Early evaluation of subclinical cardiotoxicity in patients with lung cancer receiving immune checkpoint inhibitors by cardiovascular magnetic resonance: a prospective observational study

Quantitative Imaging in Medicine and Surgery

article

Jia Liu¹  Yukun Cao¹  Kuikui Zhu³  Sheng Yao⁴  Mei Yuan¹  Xiangchuang Kong¹  Xiaoming Liu¹  Yumin Li¹  Yue Cui¹  Xiaoyu Han¹  Xiaoyue Zhou⁵  Rui Meng³  Heshui Shi¹ 

[1] Department of Radiology, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology;Hubei Province Key Laboratory of Molecular Imaging;Cancer Center, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology;Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College , Huazhong University of Science and Technology;MR Collaboration , Siemens Healthineers Ltd.

关键词: Immune checkpoint inhibitor (ICI);    cardiotoxicity;    cancer therapy-related cardiac dysfunction (CTRCD);    cardiovascular magnetic resonance (CMR);    myocardial strain;   

DOI  :  10.21037/qims-22-41

学科分类：外科医学

来源: AME Publications

【 摘 要 】

Background: Few studies have focused on the subclinical cardiotoxicity of immune checkpoint inhibitors (ICIs) in cancer patients. This study aimed to evaluate the manifestations of subclinical cardiotoxicity of ICI therapy using cardiovascular magnetic resonance (CMR) and to explore whether CMR parameters can help predict cardiotoxicity at the early stage of ICI therapy. Methods: A prospective, longitudinal study was conducted among patients with lung cancer. The patients were planned to undergo serial CMRs before (baseline), 3 weeks after (1st follow-up), and 3 months after (2nd follow-up) the initiation of ICI therapy, respectively. Patients with 3 CMRs were included in the analysis. Serial quantitative measurements based on CMR were compared using one-way repeated measures analysis of variance (RM-ANOVA). On the basis of cancer therapy-related cardiac dysfunction (CTRCD) observed at the second follow-up, patients were categorized into a CTRCD group and a non-CTRCD group. Baseline clinical and CMR parameters and the relative reduction of left ventricular global strain at the second follow-up was compared between the CTRCD group and the non-CTRCD group. Receiver operating characteristic (ROC) analysis was used to identify CTRCD that developed 3 months after ICI therapy. Results: A total of 36 patients with 3 CMRs (60.7±9.2 years old, 77.8% male) were included in the analysis. Left ventricular-global radial strain (LV-GRS) decreased significantly at the second follow-up (37.9%±8.5% vs. 33.1%±1.0%; P=0.014), but left ventricular ejection fraction (LVEF) did not change significantly (51.5%±6.0% vs.0.05 for all). In the CTRCD group, the left ventricular-global circumferential strains (LV-GCSs) showed significant reductions at both the first and second follow-up (P=0.008 and 0.035, respectively), but the LVEF only showed a significant reduction at the second follow-up (P<0.001). The relative reduction of LV-GRS at the second follow-up was significantly higher in the CTRCD group than in the non-CTRCD group (29.8%±25.8% vs. 6.8%±20.4%; P=0.036) and was used to predict CTRCD developed at the 3-month timepoint after ICI therapy [area under the curve (AUC) =0.759; P=0.036]. Conclusions: In the early stage of ICI therapy, assessment of myocardial strain can be used to detect subclinical left ventricular systolic dysfunction in patients with lung cancer earlier than LVEF. The relative reduction of LV-GRS can be used to predict CTRCD 3 months after ICI therapy.

【 授权许可】

All Rights reserved