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Molecular Testing for Cardiac Amyloidosis

Last updated Feb. 10, 2020

Approved by: Krish Tangella MD, MBA, FCAP

Molecular Testing for Cardiac Amyloidosis is helpful in aiding in a diagnosis of the amyloidosis disorder.

What are other Names for this Test? (Equivalent Terms)

  • Gene Mutation Analysis for Cardiac Amyloidosis
  • Test for Molecular Diagnosis of Cardiac Amyloidosis

What is Molecular Testing for Cardiac Amyloidosis? (Background Information)

  • Molecular Testing for Cardiac Amyloidosis is helpful in aiding in a diagnosis of the amyloidosis disorder. The lab test results may also be subsequently useful in taking appropriate treatment decisions
  • Amyloidosis is a group of disorders in which the ‘amyloid protein’ builds up in many organs and tissues of the body. These protein aggregates form abnormally and can build-up locally in a single organ or throughout the body organs
  • When the abnormal amyloid proteins get deposited in the heart tissue, it results in Cardiac Amyloidosis. The condition typically affects older adults. There are 5 major types of amyloidosis, all of which can lead to Cardiac Amyloidosis, including AL amyloidosis, AA amyloidosis, hereditary amyloidosis, wild-type ATTR amyloidosis, and dialysis-related amyloidosis

Molecular Testing for Cardiac Amyloidosis may be required in the following cases:

  • To check if the disease is inherited
  • In order to understand the type of amyloidosis an individual is affected with
  • Or, for discerning the type of amyloid protein causing Cardiac Amyloidosis

A positive or negative test result should always be interpreted in the context of the individual’s overall signs and symptoms.

Molecular testing, in general, can be performed using a variety of methods. Some of these methods include:

  • In situ hybridization techniques, such as fluorescence in situ hybridization (FISH)
  • Immunohistochemistry (IHC)
  • Next-generation sequencing (NGS)
  • Methylation profiling
  • Polymerase chain reaction (PCR)
  • Comparative genomic hybridization (CGH)
  • Karyotyping including spectral karyotyping
  • mRNA analysis
  • Tissue microarrays (TMAs)
  • Laser Microdissection (MLD): Mass spectrophotometric (MS) analysis of amyloid deposits to differentiate between AL and AA chains, or to identify type the protein causing Cardiac Amyloidosis
  • Comparative histochemical analysis, in which an array of antibodies is used to accurately detect AA amyloid fibrils
  • Southern blot test
  • Northern blot test
  • Western blot test
  • Eastern blot test

The methodology used for Cardiac Amyloidosis may vary from one laboratory to another.

Note: Molecular testing has limitations depending on the method being used, and genetic mutational abnormalities being tested. This can affect the results on a case-by-case basis. Consultation with your healthcare provider will help in determining the right test and right molecular method, based on individual circumstances.

What are the Clinical Indications for performing the Molecular Testing for Cardiac Amyloidosis?

Molecular Testing for Cardiac Amyloidosis may be undertaken in the following situations: 

  • To assist (and in some cases, confirm) the initial diagnosis of Cardiac Amyloidosis
  • To check for or ascertain a family history of amyloidosis
  • To distinguish other conditions that have similar features (signs and symptoms)
  • To help determine treatment options

How is the Specimen Collected for Molecular Testing for Cardiac Amyloidosis?

The type and source and specimen sample requirements will depend on the preference of the individuals and the preference of the testing lab. Thus, it may vary from one individual to another and from one lab to another. Therefore, it is important to contact the testing lab for exact specimen requirements, before initiating the collecting and testing process.

In individuals with a preliminary diagnosis of Cardiac Amyloidosis, the following samples may be required to classify amyloid proteins at the molecular level:

  • Blood, for checking elevated SAA levels
  • Biopsy sample of affected tissue, to stain with Congo Red and visualize areas of amyloid deposits under a fluorescent microscope
  • Laser dissection of amyloid deposits identified from tissue samples 
  • Trypsin digestion of dissected tissue (containing amyloid protein) sample to process the peptides for mass spectrometry

When an individual need to be screened for gene mutation(s) the following is the specimen collection process for molecular testing for TTR gene mutation(s), or heritable conditions that may lead to amyloidosis, and consequently, Cardiac Amyloidosis:

