Echocardiographic Evaluation of Diastolic Dysfunction in Patients with Multiple Myeloma Treated with Melphalan

Abstract

Background: Melphalan, which is used in the treatment of malignancies such as multiple myeloma, leukemia, and ovarian cancer, can induce cardiac complications. The exact mechanism of melphalan-induced cardiotoxicity remains unclear. Objectives: The present work was designed to investigate the effect of melphalan on diastolic function in multiple myeloma patients. Methods: This descriptive cross-sectional investigation was performed on 20 patients with multiple myeloma treated with melphalan at Ayatollah Taleghani Hospital during 2024 - 2025. Patients underwent echocardiography before starting melphalan and 6 months after receiving the drug. Changes in echocardiographic indices, including wall motion abnormalities, left ventricular systolic function, left ventricular diastolic function-related parameters including early diastolic velocity (E wave), late diastolic velocity (A wave), and E wave descent time (DT), and parameters related to tissue Doppler echocardiography (TDI) were evaluated during the 6-month follow-up. Results: According to the results of this study, the parameters Septal e’ velocity, Lateral e’ velocity, E/A, and E decreased significantly 6 months after starting treatment with melphalan. Four patients also developed diastolic dysfunction (DD) based on the criteria. Parameters including LAVi, E/e’, EF, TR velocity, and A did not differ significantly. Conclusions: Accurate evaluation of multiple myeloma patients treated with melphalan, using echocardiography as a noninvasive and accessible method, can be useful in identifying possible early cardiac changes in these patients. Early identification of cardiac changes in favor of diastolic failure can lead to faster intervention and better prognosis in these patients.