ArticlePloS one2021
Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.Reviews in cardiovascular medicine · 2025Pooled it
- Effect of immune checkpoint inhibitor therapy on biventricular mechanics in cancer patients over a short-term follow-up: a systematic review.Frontiers in immunology · 2025Pooled it
- Prospective serial cardiovascular magnetic resonance imaging of immune checkpoint inhibitor myocarditis correlates with cardiovascular outcomes.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2026Article
- The Dyspnea Dilemma: Immune Checkpoint Inhibitor-Associated Myocarditis Mimicking Overlapping Cardiac Pathologies-A Case Report.Case reports in cardiology · 2026Article
- [Cardiac side effects of immunotherapy : Role of imaging in immuno-oncology].Radiologie (Heidelberg, Germany) · 2026Review
- Cardiac Magnetic Resonance Imaging in Immune Checkpoint Inhibitor-Myocarditis: Diagnostic and Prognostic Evidence and Limitations.Current heart failure reports · 2025Review
- Navigating Cardiotoxicity in Immune Checkpoint Inhibitors: From Diagnosis to Long-Term Management.Journal of cardiovascular development and disease · 2025Review
- Chemotherapy-Associated Cardiotoxicity: A Silent Threat Evidenced in a Retrospective Cohort Study.Cureus · 2025Article
- Acute Myocarditis and Inflammatory Cardiomyopathies: Insights From Cardiac Magnetic Resonance Findings.Echocardiography (Mount Kisco, N.Y.) · 2025Review
- Overview of immune checkpoint inhibitor associated myocarditis mechanisms diagnostics and treatment.Frontiers in immunology · 2025Review
- Case Report: Immune checkpoint-inhibitor related myotoxicity monitoring using a comprehensive cardiothoracic MRI approach: insights from a clinical case.Frontiers in cardiovascular medicine · 2025Article
- Prognostic value of cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis: A systematic review and meta-analysis.Cancer innovation · 2024Article
- Usefulness of Longitudinal Strain to Assess Cancer Therapy-Related Cardiac Dysfunction and Immune Checkpoint Inhibitor-Induced Myocarditis.Pharmaceuticals (Basel, Switzerland) · 2023Article
- Assessment of early anthracycline-induced cardiotoxicity using segmental strain of cardiac magnetic resonance compared with global strain and functional parameters: an animal study.Quantitative imaging in medicine and surgery · 2023Article
- Role of Biomarkers in the Management of Immune-Checkpoint Inhibitor-Related Myocarditis.Current cardiology reports · 2023Review
- Impaired left-ventricular global longitudinal strain by feature-tracking cardiac MRI predicts mortality in systemic sclerosis.Rheumatology international · 2023Article
- Evolving field of cardio-oncology.Cancer pathogenesis and therapy · 2023Review
- Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases.Frontiers in cardiovascular medicine · 2023Review
- Global Circumferential and Radial Strain Among Patients With Immune Checkpoint Inhibitor Myocarditis.JACC. Cardiovascular imaging · 2022Article
- 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 · 2022Article
Corrections and comments
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Authors and funding
19 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundImmune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity.
methodsWe identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis.
resultsOf the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of -9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at -12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = -0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = -0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment.
conclusionIn patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.
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