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Published on: November 27, 2013
Echocardiography-Defined Pulmonary Hypertension in Multiple Myeloma: Risk Factors and Impact on Outcomes
Rahul G Sangani1, Matthew Butler1, H Lester Kirchner1
1From the Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, the Divison of Hematology and Oncology, University of Texas Health Science Center, San Antonio, and the Center for Health Research and the Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania.
Objectives:
Survival of patients with multiple myeloma (MM) has improved as a result of therapeutic advances. There is evidence that some patients with MM develop pulmonary hypertension (PH). The objective of this study was to identify risk factors of echocardiographic PH and its impact on outcomes of patients with MM.
Methods:
We conducted a retrospective study of patients with MM (N = 359) diagnosed between 2000 and 2011 within the Geisinger Medical Center. Chart review was conducted on the subgroup of patients who underwent a transthoracic echocardiogram within 2 years of being diagnosed as having MM.
Results:
A total of 34% of patients (N = 123/359) underwent transthoracic echocardiogram and 32% (N = 39/123) had echocardiography-defined PH. PH was significantly associated with older age (70.5 vs 65.3 years; P = 0.019), greater left atrial diameter (4.0 vs 3.7 cm; P = 0.025), and a trend toward decreased renal function. PH was not associated with myeloma-specific features. Fewer patients with PH underwent hematopoietic stem cell transplantation compared with those without PH (10% vs 30%; P = 0.018). There was no significant difference in survival between the PH and non-PH groups (P = 0.2775).
Conclusions:
Echocardiography-defined PH was found in a sizeable minority of our MM cohort. Although the specific etiology of PH can be determined only through a prospective clinical evaluation, including right heart catheterization, our results suggest that PH in patients with MM is secondary to left heart disease and perhaps impaired renal function. Patients with PH were significantly less likely to undergo hematopoietic stem cell transplantation. Future studies should assess the etiology of PH, its impact on treatment decisions, and prognosis of patients with MM.
Insights
Pulmonary hypertension (PH) affects a significant minority of multiple myeloma (MM) patients, often linked to age and left heart issues, not MM specifics. PH patients were less likely to receive stem cell transplants.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Multiple myeloma (MM) survival has improved due to therapeutic advances.
- Pulmonary hypertension (PH) is an emerging complication in MM patients.
- Understanding PH risk factors and impact in MM is crucial.
Purpose of the Study:
- Identify risk factors for echocardiographic PH in MM patients.
- Determine the impact of PH on MM patient outcomes.
- Investigate associations between PH and MM characteristics.
Main Methods:
- Retrospective study of 359 MM patients diagnosed between 2000-2011.
- Chart review of patients undergoing echocardiography within 2 years of MM diagnosis.
- Analysis of echocardiographic data for PH diagnosis and associated factors.
Main Results:
- 34% of MM patients (123/359) had echocardiograms; 32% (39/123) were diagnosed with PH.
- PH associated with older age (70.5 vs 65.3 years) and larger left atrial diameter (4.0 vs 3.7 cm).
- PH patients were less likely to undergo hematopoietic stem cell transplantation (10% vs 30%).
Conclusions:
- Echocardiography-defined PH is present in a notable minority of MM patients.
- PH in MM may be secondary to left heart disease or renal dysfunction.
- PH significantly impacts treatment choices, reducing stem cell transplantation rates, but survival was not significantly different in this cohort.
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