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Published on: October 14, 2016
A 2D-STI echocardiographic diagnostic model established for cardiac amyloidosis complicated with multiple myeloma
Hongmiao Shen1, Jiali Fan2, Xingyue Wu1
1Department of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Ave, Gusu District, Suzhou City, 215006 Jiangsu Province, China.
Objective:
This study aimed to investigate the clinical characteristics of multiple myeloma(MM) with amyloidosis(AL) and evaluate the diagnostic utility of two-dimensional speckle tracking imaging(2D-STI) echocardiography in MM with cardiac amyloidosis(CA), with the goal of providing guidance for early screening and differentiation.
Methods:
Among 616 newly diagnosed multiple myeloma (NDMM) patients, 359 met the inclusion and exclusion criteria, and divided into MM-AL and MM without AL according to the histopathological results. MM-AL patients were subdivided into MM-CA and MM without CA subgroups according to cardiac involvement criteria. Baseline characteristics and 2D-STI echocardiographic parameters were comparatively analyzed. Variables potentially predictive of MM-CA were identified through univariate analysis, with accuracy assessed by area under the curve (AUC). Variables were dichotomized using optimal cut-off values to construct a multivariate logistic regression model.
Results:
The initial symptoms of MM-AL were mainly bone pain and anemia, but the incidence of ostealgia was lower (45.7 %) and the prevalence of congestive heart failure (CHF) was higher (12.8 %) compared with MM without AL patients. No significant differences were observed in myocardial injury biomarkers, tumor burden, or t(11,14) translocation. MM-CA patients presented with 40.0 % severe heart failure (HF) NYHA class III-IV at diagnosis and experienced 33.3 % adverse cardiovascular events. An echocardiographic model incorporating left ventricular ejection fraction(LVEF), pulmonary artery systolic pressure(PASP), hydropericardium, and global longitudinal strain (GLS) demonstrated the highest diagnostic accuracy for MM-CA, with an AUC of 0.90 (95 % CI, 0.81-1.00) (sensitivity: 95.6 %, specificity: 80.0 %, accuracy: 90.8 %).
Conclusion:
There was no specific difference between the clinical manifestations and routine examinations of MM with or without AL patients. This study introduces a novel multi-parameter echocardiographic model for MM-CA diagnosis, providing a clinically valuable tool for early screening and differentiation.
