Elsevier

Journal of Cardiac Failure

Volume 26, Issue 11, November 2020, Pages 909-916
Journal of Cardiac Failure

Prior Carpal Tunnel Syndrome and Early Concomitant Echocardiographic Findings Among Patients With Cardiac Amyloidosis

https://doi.org/10.1016/j.cardfail.2020.06.009Get rights and content

Abstract

Background

We aimed to characterize patients with systemic amyloidosis stratified by a prior diagnosis of carpal tunnel syndrome (CTS) and to describe early echocardiographic parameters concomitant with CTS.

Methods and Results

Patients with suspected amyloidosis during CTS diagnosis were excluded. Our cohort included 108 patients with systemic amyloidosis of which 36% had a prior CTS at a median of 4 years (interquartile range [IQR] 2.8–6.7 years) before disease diagnosis. Patients with prior CTS were more likely to present subsequently with cardiac amyloidosis (78% vs 53%, P = .013), yet overall survival was comparable between groups (53% vs 61%, P = .825). Prior CTS was more commonly diagnosed in subsequent patients with transthyretin (62%) than in patients with immunoglobulin light chain (24%, P < .001). Furthermore, in a subanalysis of patients subsequently diagnosed with cardiac amyloidosis, findings at CTS diagnosis (n = 17) demonstrated a mild increase in septal thickness 1.3 cm (IQR 1.2–1.5 cm), increased relative wall thickness 0.46 cm (IQR 0.45–0.58 cm), and increased left ventricular mass index 155 g/m2(IQR 92–177 g/m2) compared with age-adjusted normal range echocardiographic values. Doppler mitral flow data was supportive of left ventricular diastolic dysfunction.

Conclusions

Early echocardiographic findings at CTS diagnosis, preceding the diagnosis of cardiac amyloidosis by several years, are suggestive of increased wall thickness and diastolic dysfunction.

Section snippets

Study Population

The population of the current study was comprised of consecutive patients with AL and ATTR treated at our institution (Rabin Medical Center, Israel) between 2008 and 2018. For all patients, electronic medical records, echocardiographic and nuclear scintigraphy scans were reviewed.

The diagnosis of AL was made in the presence of a monoclonal protein (identified by serum and urine protein immunofixation plus serum free light chain assay) and histologic evidence of amyloid deposition in tissue

Study Population

In total, 112 patients with systemic amyloidosis were identified during the study period. Four patients were excluded owing to suspected or confirmed amyloidosis at the time of CTS diagnosis. Therefore, our study population included 108 patients, of whom 82 (76%) had AL and 26 (24%) had ATTR. Cardiac amyloid involvement was diagnosed in 61% of patients (n = 66) with systemic amyloidosis (Table 1). Among the 82 patients with AL, 41 (50%) had cardiac involvement as determined by one or more

Discussion

This study evaluated the incidence of prior CTS diagnosis as well as concomitant echocardiographic parameters in a cohort of patients with systemic amyloidosis comprised of both AL and ATTR patients. We found that (1) CTS is a common finding (62%) in ATTR, and to a lesser extent AL (24%), and precedes the diagnosis of systemic amyloidosis by a median of 4 years, and (2) early echocardiographic findings concomitant with CTS diagnosis demonstrate increased wall thickness, LV mass, and LV

Funding

None

Disclosure of interest

None declared

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