Immune Checkpoint Inhibitor Myocarditis With Normal Cardiac Magnetic Resonance Imaging: Importance of Cardiac Biopsy and Early Diagnosis

Immune checkpoint inhibitors (ICIs) have improved the management and the prognosis of patients with cancer but are associated with an increased risk of toxicities that can affect every organ. ICI-associated myocarditis has a low incidence (< 1%) but a high fatality rate (30%-50%). Herein we report a patient treated with ICI admitted for suspicion of myocarditis. Cardiac magnetic resonance imaging (cMRI) was normal. An endomyocardial biopsy (EMB) was in favour of ICI-related myocarditis with cardiac lymphohistiocytic infiltrate. This case highlights the role of a systematic evaluation with electrocardiography and troponin and the potential value of EMB in patients without a suggestive cMRI.

Prevalence and progression of aortic dilatation in adult patients with Turner syndrome: a cohort study

OBJECTIVE

Turner syndrome (TS) is a rare disorder affecting 1/2500 female newborn. Aortic dilatation (AD) and aortic dissection represent a major concern in TS. The aims of our study were to describe the aortic root growth, potential aortic dilatation (AD) risk factors and cardiovascular outcomes in a cohort of patients with TS.

METHODS

Among 204 adult patients included, 197 were studied using a standardized 1.5 Tesla MRI protocol. AD was defined as an aortic diameter ≥20 mm/m2 at the Valsalva sinuses and/or at the ascending aorta, when indexed to body surface area.

RESULTS

At baseline, AD was present in 81/197 (41.1%) and 32/197 (16.2%) of patients, at the levels of Valsalva and ascending aorta, respectively. The aortic Valsalva diameter was larger in patients treated for thyroiditis (P < 0.001). Potential risk factors of AD were aging (P < 0.001) and the presence of bicuspid aortic valve (BAV) (P = 0.002). The hazard ratio (HR) of AD occurrence in the presence of BAV was 2.2 (95% CI: 1.33-3.71). After a median follow-up period of 5.1 years (n = 143), AD was present in 58/143 (40.6%) and 25/143 (17.5%) of patients at the levels of Valsalva and ascending aorta, respectively. The median aortic growth of the Valsalva sinuses remained stable. At the ascending aorta, it increased by 0.14 ± 0.61 mm/year. Only one aortic-related death was observed.

CONCLUSION

AD is common in adult patients with TS. However, our results are rather reassuring, as the median aortic diameters remained stable after 5.1 years and few aortic events were observed.