Structural-geometric and functional indicators of the heart in patients with multiple myeloma after anti-tumor treatment and COVID-19

Abstract

Multiple myeloma is a severe hematologic malignancy characterized by aggressive progression. Over the last decade, the introduction of novel targeted therapies has significantly improved treatment outcomes. Despite these advancements, cardiovascular complications following antitumor therapy continue to pose a significant challenge, adversely affecting patient life expectancy.

The aim of the study was to assess the predictive role of regional myocardial contractile function indicators in identifying the risk of cardiovascular events in patients with multiple myeloma.

Materials and methods. The study included 107 patients who achieved regression of multiple myeloma after completing a course of antitumor therapy and did not experience disease progression during the entire observation period. All stages of the study were conducted in compliance with strict compliance with clinical trial regulations. The study participants were categorized into distinct groups based on whether they experienced cardiovascular complications during the follow-up period. To assess biomarkers, blood plasma samples were analyzed using the enzyme-linked immunosorbent assay (ELISA) method, which allowed for the quantification of circulating substances.

Results. A total of 65 cardiovascular complications were recorded among 29 patients, representing 27.1 % of the studied population. The spectrum of complications comprised 4 cardiovascular-related deaths, 15 arrhythmia episodes requiring treatment, and 8 ischemic events. Other notable incidents included 2 strokes, 4 cases of pulmonary embolism, and 2 instances of deep vein thrombosis. Moreover, 11 patients exhibited decompensation of pre-existing chronic heart disease, and 19 were hospitalized for cardiovascular pathologies.

The values of the parameter e’ were significantly lower than in the control group in patients with multiple myeloma by 17.6 % (p < 0.05), especially in the subgroup of patients with a history of symptomatic COVID-19, where the decrease was 23.5 % (p < 0.05). The lowest values of the E and E/A indices were observed in patients with a history of symptomatic COVID-19 compared to those who did not have this disease. Circular systolic myocardial strain was significantly lower in the multiple myeloma group compared to the control group by 38.1 % (p < 0.001), including the subgroup of patients with symptomatic COVID-19, where the reduction was 42.6 % (p < 0.001), and the subgroup without a previous infection, where the reduction was 38.5 % (p < 0.001).

Using univariate analysis, it was found that the highest relative risk of cardiovascular events was associated with: symptomatic COVID-19 (HR = 1.880; 95 % CI = 1.291–2.745, p = 0.009), chemotherapy with anthracyclines (HR = 1.493; 95 % CI = 1.014–2.040, p = 0.041), reduced longitudinal systolic myocardial strain (HR = 1.354; 95 % CI = 1.139–1.611, p = 0.008), chemotherapy with immunomodulating drugs (HR = 1.210; 95 % CI = 1.009–1.345, p = 0.048), and reduced circular systolic myocardial strain (HR = 1.171; 95 % CI = 1.056–1.297, p = 0.028). During multivariate analysis, the prognostic significance was preserved only for some factors: prior symptomatic COVID-19 (HR = 1.079; 95 % CI = 1.041–1.780, p = 0.025) and reduced longitudinal systolic myocardial strain (HR = 1.078; 95 % CI = 1.021–1.184, p = 0.032).

Conclusions. A decrease in circular and longitudinal systolic myocardial strain has prognostic value for the occurrence of cardiovascular complications in multiple myeloma treatment within 12 months after anticancer treatment. The prognostic significance of these indicators did not depend on the presence of cardiac infection in the anamnesis.