Key result
Noninvasive imaging fails to distinguish AL from ATTR amyloidosis in MGUS, requiring endomyocardial biopsy.
Why the study?
The link between monoclonal gammopathy and an increased prevalence of ATTR cardiac amyloidosis confounds whether changes detected on cardiac MRI indicate AL or ATTR cardiac amyloidosis.
Case Report (n=1)
No
In patients with both monoclonal gammopathy of undetermined significance and positive cardiac bone scintigraphy/MRI findings, an endomyocardial biopsy with mass spectrometry is essential to definitively distinguish between AL and ATTR cardiac amyloidosis before initiating therapy.
Patients with monoclonal gammopathy of undetermined significance are followed for years in hematology clinics, and most do not progress to develop defining events of multiple myeloma such as pathologic fractures or a high percentage of plasma cells on a bone marrow biopsy.Newer technologies such as cardiac MRI may lead to the definition of cardiovascular involvement by illness related to monoclonal gammopathy at an earlier time point than previously detected in clinical practice.The link between monoclonal gammopathy and an increased prevalence of transthyretin (ATTR) cardiac amyloidosis also confounds the question of whether changes detected on cardiac MRI indicate AL or ATTR cardiac amyloidosis.Here, a patient with both monoclonal gammopathy, cardiac amyloidosis, and a positive technetium pyrophosphate scan is referred for endomyocardial biopsy to clarify whether he suffers from AL or ATTR cardiac amyloidosis.
No takes yet. Share an insight, caveat, or question.
Copen et al. (2026) conducted a case report in Cardiac amyloidosis in monoclonal gammopathy of undetermined significance (MGUS) (n=1). Multimodality cardiac imaging (echocardiography, cardiac MRI, and Tc-99m hydroxymethylene diphosphonate scan) and referral for endomyocardial biopsy was evaluated on Differentiation between AL and ATTR cardiac amyloidosis. In a 73-year-old man with IgG lambda MGUS (M-spike 0.7 g/dL) and Grade 3 Tc-99m HMDP cardiac uptake, noninvasive imaging could not distinguish AL from ATTR amyloidosis, requiring endomyocardial biopsy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: