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Global Longitudinal Strain and Cardiac Events in Patients With Immune Checkpoint Inhibitor-Related Myocarditis.
- Source :
-
Journal of the American College of Cardiology (JACC) . Feb2020, Vol. 75 Issue 5, p467-478. 12p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>There is a need for improved methods for detection and risk stratification of myocarditis associated with immune checkpoint inhibitors (ICIs). Global longitudinal strain (GLS) is a sensitive marker of cardiac toxicity among patients receiving standard chemotherapy. There are no data on the use of GLS in ICI myocarditis.<bold>Objectives: </bold>This study sought to evaluate the role of GLS and assess its association with cardiac events among patients with ICI myocarditis.<bold>Methods: </bold>This study retrospectively compared echocardiographic GLS by speckle tracking at presentation with ICI myocarditis (cases, n = 101) to that from patients receiving an ICI who did not develop myocarditis (control subjects, n = 92). Where available, GLS was also measured pre-ICI in both groups. Major adverse cardiac events (MACE) were defined as a composite of cardiogenic shock, arrest, complete heart block, and cardiac death.<bold>Results: </bold>Cases and control subjects were similar in age, sex, and cancer type. At presentation with myocarditis, 61 cases (60%) had a normal ejection fraction (EF). Pre-ICI, GLS was similar between cases and control subjects (20.3 ± 2.6% vs. 20.6 ± 2.0%; p = 0.60). There was no change in GLS among control subjects on an ICI without myocarditis (pre-ICI vs. on ICI, 20.6 ± 2.0% vs. 20.5 ± 1.9%; p = 0.41); in contrast, among cases, GLS decreased to 14.1 ± 2.8% (p < 0.001). The GLS at presentation with myocarditis was lower among cases presenting with either a reduced (12.3 ± 2.7%) or preserved EF (15.3 ± 2.0%; p < 0.001). Over a median follow-up of 162 days, 51 (51%) experienced MACE. The risk of MACE was higher with a lower GLS among patients with either a reduced or preserved EF. After adjustment for EF, each percent reduction in GLS was associated with a 1.5-fold increase in MACE among patients with a reduced EF (hazard ratio: 1.5; 95% confidence interval: 1.2 to 1.8) and a 4.4-fold increase with a preserved EF (hazard ratio: 4.4; 95% confidence interval: 2.4 to 7.8).<bold>Conclusions: </bold>GLS decreases with ICI myocarditis and, compared with control subjects, was lower among cases presenting with either a preserved or reduced EF. Lower GLS was strongly associated with MACE in ICI myocarditis presenting with either a preserved or reduced EF. [ABSTRACT FROM AUTHOR]
- Subjects :
- *MYOCARDITIS
*CARDIAC patients
*CONFIDENCE intervals
*HEART block
*CARDIOGENIC shock
*ECHOCARDIOGRAPHY
*RESEARCH
*CARDIOMYOPATHIES
*MELANOMA
*RESEARCH methodology
*ANTINEOPLASTIC agents
*RETROSPECTIVE studies
*LUNG tumors
*EVALUATION research
*MEDICAL cooperation
*COMPARATIVE studies
*RESEARCH funding
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 75
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 141636550
- Full Text :
- https://doi.org/10.1016/j.jacc.2019.11.049