Cardiovascular involvement in patients affected by multiple myeloma: a comprehensive review of recent advances

Camilli, Massimiliano; Vecchia, Giulia La; Lillo, Rosa E.; Iannaccone, Giulia; Lamendola, Priscilla; Montone, Rocco Antonio; Hohaus, Stefan; Aspromonte, Nadia; Massetti, Massimo; Lanza, Gaetano Antonio; Crea, Filippo; Graziani, Francesca; Lombardo, Antonella

doi:10.1080/17474086.2021.2003704

Cited by 7 publications

(18 citation statements)

References 111 publications

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“…However, little is known about the appropriate management of MM-associated AL CA. Close surveillance and avoidance of treatment-related cardiac toxicity would contribute to delaying the progression of heart failure, leading to improved outcomes among MM patients with concurrent AL CA ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

A Risk Score to Diagnose Cardiac Involvement and Provide Prognosis Information in Patients at Risk of Cardiac Light-Chain Amyloidosis

Zhu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCardiac light-chain amyloidosis (AL CA) portends poor prognosis. Contrast cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging is an important tool in recognizing AL CA. But contraindications to contrast CMR would significantly restrict its clinical application value. Our study aims to construct a convenient risk score to help identify cardiac involvement in patients at risk of AL CA. Moreover, we also investigate whether this risk score could provide prognosis information.Materials and MethodsSixty-three patients at risk of AL CA were retrospectively included in our study. Basic clinical characters, lab results, 12-lead electrocardiogram data, and cardiac magnetic resonance image data were collected. AL CA was diagnosed according to typical CA LGE pattern. Logistic analysis was used to figure out predictive parameters of AL CA and their β coefficients, further constructing the risk score. Receiver operating characteristics (ROC) curve was used to find the cut-off point best distinguishing AL CA+ from AL CA–patients. Bootstrapping was used for internal validation. All patients were divided into high-risk and low-risk group according to the diagnostic cut-off point, and followed up for survival information. Kaplan-Meier plots and log-rank test were performed to analyze if this score had prognostic value.ResultsThe risk score finally consisted of 4 parameters: pericardial effusion (PE) (1 point), low electrocardiographic QRS voltages (LQRSV) (1 point), CMR-derived impaired global radial strain (GRS) (<15.14%) (1 point) and increased left ventricular maximum wall thickness (LVMWT) (>13 mm) (2 points). Total score ranged from 0 to 5 points. A cut-off point of 1.5 showed highest accuracy in diagnosing AL CA with an AUC of 0.961 (95% CI: 0.924–0.997, sensitivity: 90.6%, specificity: 83.9%). Kaplan-Meier plots and log-rank test showed that the high-risk group had significantly poor overall survival rates.ConclusionIn patients at risk of AL CA, a risk score incorporating the presence of PE, LQRSV, and CMR-derived impaired GRS and increased LVMWT is predictive of a diagnosis of AL CA by LGE criteria. This risk score may be helpful especially when contrast CMR is not available or contraindicated, and further studies should be considered to validate this score.

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Section: Discussionmentioning

confidence: 99%

A Risk Score to Diagnose Cardiac Involvement and Provide Prognosis Information in Patients at Risk of Cardiac Light-Chain Amyloidosis

Zhu

et al. 2022

Front. Cardiovasc. Med.

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“…Consistent with these observations, the current evidence reports a close relationship between biochemical or structural injury, altered genesis, homeostasis, and function of the endothelium, and the onset and progression of pathological conditions correlated to inflammation, thrombosis, and atherosclerosis, as well as alterations in the vascular resistance and blood pressure [ 2 , 4 , 9 , 10 , 11 ]. Consequently, endothelial dysfunction is assumed as the axis of activation of all pathophysiological mechanisms and related disease pathways linked to excessive morbidity and mortality, such as hypertension, myocardial infarction, aneurysm, stroke, diabetes, metabolic syndrome, rheumatic diseases, renal failure, neurodegenerative diseases, cancer, and inflammatory diseases [ 2 , 4 , 5 , 8 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] (see Figure 2 ). For instance, tumor neovascularization is characterized by a highly disordered vascular endothelium network and the generation of new blood vessels.…”

