Echocardiographic Two-dimensional Speckle Tracking Strain Technique For Risk Stratification And Prognosis Of Patients With Immune Checkpoint Inhibitor-related Myocarditi

Objective:To evaluate the myocardial strain characteristics in patients with myocarditis related with immune checkpoint inhibitors(ICIs)by using two-dimensional speckle tracking echocardiography,and to monitor myocardial injury in patients with ICIs-related myocarditis in the early stage,as well as predict risk stratification and prognosis.Methods:This study enrolled 30 patients with ICIs-related myocarditis in Peking Union Medical College Hospital from May 2020 to September 2022.Baseline echocardiography images were collected and analyzed.The last follow-up time was March 2023.Patients were divided into grade Ⅰ-Ⅲ group and grade Ⅳ group according to the disease severity.Basic echocardiographic parameters and echocardiographic strains were compared between 14 patients with grade Ⅰ-Ⅲ myocarditis and 16 patients with grade Ⅳ myocarditis.We used EchoPAC software to analyze the global radial strain(GRS),global longitudinal strain(GLS),GLS of endocardial layers(endoGLS),GLS of epicardial layers(epiGLS),global circumferential strain(GCS),GCS of endocardial and epicardial layers(endoGCS and epiGCS),as well as 18-segment strains of left ventricular GLS,and left atrial strain parameters,and left atrial stiffness index(LASI).Major adverse cardiovascular events(MACEs)were defined as a composite of cardiogenic shock,cardiac arrest,complete heart block,and cardiac death.Results:Patients in the two groups were comparable in sex,age,and cancer type.The value of GRS(12.3%±4.7%vs.23.7%±14.0%,P=0.015),|GLS|(10.6%±3.1%vs.14.0%±3.3%,P=0.014),|GCS|(13.2%±5.6%vs.17.8%±5.0%,P=0.042),epi|GLS|(9.3%±2.7%vs.12.4%±2.8%,P=0.009),as well as several segments strains of left ventricular GLS in grade Ⅳ group were significantly impaired compared to grade Ⅰ-Ⅲgroup.Similarly,the absolute value of peak left atrial longitudinal strain(P=0.003)and left atrial systolic strain(P=0.001)in grade Ⅰ-Ⅲ group were significantly lower than those in grade Ⅰ-Ⅲ group.In receiver-operating characteristic(ROC)curves,LVEF and GRS,|GLS|,epi|GLS|,basal postal/inferolateral |GLS|,basal anteroseptal|GLS|,basal inferior|GLS|,mid inferior|GLS|,mid anterior|GLS|,peak left atrial longitudinal strain,left atrial systolic strain,left atrial stiffness index showed better performance in predicting the grade IV ICIs-related myocarditis.In terms of survival analysis,patients with GRS<13.7%(Wilcoxon P=0.006),basal inferior|GLS|<14.5%(Wilcoxon P<0.001),and the absolute value of left atrial systolic strain<10.5%(Wilcoxon P=0.006)had short survival period.Conclusion:Patients with grade IV ICIs-related myocarditis have significantly decreased GRS,|GLS|,|GCS|,epi|GLS|,and several segments strains of left ventricular GLS,these parameters can be used to evaluate the severity of ICIs-related myocarditis.Patients with lower GRS,basal inferior|GLS|(basInf|GLS|),and left atrial systolic strain(|s-CT|)have short survival period.