A call to action: improving access to cardiac MRI for diagnosis of immune checkpoint inhibitor related myocarditis in low and middle income countries

Immune checkpoint inhibitor (ICI) therapy is a rapidly expanding pillar of cancer treatment, but it carries the risk of immune-related adverse events. Among the most fatal is ICI-related myocarditis (ICIRM). Cardiac magnetic resonance (CMR) imaging is the non-invasive current gold standard for diagnosis, with significant disparities regarding availability and utilisation. The vast majority of ICIRM cases are reported in high-income countries (HICs), reflecting not only patterns of ICI use, but also a profound diagnostic gap in low- and middle-income countries (LMICs). LMICs face barriers to CMR access, including a stark deficit of MRI scanners, with approximately 1 scanner per million people in LMICs versus 26 per million people in HICs, prohibitive costs, and a critical shortage of trained radiologists and cardiologists. The inequity means that as ICI therapy becomes increasingly accessible worldwide, patients in resource-limited settings will be at a high-risk of undiagnosed and untreated ICIRM. Our paper issues a call to address this critical healthcare disparity. To improve CMR access for ICIRM diagnosis in LMICs, a multi-pronged strategy is imperative - Governmental support and policy change to prioritise infrastructure investment and integrate CMR into national health strategies; targeted educational programmes, such as the SWiM and 'train the trainer' initiatives, to build local expertise in CMR acquisition and interpretation; adoption of technological innovations, including cost-effective rapid CMR protocols and artificial intelligence (AI) tools that can reduce scan times.

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Publication Details

Journal
Cardio-Oncology
Published
2025-10-30
DOI
https://doi.org/10.1186/s40959-025-00393-8
Citations
1
Primary Topic
Cardiac Imaging and Diagnostics
Type
article
Field-Weighted Citation Impact
1.36
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article

A call to action: improving access to cardiac MRI for diagnosis of immune checkpoint inhibitor related myocarditis in low and middle income countries

Sebastian Szmit, Arjun K. Ghosh, Mark Westwood, Sola Adeleke et al.
1 citations
Cardio-Oncology
Cardiac Imaging and Diagnostics
1.36
article

A call to action: improving access to cardiac MRI for diagnosis of immune checkpoint inhibitor related myocarditis in low and middle income countries

Sebastian Szmit, Arjun K. Ghosh, Mark Westwood, Sola Adeleke, Tejinder Singh, Andrés J. Daniele, Ariane Vieira Scarlatelli Macedo, Susan Dent, Charlotte Manisty, Akash Maniam, Stephen Casselli, Aruni Ghose, Bonnie Ky, Suvro Banerjee, Abhinav Kandala, Daniel J. Lenihan, Daniel Sierra-Lara Martinez, Vanita Noronha, Carl Simela, Maryam Hasanova, Isha Sabnis
article en
1 citations

Abstract

Immune checkpoint inhibitor (ICI) therapy is a rapidly expanding pillar of cancer treatment, but it carries the risk of immune-related adverse events. Among the most fatal is ICI-related myocarditis (ICIRM). Cardiac magnetic resonance (CMR) imaging is the non-invasive current gold standard for diagnosis, with significant disparities regarding availability and utilisation. The vast majority of ICIRM cases are reported in high-income countries (HICs), reflecting not only patterns of ICI use, but also a profound diagnostic gap in low- and middle-income countries (LMICs). LMICs face barriers to CMR access, including a stark deficit of MRI scanners, with approximately 1 scanner per million people in LMICs versus 26 per million people in HICs, prohibitive costs, and a critical shortage of trained radiologists and cardiologists. The inequity means that as ICI therapy becomes increasingly accessible worldwide, patients in resource-limited settings will be at a high-risk of undiagnosed and untreated ICIRM. Our paper issues a call to address this critical healthcare disparity. To improve CMR access for ICIRM diagnosis in LMICs, a multi-pronged strategy is imperative - Governmental support and policy change to prioritise infrastructure investment and integrate CMR into national health strategies; targeted educational programmes, such as the SWiM and 'train the trainer' initiatives, to build local expertise in CMR acquisition and interpretation; adoption of technological innovations, including cost-effective rapid CMR protocols and artificial intelligence (AI) tools that can reduce scan times.

Cardio-OncologyVol. 11(1)
St Bartholomew's Hospital (GB), Apollo Hospitals (IN), University College London Hospitals NHS Foundation Trust (GB), King's College London (GB), Homi Bhabha National Institute (IN), Barts Health NHS Trust (GB), Tata Memorial Hospital (IN), Santa Casa Hospital (BR), University of Rochester Medical Center (US), Management College of Southern Africa (ZA), Caribbean Agricultural Research and Development Institute (TT), Ontario Stroke Network (CA), Instituto Nacional de Cardiologia (BR), Saint Francis Medical Center (US), Faculdade de Ciências Médicas da Santa Casa de São Paulo (BR), The Asiatic Society of Mumbai (IN), Vascular Society of Southern Africa (ZA), National Institute of Oncology (HU), Production Management Institute of Southern Africa (ZA), Cancer Research UK Manchester Institute (GB), Apollo Hospitals (IN), Asociación por los Derechos Civiles (AR), Netcare Unitas Hospital (ZA), Instituto de Oncología de Rosario (AR), Apollo Hospitals (IN), NIHR Research Delivery Network (GB), University College London (GB), University of Rochester (US), International Society of Nephrology (BE), University of Pennsylvania (US), University of Sheffield (GB)
Openalex Percentile: Top 14%
Cardiac Imaging and Diagnostics
1.36
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