A 2D-STI echocardiographic diagnostic model established for cardiac amyloidosis complicated with multiple myeloma

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.