ArticleThe American journal of surgical pathology2011
Strong transthyretin immunostaining: potential pitfall in cardiac amyloid typing.
Article in The American journal of surgical pathology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 2 of them syntheses that pooled it.
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Who cites it
38 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Suspicion, screening, and diagnosis of wild-type transthyretin amyloid cardiomyopathy: a systematic literature review.ESC heart failure · 2022Pooled it
- Transthyretin amyloid cardiomyopathy in women: frequency, characteristics, and diagnostic challenges.Heart failure reviews · 2021Pooled it
- Quantitative enrichment of amyloid precursors refines mass spectrometry-based amyloidosis diagnosis.Clinical proteomics · 2026Article
- Endomyocardial Biopsy Revisited: Diagnostic Value and Expanding Roles in Cardiac Amyloidosis.Current heart failure reports · 2026Review
- Negative [99mTc]Tc -DPD Scintigraphy, Presence of Monoclonal Protein and Biopsy Suggestive of AL Amyloidosis in a Patient With Homozygous p.Ala101Val Transthyretin Gene Variant.Clinical case reports · 2026Article
- Navigating Diagnostic Ambiguities in Cardiac Amyloidosis: Insights from a Case with Delayed Diagnosis of AL Amyloidosis.The American journal of case reports · 2025Article
- The Challenge in Subtyping Cardiac Amyloidosis with Immunohistochemistry Staining: A Case Report.Acta Cardiologica Sinica · 2025Article
- Article
- Pilot Study on the Use of Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy for Diagnosing and Characterizing Cardiac Amyloidosis.International journal of molecular sciences · 2024Article
- Machine Learning Approaches in Diagnosis, Prognosis and Treatment Selection of Cardiac Amyloidosis.International journal of molecular sciences · 2023Review
- Diagnosis and Treatment of AL Amyloidosis.Drugs · 2023Review
- Mass spectrometry-based proteomics in clinical practice amyloid typing: state-of-the-art from a French nationwide cohort.Haematologica · 2022Article
- Amyloidosis: What does pathology offer? The evolving field of tissue biopsy.Frontiers in cardiovascular medicine · 2022Review
- Proteoforms and their expanding role in laboratory medicine.Practical laboratory medicine · 2022Review
- Classification of Amyloidosis by Model-Assisted Mass Spectrometry-Based Proteomics.International journal of molecular sciences · 2021Article
- Amyloid Deposits and Fibrosis on Left Ventricular Endomyocardial Biopsy Correlate With Extracellular Volume in Cardiac Amyloidosis.Journal of the American Heart Association · 2021Article
- Practical recommendations for the diagnosis and management of transthyretin cardiac amyloidosis.Heart failure reviews · 2021Review
- Assessment of cardiac amyloidosis withEJNMMI physics · 2021Article
- Diagnosing cardiac amyloidosis in every-day practice: A practical guide for the cardiologist.International journal of cardiology. Heart & vasculature · 2020Review
- ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2019Article
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Abstract
Although systemic amyloidosis commonly presents with renal disease, cardiac involvement usually determines the patient's prognosis. Cardiac involvement is seen in light chain amyloid and transthyretin amyloidosis. Distinguishing between these two is critical because prognosis and treatment differ. Our study demonstrates the unreliability of transthyretin immunostaining in subtyping cardiac amyloid. Between January 2003 and August 2010, we retrieved 229 native endomyocardial biopsies, of which 24 had amyloid. Immunohistochemistry for κ, λ, transthyretin, and serum amyloid A protein was performed on formalin-fixed, paraffin-embedded sections. Staining was graded as weak (trace to 1+) or strong (2 to 3+). Mass spectrometry (MS)-based proteomic typing of microdissected amyloid material was performed on selected cases. Fifteen patients had monoclonal gammopathy/plasma cell dyscrasia with cardiac amyloid. Eight of them (53%) showed strong transthyretin staining in the cardiac amyloid deposits. MS was performed in 5 of these 8 biopsies, and all 5 biopsies revealed light chain amyloid-type amyloid. Two of these 5 light chain amyloid biopsies did not even have concomitant strong staining for the appropriate light chain. Among the 15 cases with plasma cell dyscrasia, only 7 biopsies showed strong staining for the corresponding monoclonal light chain. Strong, false-positive immunostaining for transthyretin in cardiac amyloid is a potential pitfall, augmented by the frequent lack of staining for immunoglobulin light chains. Therefore, the presence of amyloid in the cardiac biopsy should prompt a search for plasma cell dyscrasia irrespective of transthyretin staining. Confirmation with MS should be sought, particularly if there is any discrepancy between κ/λ staining and serum immunofixation results.
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