title: Association between left ventricular function and paraprotein type in patients with multiple myeloma.
abstract: OBJECTIVE
  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-κ/-λ) 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-λ (log-λ) 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-λ 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-λ 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.
authors.affiliation: Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea.|Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jeong-Eun
authors.initials: JE
authors.lastname: Yi
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung-Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hae-Ok
authors.initials: HO
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Min
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009194:Myeloma Proteins / Q000378:metabolism*; D012189:Retrospective Studies; D016277:Ventricular Function, Left
chemical_list: D009194:Myeloma Proteins; C085016:multiple myeloma M-proteins
keywords: Multiple myeloma; Serum monoclonal paraprotein; Ventricular function, left