association between CMR features and cardiovascular events among patients with ICI-associated myocarditis are presented. Methods and results From an international registry of patients with ICI-associated myocarditis, clinical, CMR, and histopathological findings were collected. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. In 103 patients diagnosed with ICI-associated myocarditis who had a CMR, the mean left ventricular ejection fraction (LVEF) was 50%, and 61% of patients had an LVEF ≥50%. Late gadolinium enhancement (LGE) was present in 48% overall, 55% of the reduced EF, and 43% of the preserved EF cohort. Elevated T2-weighted short tau inversion recovery (STIR) was present in 28% overall, 30% of the reduced EF, and 26% of the preserved EF cohort. The presence of LGE increased from 21.6%, when CMR was performed within 4 days of admission to 72.0% when CMR was performed on Day 4 of admission or later. Fifty-six patients had cardiac pathology. Late gadolinium enhancement was present in 35% of patients with pathological fibrosis and elevated T2-weighted STIR signal was present in 26% with a lymphocytic infiltration. Forty-one patients (40%) had MACE over a follow-up time of 5 months. The presence of LGE, LGE pattern, or elevated T2-weighted STIR were not associated with MACE. Conclusion These data suggest caution in reliance on LGE or a qualitative T2-STIR-only approach for the exclusion of ICI-associated myocarditis.

Long-term prognostic value of ischaemia and cardiovascular magnetic resonance-related revascularization for stable coronary disease, irrespective of patient’s sex: a large retrospective study

2021 ◽  
Author(s):  
Théo Pezel ◽  
Philippe Garot ◽  
Marine Kinnel ◽  
Thomas Hovasse ◽  
Stéphane Champagne ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Ventricular Ejection Fraction ◽  
Inducible Ischaemia

Abstract Aims To assess the sex-specific, long-term prognostic value of myocardial ischaemia induced by stress cardiovascular magnetic resonance (CMR) and early CMR-related revascularization in consecutive patients from a large registry. Methods and results Between 2008 and 2010, all consecutive patients referred for stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (MI). Early CMR-related revascularization was defined as any revascularization within 90 days after CMR. Among 3664 patients (56.9% male, mean age 69.9 ± 11.8 years), 472 (12.9%) had MACE (163 women and 309 men) after a median follow-up of 8.8 (IQR 6.9-9.5) years. Inducible ischaemia and late gadolinium enhancement (LGE) by CMR were associated with MACE in women and men (all P < 0.001). In multivariable Cox regression, inducible ischaemia, LGE, and CMR-related revascularization were independent predictors of MACE both in women [heart rate (HR) 4.79, 95% confidence interval (CI) 2.17–9.10; HR 1.82, 95% CI 1.22–2.71; HR 0.71, 95% CI 0.54–0.92, respectively; all P < 0.001] and men (HR 3.88, 95% CI 2.33–5.98; HR 1.48, 95% CI 1.16–1.89; HR 0.78, 95% CI 0.65–0.97, respectively; all P < 0.001). The addition of CMR-parameters led to improved model discrimination for MACE (C-statistic 0.61 vs. 0.71; NRI = 0.212; IDI = 0.032) for both women and men. CMR-related revascularization was associated with a lower incidence of MACE in patients with left ventricular ejection fraction (LVEF)<50%. Conclusion Inducible ischaemia and early CMR-related revascularization were good long-term predictors of MACE irrespective of sex. CMR-related revascularization was associated with a lower MACE incidence in the sole sub-set of patients with LVEF < 50%.

scholarly journals Mean Scar Entropy by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Associated With Ventricular Arrhythmias Events in Hypertrophic Cardiomyopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Yang Ye ◽  
ZhongPing Ji ◽  
Wenli Zhou ◽  
Cailing Pu ◽  
Ya Li ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Risk Indicators ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction

Background: Ventricular arrhythmias are associated with sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Previous studies have found the late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) was independently associated with ventricular arrhythmia (VA) in HCM. The risk stratification of VA remains complex and LGE is present in the majority of HCM patients. This study was conducted to determine whether the scar heterogeneity from LGE-derived entropy is associated with the VAs in HCM patients.Materials and Methods: Sixty-eight HCM patients with scarring were retrospectively enrolled and divided into VA (31 patients) and non-VA (37 patients) groups. The left ventricular ejection fraction (LVEF) and percentage of the LGE (% LGE) were evaluated. The scar heterogeneity was quantified by the entropy within the scar and left ventricular (LV) myocardium.Results: Multivariate analyses showed that a higher scar [hazard ratio (HR) 2.682; 95% CI: 1.022–7.037; p = 0.039] was independently associated with VA, after the adjustment for the LVEF, %LGE, LV maximal wall thickness (MWT), and left atrium (LA) diameter.Conclusion: Scar entropy and %LGE are both independent risk indicators of VA. A high scar entropy may indicate an arrhythmogenic scar, an identification of which may have value for the clinical status assessment of VAs in HCM patients.

Abstract 17118: Myocarditis in Multisystem Inflammatory Syndrome in Children (MIS-C) Temporally Related to COVID-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Supriya Jain ◽  
anthon fuisz ◽  
Heather Cowles ◽  
Michael H Gewitz
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Severe Left Ventricular Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Inflammatory Syndrome

Background: Little is know about the pathophysiology of Multisystem Inflammatory syndrome in Children (MIS-C) temporally associated with COVID-19 Hypothesis: Patients with MIS-C may present with myocarditis. Cardiac magnetic resonance (CMR) may help in its diagnosis. Methods: Nine children and adolescents were identified to have clinically suspected myocarditis based on their clinical presentation, abnormal cardiac enzymes and evidence of ventricular dysfunction on echocardiogram. 5 patients underwent CMR. Results: All patients had evidence of current/recent SARS-COV-2 infection. Five were PCR+, 7 were IgG+. On echocardiogram at presentation, all the patients had mild-severe left ventricular dysfunction (EF: 25%-53%). Three had left ventricular dilation, 7 had evidence of valvulitis presenting as mitral regurgitation, 4 had pericardial effusion with no evidence of tamponade and 3 patients had associated coronary dilation. Seven patients presented in cardiogenic shock requiring inotropic support. Out of the 5 patients who underwent CMR, 2 had evidence of early and late gadolinium enhancement. Small focal area of late gadolinium enhancement was noted in the inferolateral segment of the subepicardial region of the left ventricle. There was evidence of myocardial edema in the other 3 patients. Conclusions: Children with Multi system Inflammatory Syndrome in Children can present as myocarditis. Cardiac magnetic resonance has a role in its diagnosis, prognosis, better understanding of this disease and may be useful for the long term follow up of these children. Table 1: Patient characteristics, labs, imaging findingsAbbreviations:-BNP: Brain natriuretic peptide, CRP:C-reactive protein, LV EF: Left ventricular ejection fraction, CAs: Coronary abnormalities, Valvar R: valvar regurgitation, EGE: Early gadolinium enhancement, LGE: Late gadolinium enhancement

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