Prevalence and Prediction of ATTR in Ambulatory Patients With HFpEF (TTRinHFpEF)

Prevalence and Prediction of Transthyretin Amyloidosis in Ambulatory Patients With Heart Failure With Preserved Ejection Fraction

Recent studies have shown that transthyretin amyloidosis (ATTR) can sometimes cause a type of heart failure where the pumping function of the heart is normal, also known as Heart Failure with Preserved Ejection Fraction (HFpEF) or diastolic heart failure. In this single center diagnostic study, we will evaluate for ATTR in patients with HFpEF in order to to determine how frequently this occurs and how we can predict which heart failure patients may have TTR amyloidosis. Our goal is to identify amyloidosis in heart failure patients earlier so that they can start treatment.

Patients 65-years and older with HFpEF will be enrolled to participate in this single center, event driven (positive nuclear amyloid scan also known as 99mTc-pyrophosphate SPECT scan) study. During the single study visit the following will be obtained: 99mTc-pyrophosphate SPECT scan Blood and DNA (optional) sample collection Questionnaires in regards to neuropathy, carpal tunnel, frailty, and Heart failure symptoms and how they may affect ones quality of life 6-Minute Walk Test ECG (electrocardiogram) Echocardiogram Electronic health records will be reviewed for up to 5 years in order to determine hospitalization and survival of the study participants. Clinical outcomes of interest include a combined endpoint of days alive outside of the hospital from heart failure hospitalizations at one and five years, presence of autonomic neuropathy, presence of carpal tunnel syndrome, presence of polyneuropathy. Additionally, Individual clinical endpoints are also endpoints of interest. The results from this study will be used to determine how frequently heart failure patients have transthyretin amyloidosis in their heart and better understand their symptoms. We hope that better understanding transthyretin amyloidosis in heart failure patients will help us identify affected patients so that they can receive treatment.

Patients 65 years and older presenting to Massachusetts General Hospital with a known diagnosis of HFpEF and without a diagnosis of amyloidosis in the ambulatory (outpatient) setting will undergo a 99Tc-Pyrophosphate Scan to identify Cardiac Amyloidosis

Cardiac Imaging Technique used to diagnose Transthyretin Cardiac Amyloidosis by use of 15 mCi of 99mTC-Pyrophosphate tracer

A cardiac disease in which misfolded proteins aggregate into amyloid fibril and deposit interstitially, leading to diastolic dysfunction and heart failure

Classifies the severity of a patients Heart Failure in terms of their limitations during physical activity

Kansas City Cardiomyopathy Questionnaire is a questionnaire that determines in the impact of Heart Failure on their health status, such as quality of life, symptoms, function, etc.)

The 6 minute walk test is used to determine an objective measurement of a patients aerobic capacity and endurance

Medical records and phone follow-up with patients and/or their physicians will allow the investigators to ascertain vital status and any significant clinical events

Medical records and phone follow-up with patients and/or their physicians will allow the investigators to ascertain vital status and any significant clinical events

Medical records and phone follow-up with patients and/or their physicians will allow the investigators to ascertain vital status and any significant clinical events

Medical records and phone follow-up with patients and/or their physicians will allow the investigators to ascertain vital status and any significant clinical events

Individual endpoints of all-cause mortality, cardiovascular mortality, all-cause hospitalizations, cardiovascular hospitalizations and HF hospitalizations.

Medical records and phone follow-up with patients and/or their physicians will allow the investigators to ascertain vital status and any significant clinical events

Inclusion Criteria: Patients with a confirmed diagnosis of HFpEF. Age ≥65 years old Exclusion Criteria: End stage chronic kidney disease on dialysis (CKD stage 5 as defined as eGFR <15mL/min) no history of HFrEF (LVEF<40%) with the exception of low LVEF in the setting of acute decompensation, AF RVR, ACS/MI, etc Negative 99mTc-pyrophosphate scan within a year Unable to lie down for 15 minutes for the 99mTc-pyrophosphate scan Known diagnosis of amyloidosis Severe valvular heart disease that is uncorrected (moderate to severe is considered exclusionary)