Delayed enhancement on cardiac MRI in a patient with multiple myeloma without amyloidosis

Abstract

We report the first observation of diffuse subendocardial and myocardial delayed enhancement on cardiac MRI in a 50-year-old patient with recurrent multiple myeloma but without evidence of amyloidosis. She presented with advanced heart failure and severe restrictive cardiomyopathy. Myocardial biopsy revealed endomyocardial fibrosis. The case was associated with development of multiple arterial and venous thromboses and a fatal course. Because of the fatal outcome, the prognostic significance of delayed enhancement on MRI in multiple myeloma patients may need to be further investigated.

Inversion time prolongation at late enhancement cardiac magnetic resonance in a myeloma patient

“…An increased TI has also been used to examine patients with amyloidosis. We are aware that cardiomyopathy in myeloma patients is usually attributed to amyloid deposition in the heart muscle, but in subjects with amyloidosis, the TI prolongation does not make myocardial suppression possible because LE is diffusely present, and myocardium is hyperintense (11). The cardiac muscle in our patient did not follow the typical cardiac MRI pattern of amyloidosis; in fact, with the TI increase, good myocardial suppression was obtained and no LE was detectable.…”

“…This proposed speculation shares similarities, and a few differences, with the findings of the fatal case of a patient with multiple myeloma and biopsy-proven absence of heart amyloidosis (11). Brahmbhatt et al (11) found that subendocardial and myocardial LE was well evident in the patient, and was probably due to fibrosis. However, fibrosis was present even before any chemotherapy course, thus it was not caused by myeloma therapy.…”

Atrial fibrillation following autologous stem cell transplantation in patients with multiple myeloma: incidence and risk factors

“…The higher incidence of AF despite the absence of light-chain secretion is nevertheless consistent with the finding that the myocardium is affected by multiple myeloma even in the absence of cardiac amyloidosis. For example, delayed enhancement on cardiac magnetic resonance imaging due to endomyocardial fibrosis has been noted in the presence of multiple myeloma without amyloidosis [Brahmbhatt et al . 2008].…”

A Rare Concurrence: Nonischemic Cardiomyopathy and Multiple Myeloma without Amyloidosis

“…2 Diffuse subendocardial and myocardial delayed enhancement was seen on cardiac MRI, as were multiple left and right atrial thrombi. An endomyocardial biopsy showed moderate interstitial fibrosis but no amyloid.…”