Biomarkers: Monoclonal Protein and Indicators of Cardiac Damage

Cardiac amyloidosis (CA) is characterized by abnormal protein fibril deposition in the heart, leading to heart failure and poor prognosis. This chapter focuses on the role of biomarkers in CA, specifically monoclonal protein-associated biomarkers and indicators of cardiac damage, such as natriuretic peptides (NPs) and troponins. In AL amyloidosis, quantifying free light chains (FLCs), assessing κ/λ ratio, and conducting immunofixation tests help diagnose the disease. Measuring the difference between clonal and uninvolved FLCs (dFLC) allows for precise risk stratification and assessment of therapy response. NPs and troponins are crucial for identifying cardiac involvement, risk stratification, guiding treatment decisions, and monitoring response to chemotherapy. In ATTR amyloidosis, NPs and troponins act as “red flags” to detect cardiac involvement and have been incorporated into risk stratification scores. However, further research is needed to define their role in treatment selection and monitoring response to emerging disease-modifying therapies.