title: Prevalence and clinical characteristics of a high cardiac output state in patients with multiple myeloma.
abstract: OBJECTIVE
  This study was undertaken to define the prevalence and clinical characteristics of patients with a high cardiac output state associated with multiple myeloma.
  
  
  METHODS
  Specifically, we evaluated clinical, laboratory, and two-dimensional and Doppler echocardiographic data in 36 patients with multiple myeloma. Cardiac output was determined noninvasively by a pulsed Doppler technique.
  
  
  RESULTS
  A high cardiac output state, defined as a cardiac index greater than or equal to 4.0 L/minute/m2, was present in eight of 34 (23.5%) subjects in whom cardiac output was measurable. None of the known causes of high output states could be identified in these patients. Four patients developed high output congestive heart failure, two of whom died. Age, sex, degree of anemia, serum calcium level, immunoglobulin type, or disease stage did not differ significantly between subjects with or without high output states. However, severe bone involvement was significantly more frequent in those patients with high cardiac output states, occurring in all eight patients with high cardiac indexes compared with nine of 26 patients with low or normal cardiac indexes (p = 0.001).
  
  
  CONCLUSIONS
  These data demonstrate that high cardiac output states are relatively common in patients with multiple myeloma and are associated with the presence of extensive bone disease.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
authors.forename: W
authors.initials: W
authors.lastname: McBride
authors.forename: J D
authors.initials: JD
authors.lastname: Jackman
authors.forename: P A
authors.initials: PA
authors.lastname: Grayburn
mesh_terms: D001842:Bone and Bones / Q000473:pathology; D002302:Cardiac Output; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D011446:Prospective Studies
chemical_list: D007136:Immunoglobulins