Global longitudinal strain analysis demonstrated a characteristic apical sparing pattern (GLS -9.7%) that deteriorated to -1.9% at 6 months, indicating progressive cardiac amyloidosis.
Case Report (n=1)
Does global longitudinal strain analysis aid in the diagnosis and prognostic tracking of cardiac amyloidosis in patients with multiple myeloma?
Global longitudinal strain is a sensitive diagnostic and prognostic tool for detecting and tracking cardiac amyloidosis in patients with multiple myeloma.
Background: Cardiac amyloidosis represents a challenging diagnosis in patients with multiple myeloma, often presenting as refractory heart failure with subtle early manifestations that can delay appropriate treatment. Case: We report a 55-year-old male with a three-year history of multiple myeloma who presented with progressive dyspnea and bilateral lower limb edema. Despite being normotensive and non-diabetic, he exhibited clinical signs of volume overload with elevated jugular venous pressure and bilateral crepitations. Electrocardiography revealed left ventricular hypertrophy with strain pattern, left axis deviation, and left bundle branch block, raising suspicion for infiltrative cardiomyopathy. Transthoracic echocardiography demonstrated moderate concentric left ventricular hypertrophy with reduced ejection fraction (40%) and severe grade III diastolic dysfunction. Global longitudinal strain analysis revealed markedly reduced GLS at -9.7% with characteristic apical sparing pattern, creating the pathognomonic "cherry-on-top" appearance. Despite optimal heart failure management and continued multiple myeloma treatment, six-month follow-up demonstrated dramatic GLS deterioration to -1.9% , indicating progressive cardiac amyloidosis and poor prognosis. Conclusion: Global longitudinal strain serves as both a sensitive diagnostic tool and powerful prognostic marker in cardiac amyloidosis secondary to multiple myeloma, supporting its integration into routine cardiac surveillance protocols for patients with plasma cell disorders to enable earlier diagnosis and better risk stratification.
Sridevi et al. (Sat,) conducted a case report in Cardiac amyloidosis secondary to multiple myeloma (n=1). Global longitudinal strain (GLS) analysis was evaluated on GLS measurement. Global longitudinal strain analysis demonstrated a characteristic apical sparing pattern (GLS -9.7%) that deteriorated to -1.9% at 6 months, indicating progressive cardiac amyloidosis.