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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Integrated hs-cTnI, global longitudinal strain, and coronary artery calcium for risk stratification of anthracycline-related cardiac dysfunction in multiple myeloma

  • Xueshan Zhang1
  • Zongliang Yu2
  1. 1Department of Cardiology, Suzhou Medical College of Soochow University
  2. 2Department of Cardiology, The First People’s Hospital of Kunshan
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Abstract

Background: Anthracycline-related cardiac dysfunction remains a major concern in multiple myeloma, yet conventional left ventricular ejection fraction (LVEF) surveillance may miss early injury. We evaluated whether pre-anthracycline baseline measurements of high-sensitivity cardiac troponin I (hs-cTnI), global longitudinal strain (GLS), and coronary artery calcium (CAC), obtained before anthracycline initiation, improve risk stratification for cancer therapy-related cardiac dysfunction (CTRCD).

Methods: In this retrospective study of 312 myeloma patients receiving anthracycline-based therapy, CTRCD was defined as LVEF decline >10% to <53% or relative GLS decline >15%. Predictive performance was assessed using competing-risk models and time-dependent ROC analysis. A simplified risk score (MY-CARD) was derived and temporally validated in a separate cohort.

Results: CTRCD occurred in 91 patients (29.2%). hs-cTnI elevation and GLS worsening preceded LVEF decline, with median intervals of 8.4 and 12.6 weeks. The full model (hs-cTnI + GLS + CAC) achieved an AUC of 0.91, outperforming hs-cTnI + LVEF (0.83) and LVEF alone (0.66). The MY-CARD score stratified 12-month CTRCD risk into low (6.2%), intermediate (28.7%), and high (71.4%) categories. Patients with both hs-cTnI elevation and GLS worsening had the highest subsequent CTRCD risk (adjusted HR 5.42–7.86).

Conclusions: Integrating baseline hs-cTnI, GLS, and CAC improved CTRCD risk stratification in myeloma patients. The MY-CARD score provides a practical framework for baseline and on-treatment risk assessment, supporting closer surveillance in high-risk patients. External validation and prospective studies are warranted.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026integrated,
  title = {{Integrated hs-cTnI, global longitudinal strain, and coronary artery calcium for risk stratification of anthracycline-related cardiac dysfunction in multiple myeloma}},
  author = {Xueshan Zhang and Zongliang Yu},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1830462},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1830462/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Integrated hs-cTnI, global longitudinal strain, and coronary artery calcium for risk stratification of anthracycline-related cardiac dysfunction in multiple myeloma
AU  - Xueshan Zhang
AU  - Zongliang Yu
PY  - 2026
DA  - 2026/10/08
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1830462
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1830462/full
AB  - Background: Anthracycline-related cardiac dysfunction remains a major concern in multiple myeloma, yet conventional left ventricular ejection fraction (LVEF) surveillance may miss early injury. We evaluated whether pre-anthracycline baseline measurements of high-sensitivity cardiac troponin I (hs-cTnI), global longitudinal strain (GLS), and coronary artery calcium (CAC), obtained before anthracycline initiation, improve risk stratification for cancer therapy-related cardiac dysfunction (CTRCD).  Methods: In this retrospective study of 312 myeloma patients receiving anthracycline-based therapy, CTRCD was defined as LVEF decline >10% to <53% or relative GLS decline >15%. Predictive performance was assessed using competing-risk models and time-dependent ROC analysis. A simplified risk score (MY-CARD) was derived and temporally validated in a separate cohort.  Results: CTRCD occurred in 91 patients (29.2%). hs-cTnI elevation and GLS worsening preceded LVEF decline, with median intervals of 8.4 and 12.6 weeks. The full model (hs-cTnI + GLS + CAC) achieved an AUC of 0.91, outperforming hs-cTnI + LVEF (0.83) and LVEF alone (0.66). The MY-CARD score stratified 12-month CTRCD risk into low (6.2%), intermediate (28.7%), and high (71.4%) categories. Patients with both hs-cTnI elevation and GLS worsening had the highest subsequent CTRCD risk (adjusted HR 5.42–7.86).  Conclusions: Integrating baseline hs-cTnI, GLS, and CAC improved CTRCD risk stratification in myeloma patients. The MY-CARD score provides a practical framework for baseline and on-treatment risk assessment, supporting closer surveillance in high-risk patients. External validation and prospective studies are warranted.
SN  - 2297-055X
ER  -