Clinical Testing to Rule Out Amyloidosis

To rule out amyloidosis, begin with serum and urine immunofixation plus serum free light chains (FLCs) to screen for AL amyloidosis, followed by cardiac imaging with echocardiography or cardiac MRI to assess for structural abnormalities, and if cardiac involvement is suspected with negative monoclonal protein screening, proceed with bone tracer scintigraphy (99mTc-PYP/DPD/HMDP) which can diagnose ATTR cardiac amyloidosis non-invasively.