Background: Carfilzomib (CFZ) is a proteasome inhibitor with known cardiotoxic effects used in multiple myeloma (MM) treatment. Cardio-oncology guidelines recommend cardiovascular risk assessment via echocardiography. Left atrial strain (LAS) is not yet included as a marker of cardiotoxicity, but it is emerging as a potential indicator of cardiac dysfunction. Objective: This study evaluates LAS as a predictor of CFZ-related hypertensive cardiovascular adverse events (CVAEs) in MM patients, with or without prior hypertension. Methods: A total of 125 MM patients treated with CFZ at the Hypertension Center, “Città della Salute e della Scienza” in Turin, were enrolled. Baseline assessments included transthoracic echocardiography for LAS analysis via Philips QLAB software. Results: During CFZ therapy, 52% of patients experienced hypertensive events. LAS conduit was significantly impaired in those who experienced CVAEs (−16.20 [−20.75; −12.65] vs. −20.80 [−26.30; −15.40],p= 0.006) and LAS conduit > −22 acted as a predictor of hypertensive adverse events in the normotensive population (OR 2.37 [1.02; 5.50]). Conclusion: These findings indicate that alterations in LAS conduit are linked to an increased risk of hypertensive adverse events during CFZ treatment. Incorporating LAS measurement into cardiovascular risk assessments may improve personalized risk stratification for MM patients, especially those without pre-existing hypertension.
背景：卡非佐米（CFZ）是一种用于多发性骨髓瘤（MM）治疗的蛋白酶体抑制剂，已知具有心脏毒性作用。心脏肿瘤学指南建议通过超声心动图进行心血管风险评估。左心房应变（LAS）尚未被纳入心脏毒性标志物，但正逐渐成为心脏功能障碍的潜在指标。目的：本研究评估LAS作为预测MM患者（无论既往有无高血压病史）发生CFZ相关高血压性心血管不良事件（CVAEs）的指标。方法：共纳入125名在都灵“健康与科学城”高血压中心接受CFZ治疗的MM患者。基线评估包括经胸超声心动图，并通过Philips QLAB软件进行LAS分析。结果：在CFZ治疗期间，52%的患者出现高血压事件。发生CVAEs的患者LAS传导功能显著受损（−16.20 [−20.75; −12.65] vs. −20.80 [−26.30; −15.40]，p=0.006），且LAS传导值>−22可作为血压正常人群发生高血压不良事件的预测因子（OR 2.37 [1.02; 5.50]）。结论：这些发现表明，LAS传导功能改变与CFZ治疗期间高血压不良事件风险增加相关。将LAS测量纳入心血管风险评估，可能改善MM患者的个性化风险分层，尤其对于无既往高血压病史的患者。
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