Prognostic Potential of Heart Rate and Hypertension in Multiple Myeloma Patients

Abstract

Background: The prognosis of patients with multiple myeloma (MM) is variable and partly depends on their cardiovascular status. The presence of arrhythmias can lead to worse outcomes. Therefore, this study aimed to evaluate the potential of heart rate (HR) and hypertension in predicating the outcomes of MM patients.Methods: This study retrospectively enrolled patients with MM between January 1, 2010, and December 31, 2018, at the First Affiliated Hospital of Xi'an Jiaotong University. The endpoint was all-cause mortality. The Pearson's chi-square test was used to assess the association between hypertension and outcomes. Univariate and multivariate Cox proportional hazards models were developed to evaluate the relationship between HR and all-cause mortality.Results: A total of 386 patients were included. The mean HR was 83.8 ± 23.1 beats per minute (bpm). Patients with HR >100 bpm had a higher all-cause mortality (79.4%, 50/63) than those with 60 ≤ HR ≤ 100 bpm (39.9%, 110/276) and <60 bpm (19.1%, 9/47) (p < 0.001). Subgroup analysis based on the International Staging System and sex revealed similar relationships (p < 0.01). When stratified by age, patients with HR >100 bpm had higher all-cause mortality than those with a lower HR when age was <65 years or 65–75 years (p < 0.001) but not >75 years. The proportion of patients with hypertension was 54.7% (211/386). However, hypertension was not associated with all-cause mortality in MM patients (χ2=1.729, p > 0.05). MM patients with HR >100 bpm had the highest all-cause mortality.Conclusions: The prognostic potential of HR may be useful in aiding risk stratification and promoting the management of these patients.

Burden of arrhythmias and predictors of mortality among multiple myeloma patients with arrhythmias

“…11 MM has been reported to be associated with incident atrial fibrillation, 33 and patients with MM with atrial fibrillatio were shown to have an increase in all-cause mortality. 20 These findings are similar to what was reported in our study.…”

“…A recent study by Wang et al that showed that patients with MM who had heart rate >100 (though did not specify if they were arrhythmias) reported a higher all-cause mortality in patients who were <75 years old compared with those >75 years. These findings may be because age-related cardiovascular comorbidities attenuated the effect in this age group 20…”

“…These findings may be because age-related cardiovascular comorbidities attenuated the effect in this age group. 20 Age is a known independent risk factor for arrhythmias, 21 22 and in this population of patients, many have underlying cardiovascular diseases. 8 About 63% of patients with newly diagnosed MM were found to have cardiac events prior to diagnosis with arrhythmia being most frequent.…”

From spear to trident: Upgrading arsenal of CAR-T cells in the treatment of multiple myeloma

“…Especially in the last ten years, the survival ability of people under 60 has improved significantly. In addition, current studies seem to support the view that renal function [ 16 ], heart rate and hypertension [ 17 ] are also unneglectable factors when evaluating the survival of MM, which were found to be associated with shorter survival. Nevertheless, by contrast, the most important factor related to prognosis is the cytogenetic abnormal status chiefly assessed by fluorescence in situ hybridization [ [18] , [19] , [20] , [21] ], including but not limited to abnormalities of chromosome 1 (1q gains, 1p losses),t (4, 14) (p16, q32), t(14, 16) (q32, q23), deletion of 17p13 and chromosome 22, which are associated with worse prognosis.…”

Incidence of Arrhythmias and Their Prognostic Value in Patients With Multiple Myeloma

“…Many factors have been reported to contribute to the increased incidence of cardiac arrhythmias in patients with MM, such as older age, comorbid cardiovascular conditions, chemotherapeutic agents, and the treatment of coexisting cardiac disease, cardiac amyloidosis, autologous stem cell transplantation (ASCT), and electrolyte abnormalities (6)(7)(8)(9)(10)(11). In our previous work, the QTc interval and heart rate were independently associated with all-cause mortality in patients with MM (12,13). However, the burden of different arrhythmias and the relation between these arrhythmias and prognostic survival in MM patients remain unclear in real-world studies.…”