Cardiac Diffusion Tensor Imaging May Detect Early Cardiac Amyloidosis in Carpal Tunnel Syndrome

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiac Amyloidosis and Carpal Tunnel Syndrome (n=80). Intervention: Carpal tunnel syndrome with tenosynovial amyloid vs. Healthy controls. Primary outcome: Mean diffusivity (MD) (p=0.0016).

Q: What does this research mean for the field?

Cardiac diffusion tensor imaging detects myocardial microstructural alterations indicative of early cardiac amyloidosis in patients with carpal tunnel syndrome and confirmed tenosynovial amyloid deposition. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Fayez Kanj; Danielle Kara; Emma Wexler; Dingheng Mai; Mazen A Hanna; Deborah H. Kwon; Christopher Nguyen

doi:10.1016/j.jacadv.2025.102562

January 22, 2026JACC AdvancesOpen Access

Cardiac Diffusion Tensor Imaging May Detect Early Cardiac Amyloidosis in Carpal Tunnel Syndrome

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Key result

Cardiac DTI shows ~8% higher mean diffusivity in amyloid-positive carpal tunnel syndrome vs controls.

P=0.0016
n=80

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY-NC-ND

Why the study?

Carpal tunnel syndrome is an early symptom of systemic amyloidosis and may precede clinically overt cardiac amyloidosis by 5 to 10 years, but early detection methods for cardiac amyloidosis are needed.

Study Design

Type

Cross-Sectional (n=80)

Multicenter

No

Structured PICO

P

Population

80 adults, including patients with carpal tunnel syndrome and tenosynovial amyloid, cardiac amyloidosis, hypertrophic cardiomyopathy, and healthy controls, underwent cardiac diffusion tensor imaging to evaluate myocardial microstructural alterations.

E

Exposure

Cardiac diffusion tensor imaging (cDTI) using a 3T MRI scanner with an electrocardiogram-gated, free-breathing, second-order, motion-compensated spin echo acquisition

C

Comparator

Healthy controls, patients with confirmed cardiac amyloidosis, and patients with hypertrophic cardiomyopathy

O

Outcome

Mean diffusivity (MD) and fractional anisotropy (FA)

Main Result

Absolute Event Rate: 1.63% vs 1.51%

p-value: p=0.0016

Limitations

Significant differences in average ages between the cardiac amyloidosis/carpal tunnel syndrome groups and the hypertrophic cardiomyopathy/healthy groups.
Differences in the prevalence of hypertension, coronary artery disease, and diabetes between the cohorts.
Lack of endomyocardial biopsy to definitively attribute changes in myocardial microstructure in CTS patients to early cardiac amyloidosis.
Contrast-free CMR protocol prevented the investigation of differences in extracellular volume.
No comparison was performed with gadolinium-based CMR, the current gold standard for cardiac amyloidosis.

Implication

Cardiac DTI may detect early microstructural changes in carpal tunnel patients with tenosynovial amyloid; leaves open its screening utility pending prospective validation.

Abstract

BACKGROUND: Cardiac amyloidosis (CA) occurs when amyloid fibrils deposit in the myocardium, leading to diastolic dysfunction and subsequent heart failure. An early symptom of systemic amyloidosis is carpal tunnel syndrome (CTS). The prevalence of CTS in patients with transthyretin amyloidosis has been shown to be up to 50%, with CTS preceding clinically overt CA by 5 to 10 years on average. OBJECTIVES: This study applied cardiac diffusion tensor imaging (cDTI) to patients with CTS who underwent carpal tunnel release surgery and had confirmed amyloid deposition on tenosynovial biopsy in an attempt to screen for early CA. METHODS: cDTI was performed on 20 patients with CTS with confirmed tenosynovial amyloid, 20 patients with CA, 20 patients with hypertrophic cardiomyopathy, and 20 healthy controls. The diffusion scheme was an electrocardiogram-gated, free-breathing, second-order, motion-compensated spin echo acquisition obtained in systole. Mean diffusivity (MD), fractional anisotropy (FA), helix angle transmurality, absolute sheetlet angle, T1, and T2 were calculated from respiratory motion-corrected images. RESULTS: MD was significantly elevated in CA compared to CTS (1.79 ± 0.16 vs 1.63 ± 0.09, P = 0.0016), and in CTS compared to healthy controls (1.63 ± 0.09 vs 1.51 ± 0.10, P = 0.0016). FA was significantly reduced in CA compared to controls (0.25 ± 0.052 vs 0.31 ± 0.057, P = 0.0044) and CTS compared to controls (0.24 ± 0.027 vs 0.31 ± 0.057, P = 0.0004). cDTI outperformed T1 and T2 in distinguishing between healthy myocardium and those of the CA and CTS groups. CONCLUSIONS: MD and FA were significantly different between healthy patients and those with CA or CTS, suggesting that cDTI may detect evidence of myocardial microstructural alterations consistent with possible early CA.

Discussion

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Cite This Study

Kanj et al. (2026) conducted a cross-sectional in Cardiac Amyloidosis and Carpal Tunnel Syndrome (n=80). Carpal tunnel syndrome with tenosynovial amyloid vs. Healthy controls was evaluated on Mean diffusivity (MD) (p=0.0016). Patients with carpal tunnel syndrome and tenosynovial amyloid had significantly elevated mean diffusivity on cardiac diffusion tensor imaging compared to healthy controls (1.63 vs 1.51 μm2/ms, P=0.0016), suggesting early cardiac amyloid involvement.

synapsesocial.com/papers/6ac48b3bae7d56f28438f777 https://doi.org/10.1016/j.jacadv.2025.102562

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Cardiac Diffusion Tensor Imaging May Detect Early Cardiac Amyloidosis in Carpal Tunnel Syndrome

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiac Diffusion Tensor Imaging May Detect Early Cardiac Amyloidosis in Carpal Tunnel Syndrome

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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