Abstract:

Objective

To preliminarily investigate the diagnostic value of echocardiography in multiple myeloma （MM） combined with cardiac amyloidosis （CA） by analyzing echocardiographic parameters retrospectively， in order to provide a clinical basis for early diagnosis of MM combined with CA.

Methods

A total of 93 patients who were diagnosed with MM from January 2015 to June 2024 at Nanjing Drum Tower Hospital and had complete echocardiographic data were selected， including 61 cases with MM alone （control group） and 32 cases with MM combined with CA （case group）. Routine echocardiographic parameters and echocardiographic strain parameters were compared between the two groups. Echocardiographic parameters of MM combined with CA were assessed using univariate Logistic regression analysis， and the correlation between serum brain natriuretic peptide （BNP） and echocardiographic parameters in the case group was evaluated using Pearson's analysis.

Results

Compared with the control group， the echocardiographic parameters left atrial diameter （LAD）， left ventricular wall thickness， relative ventricular wall thickness （RWT），E/e'， apical sparing ratio （ASR）， septal apical-septal basal ratio （SAB）， and left ventricular ejection fractionto-strain ratio （EFSR） were significantly higher in the case group， and the left ventricular ejection fraction（LVEF） and left ventricular global longitudinal strain （GLS） were significantly lower in the case group （P＜0.05 for all）.Univariate Logistic regression analysis showed that LAD， left ventricular wall thickness， RWT， E/e'，LVEF， GLS， ASR， SAB， and EFSR were factors significantly associated with CA in MM （P＜0.05 for all）.Receiver operating characteristic （ROC） curve analysis showed that the area under the ROC curve values of RWT， LVEF， GLS， ASR SAB， and EFSR parameters for predicting MM combined with CA were 0.754，0.709， 0.824， 0.724， 0.66， and 0.821， respectively （P＜0.05）， their specificity ranged from 82.0% to 95.1%，and their sensitivity ranged from 50.0% to 68.8%， with the predictive efficacy of GLS and EFSR being better than that of other parameters. Compared with the control group， serum BNP level was significantly higher in the case group （P=0.007）. There were two cases of electrocardiograms suggesting low voltage in limb leads and/or poor R-wave increment in leads V₁～V₃ in the control group， and 15 cases in the case group， with a statistically significant difference between the two groups （P＜0.001）. Correlation analysis showed that LVEF was negatively correlated with serum BNP in the case group （P＜0.001）， and the strain parameters GLS， ASR， SAB， and EFSR were positively correlated with serum BNP （r = 0.666， 0.633， 0.396， and 0.609，respectively； P＜0.05 for all）.

Conclusion

Echocardiography can be used to assess the degree of cardiac function impairment in MM combined with CA and has appreciated diagnostic value in predicting this condition， especially the strain parameters GLS and EFSR， which can improve the early diagnostic efficacy of MM combined with CA and provide a more reliable basis for clinical diagnosis and treatment.

Key words: Multiple myeloma, Cardiac amyloidosis, Echocardiography