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Haemodynamic Forces: Emerging Markers of Ventricular Remodelling in Multiple Myeloma Cardiovascular Baseline Risk
Anna Colomba1,2, Anna Astarita2, Giulia Mingrone1,2
1Candiolo Cancer Institute, FPO—IRCCS, 10060 Candiolo, TO, Italy.
Insights
Multiple myeloma patients show altered haemodynamic forces (HDFs) regardless of hypertension, indicating potential early myocardial damage. HDFs analysis may aid in managing cardiovascular risk in these patients.
Area of Science:
- Cardiology
- Oncology
- Biomedical Engineering
Background:
- Multiple myeloma (MM) patients have a high prevalence of cardiovascular disease.
- Accurate cardiovascular risk evaluation is crucial for safe MM treatment regimens.
- Haemodynamic forces (HDFs) analysis detects myocardial damage earlier than standard markers.
Purpose of the Study:
- To investigate haemodynamic forces (HDFs) alterations in multiple myeloma (MM) patients.
- To compare HDFs in MM patients with and without hypertension against controls.
- To assess the impact of MM and hypertension on cardiovascular parameters.
Main Methods:
- Transthoracic echocardiography for HDFs analysis and pulse wave velocity (PWV) assessment.
- 173 patients categorized into MM hypertensive (MMHT), MM normotensive (MMNT), control hypertensive (CoHT), and control normotensive (CoNT).
Main Results:
- Hypertensive patients (MMHT, CoHT) exhibited reduced ejection fraction (EF), global longitudinal strain (GLS), and HDFs, with increased ventricular mass (LVMi) and PWV compared to CoNT.
- MMNT patients showed significantly reduced systolic and systolic ejection HDFs versus CoNT, without changes in EF, GLS, LVMi, or PWV.
Conclusions:
- Multiple myeloma induces ventricular remodeling irrespective of hypertensive status.
- HDFs analysis in MM patients can facilitate early detection of myocardial damage, particularly those on cardiotoxic drugs.
Abstract:
Multiple myeloma (MM) affects a population with a high prevalence of cardiovascular (CV) disease. These patients benefit from an accurate CV risk evaluation in order to choose the safest drug regimen. Haemodynamic forces (HDFs) analysis allows for the earlier detection of myocardial damage compared with standard markers; the role played by MM in HDFs alteration, with or without the influence of hypertension, is yet to be studied. Therefore, we aimed to identify differences in HDFs analysis in patients with MM, hypertension or both versus normotensive non-oncologic subjects. A total of 173 patients (MM hypertensive patients, MMHT; MM normotensive patients, MMNT; non-oncologic hypertensive patients, CoHT; and non-oncologic normotensive patients, CoNT) underwent transthoracic echocardiography for HDFs analysis and pulse wave velocity (PWV) assessment. Hypertensive patients (MMHT, CoHT) showed decreased ejection fraction (EF), global longitudinal strain (GLS) and HDFs values compared with CoNT, whereas ventricular mass (LVMi) and PWV increased. MMNT displayed a significant reduction in systolic HDFs (p < 0.006) and systolic ejection HDFs (p < 0.008) compared with CoNT, without significant change in EF, GLS, LVMi or PWV. In conclusion, MM leads to ventricular remodelling regardless of hypertension; HDFs application for MM patients could help detect early myocardial damage, especially in patients receiving cardiotoxic drugs.
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