Abstract 9923: Global Circumferential Strain and Cardiovascular Events in Patients with Myocarditis Related to Immune Checkpoint Inhibitors
Bibliographic record
Abstract
Introduction: Myocarditis is a rare but highly morbid complication of immune-checkpoint inhibitors (ICI) use. Improved methods for detection and risk stratification are needed. Cytotoxic chemotherapy associates with reduced global circumferential strain (GCS) but no data is available on the utility of GCS in ICI myocarditis. Hypothesis: We hypothesized that GCS by echocardiography would be reduced in ICI myocarditis and the magnitude of reduction would have prognostic implications. Methods: In this retrospective cohort, GCS from 75 patients with ICI myocarditis (cases) and 49 ICI treated patients without myocarditis (controls) was compared. Pre-ICI GCS values were available for 10 cases and 39 controls. Measurements were performed by a reader blinded to group and time (TomTec, Germany). Major adverse cardiac event was defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death. Results: Cases and controls had similar age (66±15 vs. 63±12 years; p=0.19), sex (male: 55% vs. 66%; p=0.22) and cancer type (p=0.08). Pre-ICI GCS values were lower in cases (n=10) than in controls (n=39) (-21.7±2.0 vs. -23.5±2.9, p=0.04), but within normal range. Overall, 56% (n=42) of cases had left ventricular ejection fraction (LVEF) >50% at presentation. The GCS was lower in cases than in controls (-17.5±4.2 vs. -23.5±3.0, p<0.001) in the entire cohort and in both preserved (-19.7±3.8 vs. -23.6±3.0, p<0.001) and reduced EF (-14.6±2.7 vs. -20.9±2.3, p<0.001) strata. Over a median follow-up of 30 days, 28 events occurred. An absolute GCS value < the median (17.1%) was associated with an increased rate of events (HR: 4.9, 95% CI: 1.6-15.0, p=0.005, Figure), adjusted for age and LVEF. The association was also noted when GCS is treated as continuous (HR: 1.18, 95% CI: 1.03-1.35, p=0.02). Conclusions: Global circumferential strain is lower in patients with ICI-myocarditis and the magnitude of the reduction in GCS has prognostic significance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".