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

Marc K. Halushka, George Eng, A. Bernard Collins, Daniel P. Judge, Marc J. Semigran, James R. Stone

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)264-268
Number of pages5
JournalJournal of Cardiovascular Translational Research
Volume8
Issue number4
DOIs
StatePublished - Jun 20 2015

Keywords

  • Amyloid
  • Classification
  • Diagnostic test
  • Immunoglobulin light chain
  • Transthyretin

ASJC Scopus subject areas

  • Molecular Medicine
  • Genetics
  • Pharmaceutical Science
  • Cardiology and Cardiovascular Medicine
  • Genetics(clinical)

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