Among patients undergoing carpal tunnel release surgery, tenosynovial tissue biopsy detected amyloid deposits in 10.2% of patients, allowing for identification of concomitant cardiac involvement.
Cross-Sectional (n=98)
What is the prevalence of tenosynovial and cardiac amyloidosis in older patients undergoing carpal tunnel release surgery?
Tenosynovial amyloid deposits are present in approximately 10% of older patients undergoing carpal tunnel release, and concomitant cardiac evaluation can identify early cardiac involvement.
BACKGROUND Patients with cardiac amyloidosis often have carpal tunnel syndrome that precedes cardiac manifestations by several years. However, the prevalence of cardiac involvement at the time of carpal tunnel surgery has not been established. OBJECTIVES The authors sought to identify the prevalence and type of amyloid deposits in patients undergoing carpal tunnel surgery and evaluate for cardiac involvement. The authors also sought to determine if patients with soft tissue transthyretin (TTR) amyloid had abnormal TTR tetramer kinetic stability. METHODS This was a prospective, cross-sectional, multidisciplinary study of consecutive men age ≥50 years and women ≥60 years undergoing carpal tunnel release surgery. Biopsy specimens of tenosynovial tissue were obtained and stained with Congo red; those with confirmed amyloid deposits were typed with mass spectrometry and further evaluated for cardiac involvement with biomarkers, electrocardiography, echocardiography with longitudinal strain, and technetium pyrophosphate scintigraphy. Additionally, serum TTR concentration and tetramer kinetic stability were examined. RESULTS Of 98 patients enrolled (median age 68 years, 51% male), 10 (10.2%) had a positive biopsy for amyloid (7 ATTR, 2 light chain AL, 1 untyped). Two patients were diagnosed with hereditary ATTR (Leu58His and Ala81Thr), 2 were found to have cardiac involvement (1 AL, 1 ATTR wild-type), and 3 were initiated on therapy. In those patients who had biopsy-diagnosed ATTR, there was no difference in plasma TTR concentration or tetramer kinetic stability. CONCLUSIONS In a cohort of patients undergoing carpal tunnel release surgery, Congo red staining of tenosynovial tissue detected amyloid deposits in 10.2% of patients. Concomitant cardiac evaluation identified patients with involvement of the myocardium, allowing for implementation of disease-modifying therapy. (Carpal Tunnel Syndrome and Amyloid Cardiomyopathy; NCT02792790).
Sperry et al. (2018) conducted a cross-sectional in Carpal tunnel syndrome (n=98). Tenosynovial amyloid deposits was evaluated on Prevalence of amyloid deposits. Among patients undergoing carpal tunnel release surgery, tenosynovial tissue biopsy detected amyloid deposits in 10.2% of patients, allowing for identification of concomitant cardiac involvement.