Prevalence of transthyretin amyloid cardiomyopathy in male patients who underwent bilateral carpal tunnel surgery: The ACTUAL study

• Published in: International journal of cardiology 2021-04, Vol.329, p.144-147
• Main Authors: Vianello, Pier Filippo, La Malfa, Giovanni, Tini, Giacomo, Mazzola, Vittoria, Miceli, Alberto, Santolini, Emmanuele, Briano, Stefania, Porto, Italo, Canepa, Marco
• Format: Article
• Language: English
• Subjects: Bone scintigraphy; Cardiac amyloidosis; Carpal tunnel syndrome; Screening; Transthyretin
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.12.044

Bilateral carpal tunnel syndrome (CTS), particularly in male individuals with left ventricular hypertrophy (LVH), has been recognized as a red flag for transthyretin cardiac amyloidosis (TTR-CA). Nonetheless, the opportunity of screening CTS patients for TTR has yet to be determined. Medical records of 1689 CTS surgeries performed at our institution between 2008 and 2018 were reviewed. Eighty-three males who underwent bilateral CTS surgery were considered eligible for the study, and offered a screening examination including electrocardiography and echocardiography. Individuals with LVH (diastolic septal wall thickness > 12 mm) were offered second-line diagnostic testing including blood testing and bone scintigraphy. Study population consisted of 53 bilateral CTS male patients, with median age of 73 years. LVH was found in 6 (11%) individuals. None of them had monoclonal gammopathy or reported CTS occupational risk factors. Two declined to undergo further testing, whereas 2 had negative and 2 had positive bone scintigraphy (both Perugini 2 uptake) and tested negative for TTR gene mutations (wild-type TTR-CA). Prevalence of TTR-CA in the entire study population was 4%, but among bilateral CTS patients with LVH peaked at 33%. In this latter population, screening for TTR-CA appeared feasible and effective. •Bilateral carpal tunnel syndrome (CTS), in particular in males, is a red flag suggesting a diagnosis of transthyretin cardiac amyloidosis (TTR-CA).•We investigated the presence of TTR-CA in male individuals who had undergone bilater CTS surgery.•Prevalence of TTR-CA in the entire study population was 4%, but among bilateral CTS patients with left ventricular hypertrophy peaked at 33%.