Why the study?
Targeted therapies make prompt recognition and accurate amyloid protein typing indispensable, requiring guidance on indications and techniques for tissue analysis in cardiac amyloidosis.
This consensus document outlines the indications and compares techniques for tissue characterization and amyloid typing in cardiac amyloidosis.
Supports tissue analysis for amyloid typing to guide therapies in cardiac amyloidosis; leaves open standardization and prospective validation.
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by the accumulation of protein fibrils with an abnormal 3D configuration in the myocardium. The introduction of targeted therapies for the two most common forms, light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), has made prompt recognition and accurate typing of the amyloid protein indispensable. Although in some ATTR cases a diagnosis can be reached with noninvasive imaging methods, diagnostic confirmation by peripheral or endomyocardial biopsy remains fundamental for many patients with ATTR and for all those with AL or rarer CA variants. The available typing complementary techniques are immunohistochemistry, immunofluorescence, immune electron microscopy, and mass spectrometry, each with specific strengths and limitations. This review describes the current indications for tissue analysis and compares the options for amyloid typing, with the aim of providing guidance relevant to clinical practice.
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Vergaro et al. (2026) studied this question. Tissue analysis methods like immunohistochemistry and mass spectrometry are essential for accurate amyloid typing in cardiac amyloidosis to guide targeted therapies.
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