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Stern LK, Grodin JL, Maurer MS, Ruberg FL, Patel AR, Khouri MG, Roth LR, Aras MA, Bhardwaj A, Bhattacharya P, Brailovsky Y, Drachman BM, Ebong IA, Fine NM, Gaggin H, Gopal D, Griffin J, Judge D, Kim P, Mitchell J, Mitter SS, Mohan RC, Ramos H, Reyentovich A, Sheikh FH, Sperry B, Carter S, Urey M, Vaishnav J, Vest AR, Kittleson MM, Patel JK. The Cardiac Amyloidosis Registry Study (CARS): Rationale, Design and Methodology. J Card Fail 2024; 30:669-678. [PMID: 37907148 DOI: 10.1016/j.cardfail.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND CARS (Cardiac Amyloidosis Registry Study) is a multicenter registry established in 2019 that includes patients with transthyretin (ATTR, wild-type and variant) and light chain (AL) cardiac amyloidosis (CA) evaluated at major amyloidosis centers between 1997 and 2025. CARS aims to describe the natural history of CA with attention to clinical and diagnostic variables at the time of diagnosis, real-world treatment patterns, and associated outcomes of patients in a diverse cohort that is more representative of the at-risk population than that described in CA clinical trials. METHODS AND RESULTS This article describes the design and methodology of CARS, including procedures for data collection and preliminary results. As of February 2023, 20 centers in the United States enrolled 1415 patients, including 1155 (82%) with ATTR and 260 (18%) with AL CA. Among those with ATTR, wild-type is the most common ATTR (71%), and most of the 305 patients with variant ATTR have the p.V142I mutation (68%). A quarter of the total population identifies as Black. More individuals with AL are female (39%) compared to those with ATTR (13%). CONCLUSIONS CARS will answer crucial clinical questions about CA natural history and permit comparison of different therapeutics not possible through current clinical trials. Future international collaboration will further strengthen the validity of observations of this increasingly recognized condition.
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Affiliation(s)
- Lily K Stern
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine and Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ayan R Patel
- Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA, USA
| | - Michel G Khouri
- Division of Cardiology, Duke University Hospital, Durham, NC, USA
| | - Lori R Roth
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mandar A Aras
- Division of Cardiology, Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Anju Bhardwaj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, TX, USA
| | - Priyanka Bhattacharya
- Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Yevgeniy Brailovsky
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brian M Drachman
- Division of Cardiology, Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Imo A Ebong
- Division of Cardiology, Department of Medicine, Division of Cardiology, University of California, Davis, CA, USA
| | - Nowell M Fine
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Hanna Gaggin
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Deepa Gopal
- Section of Cardiovascular Medicine, Department of Medicine and Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jan Griffin
- Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA; Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Judge
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Paul Kim
- Division of Cardiology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Joshua Mitchell
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Cardio-Oncology Center of Excellence, Washington University in St Louis, St Louis, MO, USA
| | - Sumeet S Mitter
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajeev C Mohan
- Division of Cardiology, Scripps Clinic, San Diego, CA, USA
| | - Hannia Ramos
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Alex Reyentovich
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Farooq H Sheikh
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Brett Sperry
- Saint Luke's Mid America Heart Institute and the University of Kansas City-Missouri, Kansas City, Missouri, USA
| | - Spencer Carter
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marcus Urey
- Division of Cardiology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Joban Vaishnav
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Amanda R Vest
- Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA, USA
| | - Michelle M Kittleson
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Jignesh K Patel
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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Lakhdar S, Buttar C, Nassar M, Ciobanu C, Patel R, Munira MS. Outcomes of heart transplantation in cardiac amyloidosis: an updated systematic review. Heart Fail Rev 2022; 27:2201-2209. [PMID: 35595919 DOI: 10.1007/s10741-022-10252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Cardiac amyloidosis is one of the most common infiltrative cardiomyopathies that is characterized by the extracellular deposition of misfolded fibrillar protein. Several studies have previously found that patients with amyloid in the past have performed poorly after heart transplantation. Recent advancements in treatments have been made that have significantly improved outcomes in these patients. The study aimed to evaluate the outcomes of heart transplantation in cardiac amyloidosis. We systematically searched EMBASE, PubMed/MEDLINE, and Cochrane Library databases on 30 December 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We identified 22 studies that examined 42,951 patients with cardiac amyloidosis of which only 1,329 patients underwent isolated heart transplantation. Seven studies reported individual patient data. The results of 123 patients have been pooled for analysis. There were 70 male patients, 45 female patients, and eight patients who did not report their gender. Among the types of amyloids, 63 (51%) patients were found to have light chain amyloidosis (AL) and 33 (27%) patients had transthyretin amyloidosis (ATTR). Only 41 patients (33.3%) reported a monoclonal component. There were 30 patients with AL that underwent autologous hematopoietic stem cell transplant (ASCT). The mean survival of 24 out of 30 patients was 4.33 years. In addition, the reported data include 13 patients requiring intra-aortic balloon pump (IABP), six with cardiac resynchronization therapy (CRT), and four with implantable cardioverter defibrillator (ICD). With the current advancements in treatments in combination with a multidisciplinary approach and careful patient selection, patients undergoing heart transplantation for amyloidosis may have encouraging results in the current era. Further studies will be needed to evaluate the outcomes of heart transplantation in amyloidosis patients now that several advances have been made in the field.
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Affiliation(s)
- Sofia Lakhdar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, 82-68 164th St. Queens, New York, NY, 11432, USA.
| | - Chandan Buttar
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Mahmood Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, 82-68 164th St. Queens, New York, NY, 11432, USA
| | - Camelia Ciobanu
- St. Barnabas Hospital/Albert Einstein College of Medicine, New York, NY, USA
| | - Rima Patel
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York, NY, USA
| | - Most Sirajum Munira
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York, NY, USA.,Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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