Naveen L. Pereira et al. JACC 2018;71:

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Naveen L. Pereira et al. JACC 2018;71:1130-1148 Diagnostic Algorithm for Cardiac Amyloidosis The diagnostic algorithm for cardiac amyloidosis includes cardiac or other tissue biopsy when suspicion of amyloid is present and other tests are negative, and the use of mass spectrometry for tissue typing will ensure that rare forms of amyloid are not missed. Reprinted with permission from Mayo Clinic. *Presence of monoclonal protein in serum/urine or abnormal free light chain ratio. †Fat aspirate if local expertise in acquisition and interpretation. Fat pad biopsy is an alternative. ‡Grade 2: moderate myocardial uptake (equal to bone); grade 3: severe uptake (greater than bone). §Rare amyloid types have been inadequately studied, may result in positive scans and can be confirmed by tissue amyloid typing. ‖Protein precursor identification with laser microdissection mass spectrometry. ATTR = transthyretin amyloidosis; ATTRm = pathogenic transthyretin deoxyribonucleic acid mutation amyloidosis; ATTRwt = wild-type transthyretin amyloidosis; DPD = 99mTc-labeled 3,3-diphosphono-1,2-propanodicarboxylic acid; Echo = echocardiography; HMDP = 99mTc-labeled hydroxymethylene-diphosphonate; MRI = magnetic resonance imaging; PYP = 99mTc-labeled pyrophosphate; TTR = transthyretin. Naveen L. Pereira et al. JACC 2018;71:1130-1148 2018 American College of Cardiology Foundation