Section: Introductionmentioning

confidence: 99%

Promising Strategies for Preserving Adult Endothelium Health and Reversing Its Dysfunction: From Liquid Biopsy to New Omics Technologies and Noninvasive Circulating Biomarkers

Balistreri

2022

IJMS

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The endothelium has multiple functions, ranging from maintaining vascular homeostasis and providing nutrition and oxygen to tissues to evocating inflammation under adverse conditions and determining endothelial barrier disruption, resulting in dysfunction. Endothelial dysfunction represents a common condition associated with the pathogenesis of all diseases of the cardiovascular system, as well as of diseases of all of the other systems of the human body, including sepsis, acute respiratory distress syndrome, and COVID-19 respiratory distress. Such evidence is leading to the identification of potential biomarkers and therapeutic targets for preserving, reverting, or restoring endothelium integrity and functionality by promptly treating its dysfunction. Here, some strategies for achieving these goals are explored, despite the diverse challenges that exist, necessitating significant bench work associated with an increased number of clinical studies.

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“… 13 Cardiac adverse events (CAEs) associated with MM treatment : Cardiotoxicity is referred to as myocardial dysfunction, which may result in heart failure (HF, most frequent) and HTN, accelerated ischemic heart disease (IHD) and arrhythmias. 10 All of these can cause, or precipitate PH. Proteasome is an essential component of cellular homeostasis by degrading majority of regulatory proteins through the ubiquitin‐proteasome system (UPS).…”

Section: Etiology and Pathophysiology Of Ph‐mmmentioning

confidence: 99%

“… 50 Carfilzomib (an irreversible PI) however is strongly associated with the development of HF and PH in both drug trials, and real‐world data from the FDA adverse event reporting system. 10 , 18 , 50 A low incidence of cardiotoxicity has also been documented after Ixazomib probably because of the reversibility of proteasome inhibition with Ixazomib. 10 Immunomodulatory agents are associated with arrhythmias and cardiomyopathy probably to a lesser extent.…”

Section: Etiology and Pathophysiology Of Ph‐mmmentioning

confidence: 99%

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Pulmonary hypertension in patients with multiple myeloma: A comprehensive review

et al. 2023

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Multiple myeloma (MM) is a common hematological malignancy resulting from clonal proliferation of plasma cells and is defined by criteria set forth by the international myeloma working group. Pulmonary hypertension (PH) is defined by an elevated mean pulmonary artery pressure >20 mmHg measured during right heart catheterization. Echocardiography‐diagnosed PH is relatively common in patients with MM and has been associated with increased mortality, morbidity, and poor stem cell transplant outcomes. PH in patients with MM (PH‐MM) is usually multifactorial in origin. MM disease‐specific factors, host comorbidities, and treatment‐related adverse effects are the key factors for the development of PH‐MM. Pragmatically, patients with PH‐MM can be grouped into either (i) PH in patients with a new diagnosis of MM or (ii) PH that develops or worsens along the way of MM treatment. In the latter group, drug‐induced PH, venous thromboembolism, pulmonary veno occlusive disease, and cardiotoxicity should be considered as possible causes. PH‐MM should be evaluated and managed in a multidisciplinary setting. Select individuals with PH‐MM could be considered for pulmonary vasodilators at PH‐specialized centers.

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Cardiovascular involvement in patients affected by multiple myeloma: a comprehensive review of recent advances

Cited by 7 publications

References 111 publications

A Risk Score to Diagnose Cardiac Involvement and Provide Prognosis Information in Patients at Risk of Cardiac Light-Chain Amyloidosis

A Risk Score to Diagnose Cardiac Involvement and Provide Prognosis Information in Patients at Risk of Cardiac Light-Chain Amyloidosis

Promising Strategies for Preserving Adult Endothelium Health and Reversing Its Dysfunction: From Liquid Biopsy to New Omics Technologies and Noninvasive Circulating Biomarkers

Pulmonary hypertension in patients with multiple myeloma: A comprehensive review

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