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Reduced global longitudinal strain indicates reduced survival in patients with multiple myeloma.

Patients suffering from multiple myeloma (MM) are at significantly higher risk for developing cardiac pathology due to multiple disease- and treatment-related factors as well as old age. The prognosis for these patients can be improved by earlier detection of cardiac disease. Left ventricular global longitudinal strain (GLS) is an echocardiographic parameter for evaluating myocardial deformation and has been determined to be an early marker of cardiac dysfunction. However, GLS measurement is time-intensive and requires expertise. Measurement of GLS with reproducible results has now been made possible with advancements in artificial intelligence (AI). A recent study published in the Journal of Clinical Medicine utilized AI and demonstrated a positive association between low GLS and decreased survival in MM patients.

Characteristics of the Study Population

A total of 242 patients were followed up for a period of 4.28 years in this retrospective cohort study. Fifty-two patients (21.49%) had GLS of less than 18%. Of these, 40 patients were male.

Echocardiographic and Electrocardiographic Parameters

During the study period, a proportionately larger number of patients (63.46%) with reduced GLS underwent ECHO as compared to those with preserved GLS. Left ventricular ejection fraction (LVEF) and stroke volume were significantly lower, whereas left ventricular mass index was significantly higher in subjects with reduced GLS. Interventricular septum thickness during diastole (IVSd) ≥ 1.2 cm and E/E’ > 9.6 were more prevalent in the reduced GLS group. Nine subjects in this group had an ejection fraction (EF) to strain ratio ≥ 4.1 as compared to zero patients in the preserved GLS group.

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A total of 170 (70.3%) patients had an ECG. Conduction abnormalities were identified in 17.6% of subjects and prolonged QTc in 6.5%. The low GLS group showed a higher prevalence of low-voltage ECG.

 Association With Overall Survival 

One hundred twenty-six deaths were documented over the duration of the study period. Reduced GLS was correlated with a higher risk of mortality after adjusting for co-variables (adjusted Cox regression survival analysis). A median overall survival time of 3.98 years was documented in the reduced GLS group compared to 4.31 years in the preserved GLS group.

Patients With Amyloidosis

Cardiac amyloidosis may be a cause of reduced GLS in this study group. Increased EF to GLS ratio, a characteristic finding in cardiac amyloidosis, was seen in some of these patients. However, biopsy confirmation was not done.

Use of AI for Automated GLS Assessment

A unique feature of this study was the use of AI software for GLS measurement. This technology provides faster analysis with reduced manual labor, thereby transforming this assessment into a routine procedure.


Cui, Z., Castagna, F., Hanif, W., Apple, S. J., Zhang, L., Tauras, J. M., Braunschweig, I., Kaur, G., Janakiram, M., Wang, Y., Fang, Y., Diaz, J. C., Hoyos, C., Marin, J., Pellikka, P. A., Romero, J. E., Garcia, M. J., Verma, A. K., Shah, N., & Slipczuk, L. (2023). Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma. J Clin Med, 12(7). https://doi.org/10.3390/jcm12072595