The value of speckle tracking echocardiography in early identification of subclinical cardiac involvement in patients with multiple myeloma: a pilot retrospective study.

INTRODUCTION: Multiple myeloma (MM) is frequently associated with cardiac involvement, particularly myocardial amyloidosis. Current gold-standard diagnostic modalities include cardiac MRI, and endomyocardial biopsy. Speckle-tracking echocardiography (STE) enables detection of subclinical left ventricular dysfunction prior to overt structural or functional deterioration. This pilot retrospective study explored the association between GLS and clinically defined cardiac involvement in MM patients, in the absence of gold-standard confirmation.

METHODOLOGY: We conducted a retrospective analysis of 20 consecutive MM patients, stratified into two groups: cardiac involvement (CI; n = 5) and non-cardiac involvement (Non-CI; n = 15). CI was defined using surrogate clinical criteria, documented heart failure and elevated NT-proBNP (age-specific) or unexplained interventricular septal thickness >12 mm. GLS was compared between groups, and the exploratory diagnostic performance of GLS was assessed using ROC analysis. A sensitivity analysis excluded patients who did not strictly meet the objective criteria.

RESULTS: Absolute GLS was significantly lower in the cardiac involvement group (median 9.6% vs. 16.9%, p = 0.007). GLS showed a promising area under the ROC curve of 0.980 (95% CI: 0.92-1.00) for identifying clinical cardiac involvement, with an optimal cut-off of -16% (sensitivity 100%, specificity 53.3%). All findings are preliminary due to the small sample size and lack of gold-standard confirmation.

CONCLUSION: In this study, STE-derived GLS demonstrated promising diagnostic performance for identifying cardiac involvement in MM patients. However, given the small sample size, these findings should be considered hypothesis-generating. External validation in large, prospective, multi-center cohorts is required before any clinical implementation.