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Screening for Cardiac Amyloidosis After Carpal Tunnel Syndrome Surgery
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- Screening for cardiac amyloidosis (CA) 5-15 years after surgery for bilateral carpal tunnel syndrome showed that the prevalence of CA was 4.8% in total and 8.8% in males.
- Of note, study subjects diagnosed with CA had low disease severity scores, indicating early detection and potential benefit for systematic screening.
- Additional studies are indicated to assess the utility of systematic screening for cardiac amyloidosis in patients ≥70 years old who previously underwent bilateral carpal tunnel release and whether such systemic screening leads to improved outcomes.
Study Questions:
What is the prevalence of undiagnosed cardiac amyloidosis (CA) 5-15 years after surgery for bilateral carpal tunnel syndrome (CTS)?
Methods:
The investigators identified subjects aged 60-85 years with prior CTS surgery using national registries, where the first procedure on the second wrist was performed 5-15 years ago. Invitations to participate in the study were sent by mail. Per international recommendations, initial cardiac evaluation included echocardiography, 99mtechnetium-pyrophosphate scintigraphy, and assessment of monoclonal proteins in serum and urine. The primary study outcome was prevalence of CA, as defined: demonstration of amyloid deposits in myocardial biopsy, OR left ventricular hypertrophy (LVH) without obvious cause, AND presence of monoclonal protein in blood or urine and extracardiac demonstration of amyloid deposits, OR LVH without obvious cause AND grade II-III positive 99mtechnetium-pyrophosphate scintigraphy. Differences were evaluated using Wilcoxon-test, Chi-squared test, or Fisher’s exact test, as appropriate. Confidence intervals (CIs) for prevalence of patients diagnosed with CA were calculated using Exact binomial test.
Results:
A total of 250 subjects (35.7% of invited) participated in the study. The median age was 70.4 years and 50% were female. CA was diagnosed in 12 patients (4.8%; 95% CI, 2.5-8.2) and all cases wild type transthyretin amyloidosis (ATTRwt). The prevalence of ATTRwt in males was 8.8% (95% CI, 4.5-15.2, n = 11), and 21.2% (95% CI, 11.1-34.7) in male subjects ≥70 years with a BMI <30 kg/m2. All but two patients diagnosed with ATTRwt were in the lowest disease severity score (Mayo-score).
Conclusions:
The authors reported that screening for CA in patients with prior surgery for bilateral CTS finds approximately 5% with early-stage transthyretin CA.
Perspective:
This study reports that screening for CA 5-15 years after surgery for bilateral CTS showed that the prevalence of CA was 4.8% in total and 8.8% in males. Of note, study subjects diagnosed with CA had low disease severity scores, indicating early detection and potential benefit for systematic screening. Additional studies are indicated to assess the utility of systematic screening for CA in patients ≥70 years old who previously underwent bilateral carpal tunnel release and whether such systemic screening leads to improved outcomes.
Clinical Topics: Cardio-Oncology, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Amyloid Neuropathies, Familial, Amyloidosis, Biopsy, Cardiotoxicity, Carpal Tunnel Syndrome, Diagnostic Tests, Routine, Diphosphates, Echocardiography, General Surgery, Geriatrics, Heart Failure, Hypertrophy, Left Ventricular, Plaque, Amyloid, Prealbumin, Secondary Prevention, Radionuclide Imaging
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