The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Association between left ventricular function and paraprotein type in patients with multiple myeloma

  • Yi, Jeong-Eun (Department of Internal Medicine, Ewha Womans University Mokdong Hospital) ;
  • Lee, Sung-Eun (Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Jung, Hae-Ok (Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Min, Chang-Ki (Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Youn, Ho-Joong (Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2015.11.01
  • Accepted : 2015.11.18
  • Published : 2017.05.01
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Abstract

Background/Aims: Multiple myeloma (MM)-associated cardiac damage, particularly according to the type of monoclonal (M) protein has not been elucidated. We sought to investigate relationship between elevated serum M protein levels and echocardiographic indices of cardiac structure and function in patients with MM. Methods: We evaluated a total of 184 consecutive MM patients who underwent echocardiography for bone marrow pre-transplant screening. Serum levels of intact immunoglobulin M protein and free light chain kappa/lambda ($FLC-{\kappa}/-{\lambda}$) were measured. Results: One hundred thirty-nine patients were non-light chain MM (non-LCMM) and 45 patients belonged to LCMM. In patients with non-LCMM, significant correlations were found between serum M protein and left atrial volume index (LAVi; r = 0.720, p < 0.0001), E/e' (r = 0.511, p < 0.0001), and systolic pulmonary arterial pressure (r = 0.485, p < 0.0001). In patients with LCMM, log-transformed $FLC-{\lambda}$ (${\log}-{\lambda}$) was correlated with left ventricular ejection fraction (LVEF, r = -0.536, p = 0.010), left ventricular (LV) end-systolic dimension (r = 0.500, p = 0.018), and LV end-systolic volume (r = 0.444, p = 0.038). On multivariate analyses, hematocrit and serum M protein were independent predictors of LAVi in patients with non-LCMM. In patient with LCMM, $FLC-{\lambda}$ isotype was only found to be an independent determinant of LVEF. Conclusions: An increase in serum M protein was associated with LV diastolic dysfunction, whereas an increase in serum $FLC-{\lambda}$ concentration showed a negative correlation with the echocardiographic parameters of LV systolic function. These findings also suggest that serum M protein has different effects on LV function according to the type of paraproteins in patients with MM.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

References

  1. Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med 2004;351:1860-1873. https://doi.org/10.1056/NEJMra041875
  2. Rajkumar SV, Gertz MA, Kyle RA. Primary systemic amyloidosis with delayed progression to multiple myeloma. Cancer 1998;82:1501-1505. https://doi.org/10.1002/(SICI)1097-0142(19980415)82:8<1501::AID-CNCR11>3.0.CO;2-8
  3. Cueto-Garcia L, Reeder GS, Kyle RA, et al. Echocardiographic findings in systemic amyloidosis: spectrum of cardiac involvement and relation to survival. J Am Coll Cardiol 1985;6:737-743. https://doi.org/10.1016/S0735-1097(85)80475-7
  4. International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003;121:749-757. https://doi.org/10.1046/j.1365-2141.2003.04355.x
  5. Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009;23:215-224. https://doi.org/10.1038/leu.2008.307
  6. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-1463. https://doi.org/10.1016/j.echo.2005.10.005
  7. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-133. https://doi.org/10.1016/j.echo.2008.11.023
  8. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713. https://doi.org/10.1016/j.echo.2010.05.010
  9. Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 2003;97:2869-2879. https://doi.org/10.1002/cncr.11407
  10. Russell JA, Powles RL. The relationship between serum viscosity, hypervolaemia and clinical manifestations associated with circulating paraprotein. Br J Haematol 1978;39:163-175. https://doi.org/10.1111/j.1365-2141.1978.tb01086.x
  11. Mehta J, Singhal S. Hyperviscosity syndrome in plasma cell dyscrasias. Semin Thromb Hemost 2003;29:467-471. https://doi.org/10.1055/s-2003-44554
  12. Abhayaratna WP, Seward JB, Appleton CP, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 2006;47:2357-2363. https://doi.org/10.1016/j.jacc.2006.02.048
  13. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788-1794. https://doi.org/10.1161/01.CIR.102.15.1788
  14. Firstenberg MS, Levine BD, Garcia MJ, et al. Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers. J Am Coll Cardiol 2000;36:1664-1669. https://doi.org/10.1016/S0735-1097(00)00909-8
  15. Somer T. Rheology of paraproteinaemias and the plasma hyperviscosity syndrome. Baillieres Clin Haematol 1987;1:695-723. https://doi.org/10.1016/S0950-3536(87)80021-5
  16. Carr ME Jr, Zekert SL. Abnormal clot retraction, altered fibrin structure, and normal platelet function in multiple myeloma. Am J Physiol 1994;266(3 Pt 2):H1195-H1201.
  17. Morsdorf S, Jung F, Seyfert UT, Mrowietz C, Pindur G, Wenzel E. Haemostatical and rheological aspects of dysfibrinogenemia. Clin Hemorheol Microcirc 1997;17:13-19.
  18. Baskurt OK, Yalcin O, Meiselman HJ. Hemorheology and vascular control mechanisms. Clin Hemorheol Microcirc 2004;30:169-178.
  19. Baskurt OK, Meiselman HJ. Blood rheology and hemodynamics. Semin Thromb Hemost 2003;29:435-450. https://doi.org/10.1055/s-2003-44551
  20. Liao R, Jain M, Teller P, et al. Infusion of light chains from patients with cardiac amyloidosis causes diastolic dysfunction in isolated mouse hearts. Circulation 2001;104:1594-1597. https://doi.org/10.1161/circ.104.14.1594
  21. Jimenez-Zepeda VH. Light chain deposition disease: novel biological insights and treatment advances. Int J Lab Hematol 2012;34:347-355. https://doi.org/10.1111/j.1751-553X.2012.01419.x
  22. Schattner A, Epstein M, Berrebi A, Caspi A. Case report: multiple myeloma presenting as a diastolic heart failure with no evidence of amyloidosis. Am J Med Sci 1995;310:256-257.
  23. Garton MJ, Walton S, Ewen SW. Systemic lambda lightchain deposition presenting with predominant cardiac involvement. Postgrad Med J 1993;69:588-591. https://doi.org/10.1136/pgmj.69.813.588
  24. Shustik C, Bergsagel DE, Pruzanski W. Kappa and lambda light chain disease: survival rates and clinical manifestations. Blood 1976;48:41-51.
  25. Ozsan GH, Dispenzieri A. Serum free light chain analysis in multiple myeloma and plasma cell dyscrasias. Expert Rev Clin Immunol 2011;7:65-73. https://doi.org/10.1586/eci.10.80
  26. Wan SH, Vogel MW, Chen HH. Pre-clinical diastolic dysfunction. J Am Coll Cardiol 2014;63:407-416. https://doi.org/10.1016/j.jacc.2013.10.063

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