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Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma
Zhu Cui1, Francesco Castagna2, Waqas Hanif2
1Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Abstract:
Patients with multiple myeloma (MM) are at a high risk for developing cardiovascular complications. Global longitudinal strain (GLS) can detect early functional impairment before structural abnormalities develop. It remains unknown if reduced GLS is associated with reduced survival in patients with MM. We conducted a retrospective cohort analysis of patients diagnosed with MM between 1 January 2000 and 31 December 2017 at our institution. Patients with a 2D transthoracic echocardiogram completed within 1 year of MM diagnosis, left ventricular ejection fraction (LVEF) greater than 40%, and no history of myocardial infarction prior to MM diagnosis were included. GLS was measured using an artificial-intelligence-powered software (EchoGo Core), with reduced GLS defined as an absolute value of <18%. The primary outcome of interest was overall survival since myeloma diagnosis. Our cohort included 242 patients with a median follow up of 4.28 years. Fifty-two (21.5%) patients had reduced average GLS. Patients with reduced GLS were more likely to have an IVSd ≥ 1.2cm, E/E' > 9.6, LVEF/GLS > 4.1, higher LV mass index, and low-voltage ECG. A Total of 126 (52.1%) deaths occurred during follow-up. Overall survival was lower among patients with reduced GLS (adjusted HR: 1.81, CI: 1.07-3.05).
Insights
Reduced global longitudinal strain (GLS) in multiple myeloma (MM) patients indicates a higher risk of cardiovascular complications and lower overall survival. This finding highlights GLS as a potential prognostic marker for MM patients.
Area of Science:
- Cardiology
- Oncology
- Medical Imaging
Background:
- Multiple myeloma (MM) patients face significant cardiovascular risks.
- Global longitudinal strain (GLS) detects early cardiac dysfunction.
- The prognostic value of GLS in MM is not well-established.
Purpose of the Study:
- To investigate the association between reduced GLS and overall survival in MM patients.
- To identify cardiac functional impairment using GLS in MM.
- To establish GLS as a prognostic biomarker in MM.
Main Methods:
- Retrospective cohort analysis of 242 MM patients diagnosed between 2000-2017.
- Echocardiograms within 1 year of diagnosis; LVEF > 40%; no prior myocardial infarction.
- GLS measured by AI software; reduced GLS defined as <18% absolute value.
Main Results:
- Reduced GLS (<18%) observed in 21.5% of patients.
- Patients with reduced GLS showed higher rates of specific echocardiographic and ECG abnormalities.
- Overall survival was significantly lower in patients with reduced GLS (adjusted HR: 1.81).
Conclusions:
- Reduced GLS is associated with poorer overall survival in multiple myeloma patients.
- GLS is a valuable prognostic indicator for cardiovascular risk and survival in MM.
- Early detection of cardiac dysfunction via GLS may inform patient management.
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