Transthyretin Cardiac Amyloidosis in HFpEF

Inclusion Criteria

Resident of Southeastern Minnesota (Olmsted, Dodge, Fillmore, Mower, Freeborn, Wabasha, or Steele County)
Current diagnosis of HF per NLP search
Age > 60 years

Clinically obtained echocardiogram within 12 months of index visit showing:

EF ≥ 40% and
Increased Left Ventricular (LV) wall thickness as defined by an end-diastolic left ventricular septal or posterior wall thickness (LVWTd) ≥ 20% above the upper limit of normal measured by 2D or M-mode imaging in the parasternal long (2D) or short (M-mode) axis view (≥12 mm).

Objective evidence of HF defined as one or more of the following present within 24 months of index visit:

Meet Framingham Criteria at index visit (In-patient or outpatient)
Previous HF hospitalization
Invasive hemodynamic documentation of elevated pulmonary capillary wedge pressure (PCWP) or left ventricular end-diastolic pressure (LVEDP) (> 18 mmHg at rest or > 25 mmHg with exercise)
Left atrial enlargement + loop diuretic for HF(clinically obtained) N-terminal pro b-type natriuretic peptide (NT-proBNP) > 300 (sinus rhythm) or >900 (atrial fibrillation) pg/mL

Exclusion Criteria

Documentation of previous EF < 40%
Any cardiac surgery or major chest trauma within 4 weeks of index visit

Presence or history of hemodynamically significant left sided valvular disease defined as:

Greater than mild mitral stenosis
Intrinsic mitral valve disease (prolapse, flail) with greater than moderate regurgitation
Myocardial infarction within 4 weeks of index visit defined by typical angina, EKG changes and significant change in serial troponins. Note that chronic troponin elevation is extremely common in cardiac amyloidosis. Hospitalized patients with troponin elevation but no significant change (delta) on serial testing will NOT be excluded.
Prior or current exposure to Plaquenil (Hydroxychloroquine)