Ultrasound Therapy In Cardiac Amyloidosis (UTICA)

This is an interventional treatment trial for Amyloidosis Cardiac Read More

Inclusion Criteria:

• Age > 18 years for AL-CA, > 65 years for ATTR-CA, > 65 years for controls
• Willing and able to provide consent

• Diagnosis of systemic light chain amyloidosis by standard criteria (see below) and in hematological remission (normal serum free light chain levels)

  • (immunofixation of serum and urine, IgG free light chain (FLC) assay, a biopsy of fat pad/ bone marrow, or organ biopsy, followed by typing of the light chain using immunohistochemistry or immunogold assay with confirmation by Mass spectroscopy as needed) AND
  • proof of cardiac involvement by AL amyloidosis
  • abnormal cardiac biomarkers (Abnormal high sensitivity TnT 5th generation levels (>9 ng/L: female, >14 ng/L: male) or abnormal age appropriate N terminal pro-brain natriuretic peptide, NT-proBNP (abnormal values: <50 years: >450 pg/ml; 50-75 years:>900 pg/ml; >75 years: >1800 pg/ml) or
  • abnormal echocardiogram (wall thickness > 12 mm) or
  • abnormal cardiac MRI (wall thickness > 12 mm or extracellular volume > 0.35) OR

• Diagnosis of transthyretin cardiac amyloidosis by standard criteria

  • endomyocardial biopsy followed by typing of the transthyretin amyloidosis using immunohistochemistry or immunogold assay with confirmation by Mass spectroscopy as needed
  • extracardiac biopsy with typical cardiac imaging findings, or
  • grade 2 or grade 3 myocardial uptake of technetium-99m pyrophosphate (PYP) if AL amyloidosis is excluded

Exclusion Criteria:

• Hemodynamic instability
• Severe claustrophobia despite use of sedatives
• Decompensated heart failure (unable to lie flat for 1 hour)
• Concomitant non-ischemic non-amyloid heart disease (valvular heart disease or dilated cardiomyopathy)
• Severe valve stenosis or regurgitation in the aortic, mitral or tricuspid valves, including prior valve replacement
• Severe pulmonary artery hypertension
• Severe lung disease
• Known obstructive epicardial coronary artery disease with stenosis > 50% in any single territory
• Prior cardiac surgery
• Regional wall motion abnormality on echocardiogram
• Left ventricular ejection fraction < 40%
• Pregnant state
• Documented allergy to N-13 ammonia or Definity

• Contraindications to CMR

  • Implantable Cardioverter Defibrillator (ICD)
  • Significant renal dysfunction with estimated glomerular filtration rate < 30 ml/min/m2.
  • Dialysis

• Contraindications to DEFINITY® (Perflutren Lipid Microsphere) Injectable Suspension:

  o Patients with known or suspected Right-to-left, bi-directional, or transient right-to-left cardiac shunts, Hypersensitivity to perflutren

• Contraindications or challenges to sonotherapy

  • Severe electrolyte abnormalities
  • QTc prolongation (values are greater than 450 milliseconds in males and greater than 470 milliseconds in females)
  • BMI > 35 kg/m2
  • Documented intracardiac thrombus
  • Atrial fibrillation not on anticoagulation
  • Prior history of stroke
• Any other reason determined by the investigator that makes a subject a poor candidate for ultrasound therapy