# The Emerging Role of Left Atrial Strain in Cardiovascular Risk Stratification for Multiple Myeloma Patients Undergoing Carfilzomib Therapy

## TL;DR

This study shows that left atrial strain (LAS) can predict heart-related side effects in multiple myeloma patients treated with carfilzomib, even in those without prior hypertension.

## Contribution

The study introduces left atrial strain as a novel predictor of carfilzomib-induced cardiovascular adverse events in multiple myeloma patients.

## Key findings

- Left atrial strain (LAS) was significantly worse in patients who experienced cardiovascular adverse events during carfilzomib therapy.
- LAS conduit > −22 predicted hypertensive events in normotensive patients.
- Integrating LAS into cardiovascular risk assessments may improve personalized management of multiple myeloma patients.

## Abstract

Carfilzomib (CFZ) is a cardiotoxic drug used in multiple myeloma (MM) treatment protocols. Cardio-oncology guidelines suggest cardiovascular risk stratification via echocardiography, not yet including left atrial strain (LAS) assessment. This study explores LAS as a predictor of CFZ-induced hypertensive cardiovascular adverse events (CVAEs) in MM patients, with or without pre-existing hypertension. A cohort of 125 MM patients receiving CFZ was monitored, with 52% experiencing hypertensive events. LAS conduit, measured via Philips QLAB echocardiographic software, was significantly worse in those who experienced CVAEs (−16.20 [−20.75; −12.65] vs. −20.80 [−26.30; −15.40], p = 0.006). Additionally, LAS conduit > −22 predicted hypertensive adverse events in normotensive patients (OR 2.37). These results highlight the association between altered LAS parameters and increased hypertensive risk during CFZ therapy. Integrating LAS into current cardiovascular evaluations could improve risk stratification and allow more personalized management of MM patients, particularly those without pre-existing hypertension.

Background: Carfilzomib (CFZ) is a proteasome inhibitor with known cardiotoxic effects used in multiple myeloma (MM) treatment. Cardio-oncology guidelines recommend cardiovascular risk assessment via echocardiography. Left atrial strain (LAS) is not yet included as a marker of cardiotoxicity, but it is emerging as a potential indicator of cardiac dysfunction. Objective: This study evaluates LAS as a predictor of CFZ-related hypertensive cardiovascular adverse events (CVAEs) in MM patients, with or without prior hypertension. Methods: A total of 125 MM patients treated with CFZ at the Hypertension Center, “Città della Salute e della Scienza” in Turin, were enrolled. Baseline assessments included transthoracic echocardiography for LAS analysis via Philips QLAB software. Results: During CFZ therapy, 52% of patients experienced hypertensive events. LAS conduit was significantly impaired in those who experienced CVAEs (−16.20 [−20.75; −12.65] vs. −20.80 [−26.30; −15.40], p = 0.006) and LAS conduit > −22 acted as a predictor of hypertensive adverse events in the normotensive population (OR 2.37 [1.02; 5.50]). Conclusion: These findings indicate that alterations in LAS conduit are linked to an increased risk of hypertensive adverse events during CFZ treatment. Incorporating LAS measurement into cardiovascular risk assessments may improve personalized risk stratification for MM patients, especially those without pre-existing hypertension.