Cardiovascular Magnetic Resonance Assessment of Immunotherapy Cardiotoxicity

Abstract

Purpose of Review To review the current and future role of cardiovascular magnetic resonance (CMR) assessment of immunotherapy cardiotoxicity. Recent Findings In patients who suffer from immune checkpoint inhibitor (ICI) myocarditis, pathologic CMR findings, including myocardial edema, reduced left ventricular ejection fraction (LVEF), late gadolinium enhancement (i.e., fibrosis and/or necrosis), and myocardial strain, are mostly subtle, but fulminant courses have been described. Individual cases of cardiotoxicity in chimeric antigen receptor (CAR) T cell therapy have also already been documented, but there are currently no studies addressing the role of CMR in CAR T cell therapy. There are also classes of immunotherapies for which no cases of cardiotoxicity are known yet, such as cytokines or adjuvants. Summary Together with patient symptoms, laboratory markers, electrocardiogram, and echocardiography, CMR is of high value in the diagnostic workup of immunotherapy-associated myocarditis in hemodynamically stable patients, according to recent guidelines. Additionally, quantitative strain analysis and T1 relaxation times with CMR can aid in assessing disease severity, prognosis, and patient outcomes with ICI-associated myocarditis. Future CMR studies on cardiotoxicity in CAR T cell therapy are needed.