title: Echocardiography-Defined Pulmonary Hypertension in Multiple Myeloma: Risk Factors and Impact on Outcomes.
abstract: Survival of patients with multiple myeloma (MM) has improved as a result of therapeutic advances. There is evidence that some patients with MM develop pulmonary hypertension (PH). The objective of this study was to identify risk factors of echocardiographic PH and its impact on outcomes of patients with MM.
  
  
  
  We conducted a retrospective study of patients with MM (N = 359) diagnosed between 2000 and 2011 within the Geisinger Medical Center. Chart review was conducted on the subgroup of patients who underwent a transthoracic echocardiogram within 2 years of being diagnosed as having MM.
  
  
  
  A total of 34% of patients (N = 123/359) underwent transthoracic echocardiogram and 32% (N = 39/123) had echocardiography-defined PH. PH was significantly associated with older age (70.5 vs 65.3 years; P = 0.019), greater left atrial diameter (4.0 vs 3.7 cm; P = 0.025), and a trend toward decreased renal function. PH was not associated with myeloma-specific features. Fewer patients with PH underwent hematopoietic stem cell transplantation compared with those without PH (10% vs 30%; P = 0.018). There was no significant difference in survival between the PH and non-PH groups (P = 0.2775).
  
  
  
  Echocardiography-defined PH was found in a sizeable minority of our MM cohort. Although the specific etiology of PH can be determined only through a prospective clinical evaluation, including right heart catheterization, our results suggest that PH in patients with MM is secondary to left heart disease and perhaps impaired renal function. Patients with PH were significantly less likely to undergo hematopoietic stem cell transplantation. Future studies should assess the etiology of PH, its impact on treatment decisions, and prognosis of patients with MM.
authors.affiliation: From the Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, the Divison of Hematology and Oncology, University of Texas Health Science Center, San Antonio, and the Center for Health Research and the Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Rahul G
authors.initials: RG
authors.lastname: Sangani
authors.affiliation: From the Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, the Divison of Hematology and Oncology, University of Texas Health Science Center, San Antonio, and the Center for Health Research and the Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Matthew
authors.initials: M
authors.lastname: Butler
authors.affiliation: From the Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, the Divison of Hematology and Oncology, University of Texas Health Science Center, San Antonio, and the Center for Health Research and the Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.affiliation: From the Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, the Divison of Hematology and Oncology, University of Texas Health Science Center, San Antonio, and the Center for Health Research and the Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Berger
authors.affiliation: From the Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, the Divison of Hematology and Oncology, University of Texas Health Science Center, San Antonio, and the Center for Health Research and the Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Stamm
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006325:Heart Atria / Q000000981:diagnostic imaging; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D009101:Multiple Myeloma / Q000150:complications*; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications