Optimization of Serum Immunoglobulin Free Light Chain Analysis for Subclassification of Cardiac Amyloidosis

J Cardiovasc Transl Res. 2015 Jun;8(4):264-8. doi: 10.1007/s12265-015-9628-2. Epub 2015 Apr 30.

Abstract

Accurate and rapid classification of cardiac amyloidosis is important for patient management. We have optimized the use of serum free light chain kappa and lambda values to differentiate immunoglobulin light chain amyloid (AL) amyloidosis from transthyretin amyloid and amyloid A using 85 cases of tissue-proven cardiac amyloidosis, in which there was direct classification of amyloidosis by mass spectrometry or immunofluorescence. The serum free light chain kappa/lambda ratios were non-overlapping for the three major groups: AL-lambda (0.01-0.41, n = 30), non-AL (0.52-2.7, n = 43), and AL-kappa (6.7-967, n = 12). A kappa/lambda ratio value between 0.5 and 5.0 had 100 % sensitivity and 100 % specificity for distinguishing AL amyloidosis from non-AL amyloidosis. This optimized range for serum light chain kappa/lambda ratio provides extremely robust classification of cardiac amyloidosis. Cases of cardiac amyloidosis in which the serum kappa/lambda free light chain ratio falls close to these new cutoff values may benefit most from direct amyloid subtyping.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amyloid Neuropathies, Familial / blood
  • Amyloid Neuropathies, Familial / diagnosis
  • Amyloid Neuropathies, Familial / immunology
  • Amyloidosis / blood*
  • Amyloidosis / classification
  • Amyloidosis / diagnosis
  • Amyloidosis / immunology
  • Baltimore
  • Biomarkers / blood
  • Boston
  • Cardiomyopathies / blood*
  • Cardiomyopathies / classification
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / immunology
  • Diagnosis, Differential
  • Female
  • Humans
  • Immunoglobulin kappa-Chains / blood*
  • Immunoglobulin lambda-Chains
  • Male
  • Middle Aged
  • Myocardium / immunology
  • Predictive Value of Tests
  • Serum Amyloid A Protein / analysis

Substances

  • Biomarkers
  • Immunoglobulin kappa-Chains
  • Immunoglobulin lambda-Chains
  • Serum Amyloid A Protein

Supplementary concepts

  • Amyloidosis, Hereditary, Transthyretin-Related