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. 2023 Mar 30;12(7):2595.
doi: 10.3390/jcm12072595.

Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma

Zhu Cui  1 , Francesco Castagna  2 , Waqas Hanif  2 , Samuel J Apple  1 , Lili Zhang  2 , James M Tauras  2 , Ira Braunschweig  3 , Gurbakhash Kaur  4 , Murali Janakiram  5 , Yanhua Wang  6 , Yanan Fang  6 , Juan C Diaz  7 , Carolina Hoyos  8 , Jorge Marin  7 , Patricia A Pellikka  9 , Jorge E Romero  8 , Mario J Garcia  2 , Amit K Verma  3 , Nishi Shah  3 , Leandro Slipczuk  2
Affiliations

Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma

Zhu Cui et al. J Clin Med. .

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).

Keywords: ECG; Echo; global longitudinal strain; multiple myeloma; survival.

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Conflict of interest statement

A.V. has received research funding from GlaxoSmithKline, BMS, Jannsen, Incyte, MedPacto, Celgene, Novartis, Curis, Prelude and Eli Lilly and Company, has received compensation as a scientific advisor to Novartis, Stelexis Therapeutics, Acceleron Pharma, Bakx Therapeutics and Celgene, and has equity ownership in Throws Exception and Stelexis Therapeutics. L.S. has received consulting honorarium from Amgen and Regeneron. P.A.P. has received research support from Ultromics. L.Z. has received honorarium from Bristol Myers Squibb. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Patient selection flow diagram. GLS = global longitudinal strain; MM= multiple myeloma; LVEF = left ventricular ejection fraction.
Figure 2
Figure 2
Global longitudinal strain and overall survival. Kaplan–Meier curves showing cumulative risk of all-cause mortality stratified by global longitudinal strain (GLS). Log-rank: p < 0.001.
See this image and copyright information in PMC

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