Immune Checkpoint Inhibitor Associated Myocarditis: Practical Evaluations-07 IC-OS 17th Feb

Video Transcription

Video Summary

This webinar from the International Cardio-Oncology Society focused on the use of cardiac MRI (CMR) to evaluate immune checkpoint inhibitor (ICI)-associated myocarditis. The speakers reviewed why this issue matters: ICIs are now widely used across many cancer types, combination regimens are increasing, and myocarditis—though uncommon—has a high fatality rate and can present with shock, arrhythmias, or heart block even when ejection fraction is normal.<br /><br />Dr. Tom Neelan presented two cases illustrating the diagnostic challenges. In one, abnormal ECG changes and detectable troponin were initially reassuringly followed by a normal echo and a non-diagnostic MRI, but endomyocardial biopsy confirmed lymphocytic myocarditis. In another, a patient rapidly deteriorated into cardiogenic shock after MRI, and biopsy again confirmed myocarditis; aggressive immunosuppression including corticosteroids and anti-thymocyte globulin was used, with recovery of LV function.<br /><br />The discussion emphasized that troponin is usually elevated, ECG changes can help, and normal LVEF does not exclude myocarditis. MRI findings can vary widely: late gadolinium enhancement may be patchy or absent, especially early or in preserved EF cases. Updated Lake Louise criteria, especially T1/T2 mapping and extracellular volume, improve diagnostic confidence. Strain imaging, including MRI-based global longitudinal strain, may add value, but results can be confounded because ICIs may reduce strain even without frank myocarditis.<br /><br />Dr. Eileen Carney then presented a case of early-onset myocarditis after dual ICI therapy for metastatic melanoma, where MRI supported the diagnosis and guided steroid treatment and follow-up.<br /><br />The panel closed by stressing the need for baseline ECG/troponin/echo when possible, better surveillance strategies, more prospective studies, and careful individualized decisions about re-challenge after myocarditis.

Keywords

cardiac MRI

immune checkpoint inhibitor

ICI-associated myocarditis

troponin

electrocardiogram

late gadolinium enhancement

Lake Louise criteria

T1/T2 mapping

myocarditis diagnosis

corticosteroid treatment