Study Design and Details

Brief Summary:

In this study, the investigators will recruit a cohort of elderly Black and Hispanic patients with heart failure to define the number of patients who have cardiac amyloidosis by utilizing highly sensitive heart imaging and blood tests. The investigators will also explore differences in genetics and sex as they relate to heart failure disease progression in cardiac amyloidosis.

Background

• Heart failure with preserved ejection fraction (HFpEF) disproportionately afflicts older Black and Hispanic Americans.
• There is no data regarding the prevalence of ATTRwt CA in African Americans and no data for ATTR CA prevalence, irrespective of genotype, in the Hispanic population.
• The overall hypothesis is that a significant proportion of HF in elderly Blacks and Hispanics is caused ATTR CA.
• Amyloidosis previously thought to be untreatable, promising therapies that have been recently reported are most effective if administered early in disease course, underlining the significance of early screening and diagnosis
• Endomyocardial biopsy, while nearly 100% sensitive and specific, is impractical as a screening test and genotyping alone

Study Components: 

• investigators will establish the prevalence of ATTR CA
• investigators will use a highly accurate technique for ATTR CA identification using Tc99m-pyrophosphate (PYP) imaging that avoids the need for biopsy.
  • Tc99m-PYP myocardial uptake can occur before echocardiographic or clinical changes, suggesting enhanced sensitivity.
  • Tc99m-PYP has not been applied broadly in HF patients as a means to facilitate early diagnosis.
• investigators will test the diagnostic accuracy of a point-of-care diagnostic tool that utilizes a novel biomarker, retinol binding protein 4 (RBP4), and an assay to measure TTR stability and explore the relationship between RBP4 concentration and TTR stability