Significant Reduction in Peak Left Ventricular Global Longitudinal Strain in Multiple Myeloma Patients: A Pilot Random Awareness Analysis

TL;DR

This study found that many multiple myeloma patients have reduced heart function, even when traditional tests show normal results.

Contribution

First study to report objective cardiac function measures in multiple myeloma patients across treatment stages.

Findings

74% of MM patients with normal ejection fraction had abnormal peak global longitudinal strain.

No correlation was found between ejection fraction and peak global longitudinal strain in MM patients.

Three distinct levels of peak global longitudinal strain were identified in MM patients.

Abstract

Background and methods

Multiple myeloma (MM) is a malignancy associated with cardiovascular complications. Though echocardiography plays a crucial role in assessing cardiac function, its use in the follow-up of MM patients is limited. For this descriptive analysis, we report several recommended objective measures of left ventricular (LV) systolic function, peak global longitudinal strain (PGLS), and right ventricular (RV) systolic function in 147 MM patients at various stages of their treatment who were referred to our echocardiography laboratory at the University of Arkansas for Medical Sciences (Little Rock, AR, USA).

Results

Mean age was 61 ± 11 years, (range: 30 to 86 years; 82 males). Mean left ventricular ejection fraction (LVEF) was 60 ± 9%, mitral annular (MA) systolic tissue Doppler velocity was 8 ± 2 cm/s, and LV outflow tract velocity time integral (LVOT VTI) was 21 ± 5 cm. Furthermore, RV systolic function measured by tricuspid annular plane systolic excursion (TAPSE) was 2.3 ± 0.4 cm and tricuspid annular (TA) tissue Doppler (TDI) systolic velocity (s') was 13 ± 3 cm/s. These values were reported with regards to normal published standard values. Finally, we identified three distinctive LV PGLS levels, ranging from -7% to -27%. Given the poor correlation, we identified that a total of 74% or 50% of all MM patients with normal LVEF (>55%) had abnormal LV PGLS. No correlation between LVEF and LV PGLS was seen in our study.

Conclusions

To our knowledge, this is the first study describing these objective measures of cardiac function in MM patients at different stages of treatment. However, additional studies are needed to truly assess asymptomatic changes in cardiac structure during MM treatment.

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