Longitudinal Strain in Patients on Immune Checkpoint Inhibitor Therapy

Dec 20, 2022
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Authors:
Tamura Y, Tamura Y, Takemura R, et al.
Citation:
Longitudinal Strain and Troponin I Elevation in Patients Undergoing Immune Checkpoint Inhibitor Therapy. JACC CardioOncol 2022;4:673-685.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • In patients treated with immune checkpoint inhibitor (ICI) therapy, early relative worsening in basal and mid longitudinal strain (LS) of ≥10% and in global LS of ≥15% were associated with hsTnI elevation.
  • Early basal LS reduction was observed in the majority of cases of myocarditis in patients receiving ICIs.
  • If validated in prospective studies, LS analysis may be useful as a marker for the early diagnosis of myocardial damage in ICI-treated patients.

Study Questions:

What are the changes in longitudinal strain (LS) in immune checkpoint inhibitor (ICI)–treated patients, and their associations with high-sensitivity troponin I (hsTnI) and myocarditis?

Methods:

The investigators conducted a retrospective cohort study of patients who received ICIs at their hospital from April 2017 to September 2021. All patients underwent echocardiography and blood sampling at standardized time intervals. The authors measured the changes in global and regional LS before and after ICI administration. Age- and sex-adjusted Cox regression analysis was used to evaluate the association between LS and elevations in hsTnI and myocarditis.

Results:

In a cohort of 129 patients with a median follow-up period of 170 days (Q1–Q3: 62–365); 6 and 18 patients had myocarditis and hsTnI elevation, respectively. In the age- and sex-adjusted Cox proportional hazards model, an early relative worsening of ≥10% in the basal and mid LS and ≥15% in global LS was associated with TnI elevation. Relative reductions in LS were not significantly associated with myocarditis; however, four of the six patients with myocarditis had a relative reduction of ≥10% in the basal LS.

Conclusions:

The authors concluded that an early worsening in the global and regional LS was associated with increased hsTnI in patients receiving ICIs.

Perspective:

This single-center study reports that in patients treated with ICI therapy, early relative worsening in basal and mid LS of ≥10% and in global LS of ≥15% were associated with hsTnI elevation. Furthermore, early basal LS reduction was observed in the majority of cases of myocarditis in patients receiving ICIs. If validated in prospective studies, LS analysis may be useful as a marker for the early diagnosis of myocardial damage in ICI-treated patients and may potentially guide cardioprotective strategies with ICI therapy.

Clinical Topics: Cardio-Oncology, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound

Keywords: Biomarkers, Cardiotoxicity, Diagnostic Imaging, Echocardiography, Heart Failure, Immune Checkpoint Inhibitors, Myocarditis, Secondary Prevention, Troponin I


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