Intracardiac Flow Assessment in Cardiac Amyloidosis

Inclusion criteria

• Subject is clinically stable without cardio-vascular-related hospitalizations within 6 weeks prior to enrollment as assessed by the investigators.
• Subject is able to provide written informed consent and is willing and able to complete study procedures.
• Currently in sinus rhythm by clinical assessment or documented electrocardiographic studies.
• Subject and disease characteristics noted by medical record review:

• Healthy control volunteers must also meet the following criteria: Karnofsky performance scale > 80%; ECOG status 0 or 1.
• ATTR cardiac amyloidosis based on meeting all the following criteria: Diagnosis of amyloidosis within five years prior to study screening; Documentation of absence of AL, heavy chain disease, multiple myeloma or malignant lymphoproliferative disorders; Transthyretin amyloid deposits in cardiac tissue OR technetium (99mTc) pyrophosphate scintigraphy with grade 2 or 3 cardiac uptake OR Transthyretin amyloid deposits in non-cardiac tissue with echocardiographic evidence of cardiac involvement or an end-diastolic mean wall thickness >12mm OR Transthyretin amyloid deposits in non-cardiac tissue with CMR diagnostic of amyloidosis
• AL with cardiac involvement based on meeting all the following criteria: Diagnosis of amyloidosis within five years prior to study screening; Histopathologic diagnosis of amyloidosis with AL protein identification; Documented clinical signs or symptoms consistent with heart failure; Cardiac involvement as defined by: Amyloid deposits in cardiac deposits OR Echocardiography with an end-diastolic mean wall thickness > 12 mm in the absence of other causes OR Elevated NT-proBNP (>332 ng/L) in the absence of renal failure or atrial fibrillation OR CMR diagnostic of amyloidosis;
• AL without cardiac involvement based on meeting all the following criteria: Diagnosis of amyloidosis within five years prior to study screening; Histopathologic diagnosis of amyloidosis with AL protein identification; No documented clinical signs and symptoms consistent with heart failure from AL; Absence of cardiac involvement as defined by: Echocardiography with an end-diastolic mean wall thickness < 13 mm if the subject does not have other causes for increased wall thickness AND NT-proBNP <333 ng/L if the subject does not have renal failure or atrial fibrillation AND No CMR diagnostic of amyloidosis if CMR is available prior to screening.

Exclusion criteria

• Unable to consent or unable to complete all study procedures.
• Unable to ambulate for 6 minutes (confirmed at study coordinator visit).
• Unable to maintain in supine position for 30 minutes.
• Unable to maintain breath-holding for 10 seconds (confirmed at study coordinator visit).
• Contraindications for safe CMR scanning (e.g., uncontrolled claustrophobia, cochlear implant, implanted neural stimulator).
• Presence of implantable cardiac pacemaker or defibrillator.
• History of complex congenital heart disease, intracardiac shunt (except for patent foramen ovale), prosthetic valves, prosthesis in the main pulmonary artery or ascending thoracic aorta.
• Significant artifact from prior MRI studies.
• Pregnant or breast-feeding women.
• Weight equal to or greater than 155 kg.
• Maximum body side-to-side or anterior-posterior diameter equal to or greater than 70 cm.
• Documented non-sinus rhythm within 1 week prior to screening.
• For healthy controls, the following exclusion criteria apply, confirmed per chart review and/or patient report:

• History of cardiomyopathy or structural heart disease;
• History of valvular disease of greater than mild severity;
• History of coronary artery disease or coronary heart disease;
• History of cardiac or thoracic surgery.
• History of symptomatic, persistent atrial tachyarrhythmia, ventricular tachyarrhythmia, or bradyarrhythmia;
• Left ventricular hypertrophy or abnormally increased myocardial thickness by prior echocardiography, cardiac computed tomography, or CMR;
• Acute kidney injury, OR chronic renal disease with glomerular filtration rate < 45 mL/min/1.73m^2 as per medical record review.
• Uncontrolled hypertension of systolic blood pressure > 150 mmHg or diastolic blood pressure > 90 mmHg as per medical record review;
• Taking three or more anti-hypertensive medications;
• Type 1 diabetes, OR uncontrolled type 2 diabetes mellitus of hemoglobin A1c greater than 8, as per medical record review;
• Taking three or more diabetic medications;
• History of confirmed stroke or transient ischemic attack, as per medical record review;
• Current cigarette smoker;
• History of plasma cell dyscrasia or chronic malignant hematologic diagnosis;
• BMI > 35 kg/m^2.