  • Sample on which the test is performed may include:
    • Peripheral blood in individuals showing signs and symptoms suspected of Cardiac Amyloidosis
    • Bone marrow biopsy specimen
    • For mitochondrial DNA testing, usually a muscle biopsy or a liver biopsy is preferred
    • In case of expectant mothers, prenatal testing through amniotic fluid and chorionic villi sampling
    • Fetal cord blood
    • Fresh tissue from biopsy 
    • Fresh tissue from autopsy sample 
    • Fresh tissue from fetal demise
    • Buccal brushes: Using the kit that is provided by the testing laboratory, buccal brushes can be used to collect the specimen, by scraping the inner cheek lining (buccal mucosa)
    • Oral rinse specimens
    • Body fluids such as saliva, tears, and semen
    • Dried blood spots: This specimen type is usually requested in situations where the collection and/or shipping of whole blood is not practical
    • In some cases, hair samples (with attached roots), finger nails, and buccal swabs, may be acceptable
    • Formalin-fixed paraffin-embedded solid tumor tissue (FFPE tumor tissue), often referred to as paraffin block of the tumor
    • Products of conception sample from aborted pregnancy
    • Amyloid deposits from heart, which may be extracted by laser microdissection 
  • Process of obtaining the sample: As outlined by the laboratory testing facility
  • Preparation required: As outlined by the laboratory testing facility

Important Information:

Limitations of specimen while testing for Cardiac Amyloidosis

  • For blood specimens: Individuals, who have received platelet transfusions, red blood transfusion, or white blood (leukocyte) transfusion, should wait at least 4 weeks before providing a blood specimen
  • The following specimens may not be acceptable in individuals who have received heterologous bone marrow transplant (in the past):
    • Peripheral blood samples
    • Oral rinse specimens 
    • Bone marrow biopsy specimens
  • Testing for Cardiac Amyloidosis should not be performed on a transplanted organ/specimen, since the genetic material belongs to the donor and not to the individual being tested
  • Formalin-fixed paraffin-embedded solid tumor tissue: In many cases, FFPE tissue blocks are usually not acceptable. Please contact the testing lab to ascertain, if it is an acceptable sample specimen
  • In some cases, a different source of specimen may be acceptable to the laboratory performing the test

Occasionally, additional samples may be required to either repeat the test or to perform follow-up testing.

Turnaround time for test results

  • Depending on the location of testing, it may take from 2 to 8 weeks from the time of sample collection, to obtain the test results

Sample storage information

  • Many hospitals preserve the paraffin blocks for at least 7 years. In general, older paraffin blocks (over 5 years) may affect the detection of specific mutations, due to degradation of the tissue specimen over time 

Cost of Molecular Testing for Cardiac Amyloidosis:

  • The cost of the test procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, whether your healthcare provider/facility is in-network or out-of-network of your insurance company 
  • In many cases, an estimate may be provided before the test is conducted. The final amount may depend upon the findings during the test procedure and post-operative care, if required

What is the Significance of the Molecular Testing for Cardiac Amyloidosis Result?

The significance of Molecular Testing for Cardiac Amyloidosis is explained below:

  • A positive test result, either at gene or protein level, helps aid, and in some cases, confirm the diagnosis of Cardiac Amyloidosis
  • The test results can help in the following manner:
  • Exclude other conditions presenting similar signs and symptoms
  • Differentiate between various subtypes of amyloidosis
  • Determine the prognosis of the patient
  • In management of the condition following birth of the child, if the condition is diagnosed prenatally
  • In making treatment decisions
  • Individuals showing a positive test result during pregnancy may benefit from genetic counseling
  • If a causative gene mutation for amyloidosis is identified in a family, then genetic counseling may be recommended to help assess the risk, before planning for a child

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario.

Additional and Relevant Useful Information:

  • Many laboratories may not have the capability to perform this test. Only highly-specialized labs with advanced facilities and testing procedures may offer this test
  • Ongoing research may discover additional gene mutations for this condition. This may further contribute towards diagnosis and treatment. Please consult with your healthcare provider for updates

Certain medications may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid any possibility of a misdiagnosis.

Please visit our Laboratory Procedures Center for more physician-approved health information:


References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Feb. 10, 2020
Last updated: Feb. 10, 2020