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

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.