JACC免疫检查点抑制剂心肌炎中的CMR

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CMRParametricMappinginImmuneCheckpointInhibitorMyocarditis:NovelNoninvasiveToolsinaLethalCondition?JACCEditorialCommentEarlyRecent,Mar30,./j.jacc..01.本文由“天纳”临床学术信息人工智能系统自动翻译点击文末“阅读原文”下载本文PDFCorrespondingAuthorIntroductionNovelimmunotherapieshavebeenanexcitingdevelopmentinthetreatmentofvariouscancersoverthelastdecade.Immunecheckpointinhibitor(ICI)therapiesareaformofimmunotherapythatinactivatetheinhibitoryimmunereceptorsandligandsexpressedbymanycancers.TheresultingT-cell–mediatedimmuneresponseshaveledtomajorgainsinbothprogression-freeandoverallsurvivalinseveraltypesofcancer().Unfortunately,ICIshavealsobeenassociatedwithvariouscardiovascularsideeffects,includingmyocarditis().在过去的十年中，新的免疫疗法在各种癌症的治疗中取得了令人兴奋的进展。免疫检查点抑制剂（ICI）治疗是一种免疫治疗方法，它能使许多癌症表达的抑制性免疫受体和配体失活。由此产生的T细胞介导的免疫反应已经导致了一些类型癌症的无进展生存率和总生存率的显著提高（1）。不幸的是，ICIs也与各种心血管副作用有关，包括心肌炎（1-4）。ICImyocarditishasbeenwelldescribedandfortunatelyisrare;however,whenpresent,itcanbeassociatedwithmajoradversecardiovascularevents(MACE)().ICImyocarditishasbeenreportedtohaveafatalityrateupwardof40%().Therefore,itwarrantsclosemonitoringinat-riskpatientsandpromptinvestigationifsuspected.ThediagnosisofICImyocarditiscanbechallengingandhasfocusedonmethodstraditionallyusedfordiagnosingmyocarditis,includinghistoryandphysicalexamination,laboratoryassaysformyocardialinjury,cardiacimaging,andendomyocardialbiopsy().Thelastoftheseisinvasiveandhaslimitedspatialcoverageinapotentiallylocalizedcondition,whichmakesnoninvasivecardiacimagingthepreferreddiagnosticmethod.ICI心肌炎已经被很好的描述，幸运的是它是罕见的；然而，当它出现时，它可能与主要的心血管不良事件（MACE）有关（1-4）。据报道，ICI心肌炎的病死率高达40%（4）。因此，有必要对高危患者进行密切监测，如有可疑，应及时调查。ICI心肌炎的诊断具有挑战性，主要集中在传统上用于诊断心肌炎的方法上，包括病史和体检、心肌损伤的实验室分析、心脏成像和心肌内膜活检（1-4）。最后一种是有创性的，在可能的局部情况下空间覆盖有限，这使得无创性心脏成像成为首选的诊断方法。Cardiacmagneticresonance(CMR)hasemergedasapromisingtechniqueforidentifyingICImyocarditisinat-riskpatientsgivenitsrobustabilitytocharacterizemyocardialtissueas

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