Haematologica 2003 - Supplements

vivo detected resonances was investigated in further detail in the
extracts spectra.
Conclusions. These preliminary data suggest that several
myeloma cell metabolites identified ex vivo in the 1H NMR
spectra (i.e. taurine and choline containing compounds), are
potentially detectable in vivo and thus could be good candidate
markers of MM bone marrow involvement at diagnosis and
follow-up.
Study supported by grant 01/1108 from Fondo de Investigaciones
Sanitarias (FIS).
193
Left Ventricular Diastolic Dysfunction Predicts
Myocardial Strain in Cardiac Amyloidosis
John A. Sallach, Allan L. Klein, Zoran Popovic, Jing-Ping
Sun, Li Zang, Mohamad A. Hussein and Gordan Srkalovic
Cleveland Clinic Foundation, Department of Cardiology and
Multiple Myeloma Research Program
Background: While the degree of left ventricular diastolic
dysfunction has been correlated with severity of cardiac
amyloidosis, myocardial strain remains relatively unstudied. The
purpose of this study was to determine the relationship between
left ventricle diastolic dysfunction and myocardial strain in
cardiac amyloidosis.
Methods: Eight patients with a diagnosis of cardiac amyloidosis
underwent complete echocardiographic study. We used tissue
Doppler imaging (TDI) to obtain longitudinal myocardial strain
and myocardial strain rate. Patients were classified according to
stage of diastolic dysfunction. Baseline clinical characteristics
and echocardiographic findings were compared between these
two groups.
Results: Three patients were classified as stage I (abnormal
relaxation) and five were classified as stage III (restrictive) LV
diastolic dysfunction. There were no significant differences in
baseline characteristics between these groups. Echocardiographic
findings for both groups are demonstrated in Table 1. There was
a trend for decreasing myocardial strain as LV diastolic
dysfunction worsened.
Conclusions: As LV diastolic dysfunction worsens, longitudinal
myocardial strain progressively decreases, which may imply
decreased long-axis function in amyloidosis. Further larger
studies are needed to confirm these findings.
Table 1.
Stage I LV
diastolic
dysfunction
(n=3)
Stage III LV
diastolic
dysfunction
(n=5)
P
value
Age (years) 68 ± 5 66 ± 10 0.774
LVEF (%) 55 ± 0 48 ± 16 0.492
Mitral Inflow 262 ± 63 146 ± 10 0.005
Decceleration time
Avg Septal Strain 15.4 ± 4.3 7.3 ± 1.6 0.073
(%)
Avg Lateral Strain
(%)
9.8 ± 3.0 4.0 ± 2.4 0.053
194
BONE DENSITOMETRY IN PATIENTS WITH MULTIPLE
MYELOMA
Vytrasova M., Scudla V., *Nekula J., Horak P., Bacovsky J.
IIIrd Internal Department, University Hospital Olomouc, Czech
Republic*Department of Radiology, University Hospital Olomouc,
Czech Republic
Multiple myeloma (MM) is malignant disease characterised by
skeletal involvement. Osteolytic lesions and osteoporosis are the
major couse of morbidity in MM. Bone densitometry (DEXA)
seems to be a useful method for monitoring of metabolic bone
disease, predicting fracture risk and for assessment the efficacy of
treatment on bone status.
Aims: to assess the bone involvement in patients with new
diagnosed multiple myeloma using DEXA, to assess the impact
of degenerative changes and compressive fractures of vertebral
bodies in lumbar spine BMD, to compare BMD before and after
treatement.
Methods: Analysed group consisted of 106 patients with newly
diagnosed MM. The male-to-female ratio was 51:55, the mean
age was 59 years in men and 64 years in women. In the clinical
stage I by Durie-Salmon were 25 patients, in the stage II were 38
and in III were 43 patients. BMD, T-score and Z-score of lumbar
spine and whole body was measured by the LUNAR DPX-L
scanner.
Results: Osteoporosis of lumbar spine (T-score below -2.5 SD)
was presented in 25% patients, osteopenia in 29% and normal
BMD in 46% patients. Bone mineral density expressed as Z-score
was wery low in lumbar spine, the mean value of Z-score was -1
SD (range -5.2 to +2.6 SD) and also in other trabecular bones
(ribs, pelvis and the whole spine), but Z-score of cortical bones
(lower and upper extremities) was statistically significantly
higher (mean value +0.3 SD). Patients in clinical stage I had
better bone mineralization than patients in stage II and III, in
lumbar spine and trunk; but, density of arms and legs was
significantly higher in clinical stage III. In lumbar spine, BMD
was significantly higher in patients with large number of
degenerative changes. In contrast, severity of vertebral
bodies´compressive fractures had not impact to measured BMD.
In long-term follow-up the bone density of lumbar spine
increased in patients treated by bisphosphonates and responding
to chemotherapy, did not changed in patients not responding to
therapy (or responding, but without bisphosphonates), and
decreased in relapsing patients without bisphoshonates.
Summary: DEXA seems to be a sensitive technique for
monitoring myeloma bone disease. Lumbar spine is the most
often site of bone loss in MM, while long cotrical bones are
involved not so often. In patients with clinical stage III is bone
mineral density lower in lumbar spine and trunk, but higher in
arms and legs. Osteophytes of vertebral bodies has an important
impact to BMD, but compressed vertebral bodies did not
increased bone density. Bone densitometry is also a useful way
how to asses the efficacy of chemoterapeutic and anti-resorptive
treatment.
195
Prognostic significance of Technetium –99m-MIBI
scintigraphy in multiple myeloma.
Bacovsky J., Scudla V., Myslivecek M., Nekula J.,
Vytrasova M., Budikova M.
University Hospital Olomouc , Czech Republic
Objectives: The aim of this study were to evaluate the role of
99mTc-MIBI scintigraphy in the detection of myeloma lesions.
S174