Overview
18F-Flutemetamol (Vizamyl) is a radioactive diagnostic agent indicated and FDA-approved for Positron Emission Tomography (PET) imaging of the brain to estimate β-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer's disease (AD) or other causes of cognitive decline. This study is designed to evaluate a novel use for 18F-Flutemetamol in cardiac amyloidosis.
Description
The goal of this project is to perform a proof-of-concept study to compare the ability of quantitative parametric cardiac 18F-flutemetamol positron emission tomography (PET) to assess baseline and change in disease burden after six months of therapy with tafamidis treatment in 12 patients diagnosed with transthyretin cardiac amyloidosis (ATTR-CA) at Yale-New Haven Hospital. The primary outcome of the study will be comparisons in the magnitude of change in regional and global 18F-flutemetamol cardiac PET metrics between the baseline and six-month 18F-flutemetamol PET scans versus clinical stage and echocardiographic features (wall thickness, strain, LVEF).
Eligibility
Inclusion Criteria:
- 1. Age > 18 years
- 2. Diagnosis of ATTR cardiac amyloidosis (wild-type or V142I ATTR mutation)
- Diagnosis of ATTR cardiac amyloidosis by established consensus diagnostic criteria of Gillmore et al. (either invasive or non-invasive diagnostic pathways)
- 3. Plan for initiation of tafamidis therapy for clinical indications and agree to
continue tafamidis during the duration of the study.
- 4. Stated willingness to comply with all study procedures and availability for the duration of the study
- 5. Able to understand and sign the informed consent document after the nature of the study has been fully explained.
- 6. Women of childbearing potential who are sexually active with a non-sterilized male partner and males who are sexually active with a partner of childbearing potential must agree to use adequate contraception from screening until 30 days after the Flutemetamol.
Exclusion Criteria:
- 1. Primary amyloidosis (AL) or secondary amyloidosis (AA).
- 2. Prior liver or heart transplantation.
- 3. Active malignancy or non-amyloid disease with an expected survival of less than 1 year
- 4. Inability to lie flat for 60 minutes in the PET scanner
- 5. History of prior treatment for ATTR cardiomyopathy and/or amyloid neuropathy, or decline clinical tafamidis treatment.
- 6. Pregnancy or lactation
- 7. Known allergic reactions to components of the 18F-flutemetamol and/or polysorbate 80
- 8. High risk for non-adherence as determined by screening evaluation.