RT Journal Article
SR Electronic
T1 APCU 06 Multiple myeloma coexistence with cardiac amyloidosis
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP A3
OP A3
DO 10.1136/openhrt-2024-APCU.6
VO 12
IS Suppl 1
A1 Mohd Sabri, Nurul Miftah Binti
A1 Nik Mohd Zaid, Nik Ahmad Hilmi bin
A1 Hussin, Siti Aisyah
A1 Isa MD, W Yus Haniff W
A1 Yusof, Zurkurnai
A1 Abdullah, Abu Dzarr
YR 2025
UL http://openheart.bmj.com/content/12/Suppl_1/A3.1.abstract
AB Introduction AL amyloidosis may develop in patients with multiple myeloma (MM) or may progress from monoclonal gammopathy of undetermined significance (MGUS). Coexistence of MM with cardiac amyloidosis is very rare. We are reporting a case of newly diagnosed of multiple myeloma concomitant with features of cardiac amyloidosis.Case Presentation 56 years old lady who was diagnosed with End Stage Renal Failure on regular dialysis since October 2023. Her laboratory results showed normocytic normochromic anaemia with impaired renal function and hypercalcemia. Her serum paraprotein showed presence of IgD Lambda paraprotein band with concentration of 6g/L at gamma region with raised serum lambda free light chain. The results of bone marrow biopsy specimen was consistent with MM evidenced by presence >10% plasma cells infiltration. Tissue fat biopsy showed positive Congo red stain, consistent with amyloid deposition. Echocardiogram demonstrated concentric left ventricular hypertrophy (LVH) with speckled appearance of the myocardium and apical sparring pattern. Her left ventricular ejection fraction (LVEF) was 62%.Discussion The diagnosis of cardiac amyloidosis is primarily identified through the characteristic global longitudinal strain (GLS) apical sparing pattern, combined with concentric left ventricular hypertrophy. To further differentiate between AL and ATTR amyloidosis, a nuclear scan or cardiac MRI can be utilized. However, in this case, the presence of renal impairment complicates further diagnostic confirmation. The patient's critically ill condition also poses significant challenges for additional workup. The coexistence of both multiple myeloma and cardiac amyloidosis complicates monitoring but offers some advantages. Beyond tracking paraprotein levels, serial echocardiograms can provide valuable insights into the patient's response to treatment. However, these assessments require the expertise of an experienced echocardiographer to ensure accurate classification of treatment response. This is a rare clinical scenario, as documented in limited literature. In this case, treatment options are further constrained by the patient’s dependency on dialysis. Early diagnosis might have significantly altered the clinical course.Conclusion Cardiac amyloidosis can occur alongside multiple myeloma, careful screening is essential to avoid overlooking this possibility. In addition to affecting prognosis, this combination with echocardiography assessment may provide an extra method to monitor the disease.