Longitudinal Strain and Troponin I Elevation in Patients Undergoing Immune Checkpoint Inhibitor Therapy

Yudai Tamura; Yuichi Tamura; Ryo Takemura; Kenta Yamada; Hirohisa Taniguchi; Jin Iwasawa; Hirotaka Yada; Akio Kawamura

doi:10.1016/j.jaccao.2022.10.007

Longitudinal Strain and Troponin I Elevation in Patients Undergoing Immune Checkpoint Inhibitor Therapy

JACC CardioOncol. 2022 Dec 20;4(5):673-685. doi: 10.1016/j.jaccao.2022.10.007. eCollection 2022 Dec.

Authors

Yudai Tamura^{1

2}, Yuichi Tamura^{2

3}, Ryo Takemura⁴, Kenta Yamada¹, Hirohisa Taniguchi¹, Jin Iwasawa¹, Hirotaka Yada¹, Akio Kawamura²

Affiliations

¹ Cardiovascular Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
² Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan.
³ Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
⁴ Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan.

Abstract

Background: Immune checkpoint inhibitors (ICIs) are a central part of cancer therapy; however, cardiac complications, such as myocarditis, have the potential for significant morbidity and mortality. Within this population, the clinical significance of longitudinal strain (LS) remains unknown.

Objectives: This study sought to define the changes in LS in ICI-treated patients, and their associations with high-sensitivity troponin I (hsTnI) and myocarditis.

Methods: We conducted a retrospective cohort study of patients who received ICIs at our hospital from April 2017 to September 2021. All patients underwent echocardiography and blood sampling at standardized time intervals. We 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 (IQR: 62-365) days; 6 and 18 patients had myocarditis and hsTnI elevation, respectively. In an 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 hsTnI elevation. Relative reductions in LS were not significantly associated with myocarditis; however, 4 of the 6 patients with myocarditis had relative reduction of ≥10% in the basal LS.

Conclusions: An early worsening in the global and regional LS was associated with increased hsTnI in patients receiving ICIs. Assessment of LS early after ICI administration should be further studied as a strategy for risk stratification of ICI-treated patients.

Keywords: GLS, global longitudinal strain; ICI, immune checkpoint inhibitor; LS, longitudinal strain; MRI, magnetic resonance imaging; TnI, troponin I; cardiac troponin; echocardiography; hsTnI, high-sensitivity troponin I; immune checkpoint inhibitors; longitudinal strain; myocarditis.