Cui Zhu, Castagna Francesco, Hanif Waqas, Apple Samuel J, Zhang Lili, Tauras James M, Braunschweig Ira, Kaur Gurbakhash, Janakiram Murali, Wang Yanhua, Fang Yanan, Diaz Juan C, Hoyos Carolina, Marin Jorge, Pellikka Patricia A, Romero Jorge E, Garcia Mario J, Verma Amit K, Shah Nishi, Slipczuk Leandro
Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Clin Med. 2023 Mar 30;12(7):2595. doi: 10.3390/jcm12072595.
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).
多发性骨髓瘤（MM）患者发生心血管并发症的风险很高。整体纵向应变（GLS）可在结构异常出现之前检测到早期功能损害。MM患者中GLS降低是否与生存率降低相关尚不清楚。我们对2000年1月1日至2017年12月31日在我院诊断为MM的患者进行了一项回顾性队列分析。纳入在MM诊断后1年内完成二维经胸超声心动图检查、左心室射血分数（LVEF）大于40%且在MM诊断前无心肌梗死病史的患者。使用人工智能软件（EchoGo Core）测量GLS，GLS降低定义为绝对值<18%。感兴趣的主要结局是自骨髓瘤诊断以来的总生存期。我们的队列包括242例患者，中位随访时间为4.28年。52例（21.5%）患者的平均GLS降低。GLS降低的患者更有可能出现室间隔舒张末期厚度（IVSd）≥1.2cm、E/E' > 9.6、LVEF/GLS > 4.1、左心室质量指数较高以及心电图低电压。随访期间共发生126例（52.1%）死亡。GLS降低的患者总生存期较低（校正风险比：1.81，可信区间：1.07 - 3.05）。
