Key result
Presumptive ATTR-CA affects ~24% of idiopathic carpal tunnel patients, linked to severely reduced GLS.
Why the study?
Do advanced echocardiographic and myocardial work indices differ between idiopathic carpal tunnel syndrome patients with and without presumptive concurrent cardiac amyloidosis?
Cross-Sectional (n=33)
Do advanced echocardiographic and myocardial work indices differ between idiopathic carpal tunnel syndrome patients with and without presumptive concurrent cardiac amyloidosis?
p-value: p=<0.001
Advanced echocardiographic indices, including multi-chamber strain and myocardial work, reveal profound pan-cardiac mechanical dysfunction in CTS patients with concurrent ATTR-CA, highlighting their potential as non-invasive screening markers.
May flag ATTR-CA via advanced echo in CTS; leaves open screening utility pending prospective validation.
Background/Objectives: Idiopathic carpal tunnel syndrome (CTS) can frequently precede the clinical diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to comprehensively characterize the standard and advanced echocardiographic phenotype in a screening cohort of patients with CTS assessed for concurrent ATTR-CA. Methods: Thirty-three patients with idiopathic CTS underwent comprehensive standard and advanced echocardiography. The presence of concurrent ATTR-CA was assessed using 99mTc-DPD scintigraphy, allowing the stratification of the cohort into an amyloidosis group and a non-amyloidosis control group for comparative analysis. Results: Based on scintigraphy, 8 patients (24.2%) were diagnosed with presumptive ATTR-CA, acknowledging that AL amyloidosis was not systematically excluded, while 25 served as scintigraphy-negative controls. Standard echocardiography revealed greater wall thickness and worse diastolic function (p < 0.001) in the scintigraphy-positive group. Advanced imaging demonstrated profound left ventricular (LV) mechanical dysfunction, with severely reduced global longitudinal strain (p < 0.001) and a high prevalence of apical sparing (p < 0.001). Non-invasive myocardial work (MW) analysis showed a marked reduction in Global Constructive Work (p = 0.005) and Global Work Index (p = 0.017) in scintigraphy-positive patients, despite a relatively preserved LV ejection fraction. Multi-chamber strain analysis unmasked a pan-cardiac myopathy in the amyloid group, characterized by severe impairment of right ventricular (RV) global strain (p = 0.004) and profound depression of both left (p = 0.002) and right (p < 0.001) atrial reservoir strains. Conclusions: In patients with CTS, positive scintigraphy is characterized by severe, afterload-adjusted LV mechanical failure and profound biatrial and RV dysfunction. Advanced multi-chamber strain and MW indices show potential as non-invasive markers to help identify previously unrecognized pan-cardiac amyloid infiltration, guiding prompt diagnostic referral.
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Machado et al. (2026) conducted a cross-sectional in Idiopathic carpal tunnel syndrome (n=33). Presumptive ATTR-CA (positive scintigraphy) vs. Scintigraphy-negative controls was evaluated on Global longitudinal strain (p=<0.001). In patients with idiopathic carpal tunnel syndrome, presumptive ATTR-CA was present in 24.2% and associated with severely reduced global longitudinal strain (p<0.001).
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