Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma

Zhu Cui, Francesco Castagna, Waqas Hanif, Samuel J. Apple, Lili Zhang, James M. Tauras, Ira Braunschweig, Gurbakhash Kaur, Murali Janakiram, Yanhua Wang, Yanan Fang, Juan C. Diaz, Carolina Hoyos, Jorge Marin, Patricia A. Pellikka, Jorge E. Romero, Mario J. Garcia, Amit K. Verma, Nishi Shah, Leandro Slipczuk

Research output: Contribution to journalArticlepeer-review


Patients with multiple myeloma (MM) are at a high risk for developing cardiovascular complications. Global longitudinal strain (GLS) can detect early functional impairment before structural abnormalities develop. It remains unknown if reduced GLS is associated with reduced survival in patients with MM. We conducted a retrospective cohort analysis of patients diagnosed with MM between 1 January 2000 and 31 December 2017 at our institution. Patients with a 2D transthoracic echocardiogram completed within 1 year of MM diagnosis, left ventricular ejection fraction (LVEF) greater than 40%, and no history of myocardial infarction prior to MM diagnosis were included. GLS was measured using an artificial-intelligence-powered software (EchoGo Core), with reduced GLS defined as an absolute value of <18%. The primary outcome of interest was overall survival since myeloma diagnosis. Our cohort included 242 patients with a median follow up of 4.28 years. Fifty-two (21.5%) patients had reduced average GLS. Patients with reduced GLS were more likely to have an IVSd ≥ 1.2cm, E/E’ > 9.6, LVEF/GLS > 4.1, higher LV mass index, and low-voltage ECG. A Total of 126 (52.1%) deaths occurred during follow-up. Overall survival was lower among patients with reduced GLS (adjusted HR: 1.81, CI: 1.07–3.05).

Original languageEnglish (US)
Article number2595
JournalJournal of Clinical Medicine
Issue number7
StatePublished - Apr 2023


  • ECG
  • Echo
  • global longitudinal strain
  • multiple myeloma
  • survival

ASJC Scopus subject areas

  • General Medicine


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