Author + information
- Ian Chang,
- Angela Dispenzieri,
- Grace Lin,
- Barry Karon,
- Allan Jaffe,
- Kyle Klarich and
- Martha Grogan
Background: Light-chain amyloidosis (AL) is thought to be a rare disease with a prevalence of 8-10 per million patient years. Cardiac involvement is an important prognostic factor. The serum free light chain assay (FLC) is inexpensive and recommended as an initial diagnostic test when AL is suspected. We applied this assay as a routine screening test to determine the potential incidence of AL in patients with undifferentiated heart failure.
Methods: We studied consecutive new patients referred to the heart failure clinic who had a routine FLC assay within 7 days of the initial visit at Mayo Clinic, Rochester from January 2011 to December 2015. A FLC ratio between 0.26 and 1.65 was considered normal. Patients diagnosed with amyloidosis were identified using our dysproteinemia database.
Results: Of the 1220 patients in the study (Figure 1), 218 patients had an abnormal FLC ratio (median [IQR]: 1.93 [1.74-2.29]) and 1002 had a normal ratio (1.07 [0.89-1.29]). AL was diagnosed in 1.0% (6/1220) of all patients, and in 2.8% (6/218) with an abnormal ratio. Transthyretin amyloidosis (TTR) was diagnosed in 2 patients with an abnormal ratio (0.9%, 2/218) and 18 with a normal ratio (1.8%, 18/1002).
Conclusions: The use of routine FLC screening in patients with heart failure enriched the diagnosis of AL by 3 orders of magnitude from the prevalence in the general population. Additional research is needed to determine the subset of patients with undifferentiated heart failure who might benefit most from this approach.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in HCM, PPCM and Other Cardiomyopathies
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1201-267
- 2017 American College of Cardiology Foundation