Table 2:
Clinical presentation of all patients with ICI myocarditis and patients with abnormal versus normal T1 values.
| With T1‡ mapping | Abnormal T1 values* | Normal T1 values | ||
|---|---|---|---|---|
| (N=86) | (N=67) | (N=19) | p† | |
| Time from starting ICI to admission for myocarditis, days | 57 (27, 110) | 59 (27, 116) | 37 (22, 82) | 0.27 |
| Myocarditis presentation | ||||
| Chest pain | 23 (26.7) | 17 (25.4) | 6 (31.6) | 0.57 |
| Shortness of breath | 52 (60.5) | 44 (65.7) | 8 (42.1) | 0.11 |
| Orthopnea | 16 (19.1) | 14 (21.2) | 2 (11.1) | 0.69 |
| Paroxysmal nocturnal dyspnea | 15 (17.7) | 15 (22.7) | 0 (0.0) | 0.036 |
| Fatigue | 29 (36.7) | 20 (32.8) | 9 (50.0) | 0.39 |
| Syncope | 6 (7.8) | 5 (8.3) | 1 (5.9) | 0.26 |
| Sudden cardiac death | 1 (1.3) | 1 (1.7) | 0 (0.0) | 0.23 |
| Palpitation | 19 (22.4) | 15 (22.7) | 4 (21.1) | 1.00 |
| Physical exam | ||||
| Jugular vein distention | 24 (28.2) | 21 (31.8) | 3 (15.8) | 0.14 |
| Crackles | 29 (34.5) | 26 (40.0) | 3 (15.8) | 0.11 |
| Lower extremity edema | 27 (32.1) | ^ 25 (38.5) | 2 (10.5) | 0.020 |
| SBP, mmHg | 125.9 ± 20.1 | 124.4 ± 20.4 | 130.9 ± 18.8 | 0.23 |
| DBP, mmHg | 74.2 ± 10.1 | 74.4 ± 9.1 | 73.7 ± 13.1 | 0.82 |
| Electrocardiogram at presentation | ||||
| Sinus rhythm | 70 (82.4) | 53 (80.3) | 17 (89.5) | 0.50 |
| ST-segment or T-wave changes | 43 (51.8) | 32 (48.5) | 11 (64.7) | 0.28 |
| Heart rate, beats/min | 82.7 ± 21.3 | 83.4 ± 22.5 | 78.5 ± 13.5 | 0.55 |
| Biomarkers | ||||
| Initial troponin T, ng/mL) | 1.3 (0.3, 28.4) | 1.3 (0.4, 15.6) | 21.0 (0.2, 67.4) | 0.63 |
| Peak troponin T, ng/mL | 2.0 (0.5, 96.7) | 2.0 (0.5, 54.4) | 16.2 (0.5, 114.6) | 0.73 |
| Initial BNP, pg/mL | 536.0 (183.6, 1200.0) | 559.0 (194.0, 1500.0) | 184.0 (152.0, 672.0) | 0.14 |
| Peak BNP, pg/mL | 1130.0 (194.0, 2118.0) | 1130.0 (194.0, 2275.0) | 1027.5 (370.0, 1671.5) | 0.75 |
| Echocardiogram | ||||
| Pre-ICI LVEF, % | 60.6 ± 4.9 | 59.9 ± 4.8 | 63.5 ± 4.0 | 0.021 |
| Lowest LVEF at presentation, % | 51.8 ± 14.9 | 50.0 ± 15.8 | 58.2 ± 8.8 | 0.034 |
| Change of LVEF, % | 11.0 ± 13.5 | 12.3 ± 14.3 | 5.3 ± 7.1 | 0.11 |
| LVEF<50% at presentation | 27 (31.4) | 25 (37.3) | 2 (10.5) | 0.026 |
| LVIDD, mm | 46.9 ± 6.0 | 47.8 ± 5.7 | 44.2 ± 6.1 | 0.040 |
| LA size, mm | 37.5 (34, 42) | 37.5 (34, 45) | 38.0 (35.5, 40) | 0.91 |
| Pericardial effusion | 16 (27.6) | 13 (29.6) | 3 (21.4) | 0.24 |
| Global longitudinal strain by echo, % | −14.3 (−16.8, − 12.7) | −14.1 (−16.8, − 12.4) | −15.7 (−16.7, − 15.1) | 0.27 |
| CMR | ||||
| Time from admission to CMR | 4 (2, 8) | 4 (2, 8) | 3 (2, 5) | 0.34 |
| Time from start of ICI therapy to CMR | 58 (28, 118) | 64 (34, 119) | 38 (20, 103) | 0.13 |
| Corticosteroids use before CMR | 54 (72.0) | 42 (71.2) | 12 (75.0) | 1.00 |
