• Brett W Sperry, Bryan A Reyes, Asad Ikram, Joseph P Donnelly, Dermot Phelan, Wael A Jaber, David Shapiro, Peter J Evans, Steven Maschke, Scott E Kilpatrick, Carmela D Tan, E Rene Rodriguez, Cecilia Monteiro, TangW H WilsonWHWDepartment of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio., Jeffery W Kelly, William H Seitz, and Mazen Hanna.
• Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Mid America Heart Institute, Saint Luke's Hospital, Kansas City, Missouri. Electronic address: https://twitter.com/BrettSperryMD.
• J. Am. Coll. Cardiol. 2018 Oct 23; 72 (17): 2040-2050.

BackgroundPatients 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.ObjectivesThe 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.MethodsThis 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.ResultsOf 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.ConclusionsIn 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).Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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