Cardio Oncology

1356110 - T1 mapping parameters of thoracic muscles assessed by CMR are independent predictors of all-cause mortality in patients treated by ICI suspected of myocarditis irrespective of cardiac involvement

Friday, January 27, 2023

12:20 PM – 1:20 PM

Location: Pacific Jewel

Presenting Author(s)

EC

Etienne Charpentier, MD, MSc

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France

Primary Author(s)

EC

Etienne Charpentier, MD, MSc

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France

Co-Author(s)

SB

Samia Boussouar, MD, MSc

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
MB

Marie Bretagne, MD

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
BP

Bruno Pinna, MD

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
KB

Khaoula Bouazizi, PhD

Research Engineer
Laboratoire d'Imagerie Biomédicale, France
NK

Nadjia Kachenoura, PhD

Research Director
Laboratoire d'Imagerie Biomédicale, France
NP

Nicoletta Pasi, MD

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
SL

Schahrazed Larbi Messaoud, MD

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
MK

Mathieu Kerneis, MD, PhD

Dr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
SE

Stephane Ederhy, MD

Dr
Hôpital de Saint Antoine
Paris, Ile-de-France, France
TS

Thomas Similowski, MD, PhD

Pr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
YA

Yves Allenbach, MD, PhD

Pr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
JS

Joe-Elie Salem, MD, PhD

Pr
University Hospital Pitie-Salpetriere
Paris, Ile-de-France, France
AR

Alban Redheuil, MD, PhD

Professor
Pitié-Salpêtrière Hospital - Sorbonne University, France

Disclosure(s):

Alban Redheuil, MD, PhD: No relevant disclosure to display

Background: Immune checkpoints inhibitors (ICI) are widely used for the treatment of various cancers. Despite their efficacy, ICIs are responsible for diffuse muscular toxicity with myositis including potential myocardial involvement and cardiotoxicity leading to heart rhythm abnormalities, heart failure and death. Our aim was to evaluate the diagnostic and prognostic value of cardiovascular magnetic resonance (CMR) with T1 and T2 mapping parameters measured both in the myocardium and in thoracic skeletal muscles of patients treated with ICI suspected of myocarditis.

Methods:

Seventy-eight patients treated with ICI with a suspicion of myocarditis were included (45 male, age 65 ± 14 years) between October 2018 and March 2022. Study participants underwent CMR imaging with modified Look-Locker inversion-recovery (MOLLI) T1 mapping and 3-point balanced steady-state-free precession T2 mapping. For each patient, global T1, extracellular volume (ECV) and T2 mapping values of myocardial and thoracic skeletal muscles in the field of view (Subscapularis m.) were measured and all-cause mortality was recorded over a median follow-up of 214 days. ROC-Analysis and age adjusted Cox proportional Hazard ratios were performed to analyze the ability of CMR parameters to predict all-cause mortality.

Results:

The most frequent cancer locations were lung (35%), kidney (15%), melanoma (15%) and liver (8%). Nineteen patients (24%) had myocarditis according to the modified Lake Louise criteria. At day 480 after admission, 22 patients (28%) had died, and 56 patients (72%) were alive. Predictors of mortality in the univariate analysis were age (HR=1.04, p=0.01), increased T1 relaxation time of skeletal muscle (HR=1.01, p=0.001) and increased ECV of skeletal muscles (HR=1.06, p=0.01). Optimal cut-points of thoracic muscle parameters for the prediction of mortality were: ECV ≥14.85% with sensitivity of 0.73 and a specificity of 0.79 (AUC = 0.75, p=0.0045) and native T1 ≥888 ms with sensitivity of 0.90 and a specificity of 0.47 (AUC = 0.74, p=0.0002). After adjustment for age, increased ECV (HR=4.4, p=0.002) and T1 relaxation time (HR=5.4, p=0.007) of skeletal muscles above the cut-points remained significantly associated with mortality. Conversely, left ventricular ejection fraction, myocardial T1 and T2 relaxation times and ECV did not reach significant association with mortality. Myocardial LGE was not associated with mortality irrespective of myocardial location.

Conclusion: Increased T1 and ECV of thoracic skeletal muscles assessed during a CMR examination is associated with increased all-cause mortality independent of age in patients treated with ICI irrespective of myocardial involvement.