| 1.5-T Siemens | 60 (69.8) | 45 (67.2) | 15 (79.0) | 0.14 |
| 1.5-T Philips | 4 (4.7) | 2 (3.0) | 2 (10.5) | 0.14 |
| 3-T Siemens | 22 (25.5) | 20 (29.8) | 2 (10.5) | 0.14 |
| LVEDV, ml | 142.5 (129, 159) | 142 (128, 160) | 143 (129, 151) | 0.76 |
| LV mass index, g/m2 | 70.6 (60.9, 92.0) | 69.0 (59.0, 84.3) | 78.0 (63.7, 119.0) | 0.11 |
| LVEF by CMR, % | 51.3 ± 13.8 | 49.6 ± 14.2 | 57.2 ± 10.6 | 0.034 |
| LVEF<55% | 36 (41.9) | 30 (44.8) | 6 (31.6) | 0.30 |
| LGE, % | 48 (55.8) | 35 (52.2) | 13 (68.4) | 0.30 |
| Edema by T2-weighted STIR / SPAIR | 22 (34.4) | 18 (34.0) | 4 (36.4) | 1.00 |
| Native T1 value (1.5T Siemens), ms | 1070.1 ± 50.6 | 1086.2 ± 46.3 | 1021.9 ± 26.3 | <0.001 |
| Native T1 value (3T Siemens), ms | 1212.5 ± 73.6 | 1212.3 ± 76.7 | 1214.5 ± 44.5 | 0.97 |
| Average T2 value (1.5T Siemens), ms | 56.3 ± 4.9 | 57.0 ± 5.0 | 54.0 ± 3.7 | 0.041 |
| Average T2 value (3T Siemens), ms | 48.9 ± 8.3 | 50.4 ± 7.9 | 39.0 ± 0§ | 0.070 |
| Extracellular volume, % | 33.2 ± 2.1 | 33.2 ± 2.2 | 33.3 ± 0.6 | 0.91 |
| Corticosteroid treatment | ||||
| Time from admission to treatment | ||||
| ≤24 hours | 43 (55.8) | 30 (50.9) | 13 (72.2) | 0.019 |
| 24–72 hours | 17 (22.1) | 12 (20.3) | 5 (27.8) | |
| >72 hours | 17 (22.1) | 17 (28.8) | 0 (0) | |
| Initial corticosteroids dose | ||||
| Low (<60mg/day) | 12 (19.1) | 9 (17.7) | 3 (25.0) | 0.28 |
| Intermediate (60–500mg/day) | 28 (44.4) | 21 (41.2) | 7 (58.3) | |
| High (501–1000mg/day) | 23 (36.5) | 21 (41.2) | 2 (16.7) |
Values are mean ± SD, n (%), median (interquartile range), or n(%).
Percentages are represented as percentage of available data.
Abnormal T1 values were defined as values >2 standard deviation above the site, CMR vendor/field strength specific reference ranges.
Comparison between patients with abnormal and normal T1 values were performed using the Student’s t-tests or Wilcoxon Rank Sum tests for continuous variables, as appropriate based on their normality and the Chi-squared test for categorical variables.
Only 2 patients with identical values. Anti-CTLA4 = anti-cytotoxic T-lymphocyte-associated protein 4; anti-PD1 = anti-programmed cell death protein 1; anti-PDL1 = anti-programmed death-ligand 1; BNP = Brain natriuretic peptide; CMR = cardiovascular magnetic resonance; CV = cardiovascular; DBP = diastolic blood pressure; ICI = immune checkpoint inhibitors; LA = left atrium; LGE = late gadolinium enhancement; LVEDV = left ventricular end-diastolic volume; LVEF = left ventricular ejection fraction; LVIDD = left ventricular internal diameter end diastole; LVIDS = left ventricular internal diameter end systole; LV mass = left ventricular mass; MACE = major adverse cardiac events; N/A = not applicable; SBP = systolic blood pressure; STIR = short tau inversion recovery; SPAIR: Spectral attenuated inversion recovery.