Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

Background: The complex process of cardiac magnetic resonance (CMR) and the uncertainty of each parameter in the diagnosis and prognosis of cardiotoxicity limit its promotion in the cardiac evaluation of patients treated with immune checkpoint inhibitors (ICI)....

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Main Authors: Jialian Li, Yanwei Li, Li Tao, Chuan Zhang, Zhong Zuo
Format: Article
Language:English
Published: IMR Press 2025-02-01
Series:Reviews in Cardiovascular Medicine
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Online Access:https://www.imrpress.com/journal/RCM/26/2/10.31083/RCM25508
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author Jialian Li
Yanwei Li
Li Tao
Chuan Zhang
Zhong Zuo
author_facet Jialian Li
Yanwei Li
Li Tao
Chuan Zhang
Zhong Zuo
author_sort Jialian Li
collection DOAJ
description Background: The complex process of cardiac magnetic resonance (CMR) and the uncertainty of each parameter in the diagnosis and prognosis of cardiotoxicity limit its promotion in the cardiac evaluation of patients treated with immune checkpoint inhibitors (ICI). Methods: A comprehensive search was conducted across PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Cochrane databases for relevant articles published up until September 28, 2024. Results: After screening, 8 articles were included in this study. The analysis revealed that following ICI treatment, the left ventricular global longitudinal strain (GLS) increased significantly [weighted mean difference (WMD) 2.33; 95% confidence interval (CI) 1.26, 3.41; p < 0.01], while the global radial strain (GRS) decreased [WMD –4.73; 95% CI –6.74, –2.71; p < 0.01]. Additionally, T1 and T2 values increased [standardized mean difference (SMD) 1.14; 95% CI 0.59, 1.68; p < 0.01] and [SMD 1.11; 95% CI 0.64, 1.58; p < 0.01], respectively. An elevated T2 was associated with a higher occurrence of major adverse cardiovascular events (MACE), with a hazard ratio of 1.36 (95% CI 1.12, 1.64). Conclusions: Our findings demonstrate that T1, T2, and GLS increase, while GRS decreases following ICI administration. By consolidating these critical metrics, we propose a streamlined, abbreviated (non-contrast) CMR protocol that can be completed within 15 minutes, thereby facilitating the integration of CMR in cardio-oncology. The PROSPERO registration: CRD42023437238, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437238.
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issn 1530-6550
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publishDate 2025-02-01
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series Reviews in Cardiovascular Medicine
spelling doaj-art-a5d7dbef461844e79c6f96b9bf1eac192025-08-20T02:55:06ZengIMR PressReviews in Cardiovascular Medicine1530-65502025-02-012622550810.31083/RCM25508S1530-6550(24)01671-5Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-AnalysisJialian Li0Yanwei Li1Li Tao2Chuan Zhang3Zhong Zuo4Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, ChinaBackground: The complex process of cardiac magnetic resonance (CMR) and the uncertainty of each parameter in the diagnosis and prognosis of cardiotoxicity limit its promotion in the cardiac evaluation of patients treated with immune checkpoint inhibitors (ICI). Methods: A comprehensive search was conducted across PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Cochrane databases for relevant articles published up until September 28, 2024. Results: After screening, 8 articles were included in this study. The analysis revealed that following ICI treatment, the left ventricular global longitudinal strain (GLS) increased significantly [weighted mean difference (WMD) 2.33; 95% confidence interval (CI) 1.26, 3.41; p < 0.01], while the global radial strain (GRS) decreased [WMD –4.73; 95% CI –6.74, –2.71; p < 0.01]. Additionally, T1 and T2 values increased [standardized mean difference (SMD) 1.14; 95% CI 0.59, 1.68; p < 0.01] and [SMD 1.11; 95% CI 0.64, 1.58; p < 0.01], respectively. An elevated T2 was associated with a higher occurrence of major adverse cardiovascular events (MACE), with a hazard ratio of 1.36 (95% CI 1.12, 1.64). Conclusions: Our findings demonstrate that T1, T2, and GLS increase, while GRS decreases following ICI administration. By consolidating these critical metrics, we propose a streamlined, abbreviated (non-contrast) CMR protocol that can be completed within 15 minutes, thereby facilitating the integration of CMR in cardio-oncology. The PROSPERO registration: CRD42023437238, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437238.https://www.imrpress.com/journal/RCM/26/2/10.31083/RCM25508cardiac magnetic resonanceimmune checkpoint inhibitorscardiotoxicityglobal longitudinal strainglobal radial straint1t2
spellingShingle Jialian Li
Yanwei Li
Li Tao
Chuan Zhang
Zhong Zuo
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
cardiac magnetic resonance
immune checkpoint inhibitors
cardiotoxicity
global longitudinal strain
global radial strain
t1
t2
title Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis
title_full Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis
title_fullStr Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis
title_full_unstemmed Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis
title_short Diagnostic and Prognostic Value of Cardiac Magnetic Resonance for Cardiotoxicity Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis
title_sort diagnostic and prognostic value of cardiac magnetic resonance for cardiotoxicity caused by immune checkpoint inhibitors a systematic review and meta analysis
topic cardiac magnetic resonance
immune checkpoint inhibitors
cardiotoxicity
global longitudinal strain
global radial strain
t1
t2
url https://www.imrpress.com/journal/RCM/26/2/10.31083/RCM25508
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