{
  "abstract": "Introduction Immune checkpoint inhibitor (ICI) myocarditis is associated with an increased risk of morbidity and mortality. The management of ICI myocarditis often involves immunosuppressive therapies, as guided by both serum and imaging biomarkers. Elevated levels of serum cardiac injury markers, such as high-sensitivity cardiac troponin (hs-cTn) and N-terminal pro B-type natriuretic peptide (NT-pro BNP), can raise suspicion for ICI myocarditis. Certain cardiovascular magnetic resonance (CMR) based techniques, such as native T1- and T2-mapping, extracellular volume (ECV) fraction and late gadolinium enhancement (LGE), are helpful in the assessment of ICI myocarditis. We assessed the correlation between serum cardiac injury markers and CMR-based markers in ICI myocarditis.Methods Twenty-nine patients with a clinical diagnosis of ICI myocarditis, as adjudicated by a regional cardio-oncology MDT meeting, underwent clinical CMR studies. Patients underwent immunosuppressive therapies after the clinical diagnosis of ICI myocarditis was made owing to clinical care necessity. The CMR scans were performed after the immunosuppressive therapies were started. The CMR protocol included cines, native T1-mapping, native T2-mapping, LGE and post-contrast T1-mapping. Synthetic ECV was derived from the native and post-contrast T1-maps. Peak serum hs-cTnT and NT-pro BNP levels were measured around the time of the scan. Serum and CMR biomarkers were compared.Results The 29 ICI myocarditis patients (age 75±8 years; 62% males) had elevated mean peak hs-cTnT (220±362 ng/L) and NT-pro BNP (9449±7842 ng/L). The patients had a mean LVEF of 58±11% and RVEF of 56±7%. The ICI myocarditis patients had mean native myocardial T1 values of 1035±82ms; mean native myocardial T2 values of 58±6ms, and mean ECV of 0.32±0.06. Hs-cTnT had no significant correlations with native myocardial T1 values (Spearman’s rho= -0.043; p=0.827); native myocardial T2 values (r=0.069; p=0.722); or synthetic ECV (r=0.076; p=0.759). Patients with myocardial LGE had similar hs-cTnT levels as compared to patients without LGE (p=0.33). NT-pro BNP also had no significant correlations with native myocardial T1 values (r=-0.267; p=0.170); native myocardial T2 values (r=0.009; p=0.963); or synthetic ECV (r=-0.059; p=0.811). Patients with myocardial LGE also had similar NT-pro BNP levels as compared to patients without LGE (p=0.07). Neither hs-cTnT nor NT-pro BNP had significant correlations with LVEF in this cohort of ICI myocarditis patients (both p>0.05).Conclusions This study showed that elevated cardiac injury markers in patients with ICI myocarditis were not significantly correlated with CMR-based tissue characterisation methods, in a clinical cohort. The major caveat is that patients were treated with immunosuppressive therapy when CMR scans were performed, which may reflect a blunted myocardial pathology. Further work is required to refine imaging-based diagnostic methods in ICI myocarditis.",
  "authors": [
    {
      "affiliations": [
        "Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, United Kingdom"
      ],
      "name": "Millie Duckett"
    },
    {
      "affiliations": [
        "Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, United Kingdom"
      ],
      "name": "Ella Jacobs"
    },
    {
      "affiliations": [
        "Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom"
      ],
      "name": "Ali Hodge"
    },
    {
      "affiliations": [
        "Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom"
      ],
      "name": "Anna Olsson-Brown"
    },
    {
      "affiliations": [
        "Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, United Kingdom"
      ],
      "name": "Susan Ellery"
    },
    {
      "affiliations": [
        "Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, United Kingdom",
        "Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom"
      ],
      "name": "Alexander Liu"
    }
  ],
  "title": "31 Comparison of cardiac injury and cardiovascular magnetic resonance biomarkers in immune checkpoint inhibitor myocarditis",
  "uid": "498e5858-6098-5485-99a2-367279e91a32"
}