Should Cardiac Amyloids Be Screened For After Carpal Tunnel Release Surgery?

Results from a new analysis suggested that carpal tunnel syndrome was linked with amyloid deposits at the time of carpal tunnel release surgery and could be suggestive of future cardiac amyloid-related events.  

Researchers for the cross-section, prospective study included consecutive men ≥50 years and women ≥60 years of age who were undergoing carpal tunnel release surgery. The authors obtained biopsy specimens of the tenosynovial tissue and stained them with Congo red to determine the prevalence and type of amyloid deposits, if any. Biopsies found with amyloid deposits were further analyzed for other biomarkers indicating cardiac involvement. The study included a total of 98 patients.  

Is carpal tunnel release surgery in amyloid patients an opportunity to screen for cardiac amyloid? https://t.co/0dioKdaaKm #JACC @maz_hanna @BrettSperryMD pic.twitter.com/CMaV1Ve7n5

— JACC Journals (@JACCJournals) October 16, 2018

According to the results, 10 (10.2%) of patients had a positive biopsy for amyloid presence. Two patients were diagnosed with hereditary amyloid transthyretin, two patients had cardiac involvement, and three patients were initiated on therapy. In patients with biopsy-diagnosed transthyretin amyloid, there was no difference in plasma transthyretin concentration.  

“In a cohort of patients undergoing carpal tunnel release surgery, Congo red staining of tenosynovial tissue detected amyloid deposits in 10.2% of patients,” the researchers concluded. “Concomitant cardiac evaluation identified patients with involvement of the myocardium, allowing for implementation of disease-modifying therapy.” 

Honored to be involved in this multi-specialty effort that led to a detection of amyloid deposits in 10% of older patients undergoing carpal tunnel release surgery. Early diagnosis of #amyloidosis is paramount. Proposed algorithm and thread below. 1/n https://t.co/larBBlMIj0

— Brett Sperry, MD (@BrettSperryMD) October 17, 2018

A must read review! Amyloidosis and carpal tunnel syndrome … Thanks for sharing @NadeenFaza https://t.co/9ILJ0hJMEc

— Alma Sthela Arrioja, MD (@almasthela) October 17, 2018

Outstanding paper on #amyloidosis and carpal tunnel syndrome! A must read! https://t.co/8lcOLa2WWj Congratulations @BrettSperryMD and team! @JACCJournals #ACCFIT @ACCmediacenter @ACCinTouch @ACCCardioEd #ACCimaging @AHAScience pic.twitter.com/A9vwjwTu5j

— Nadeen N. Faza, M.D. (@NadeenFaza) October 17, 2018

Should older patients with carpal tunnel be screened for amyloid? Great study by @BrettSperryMD @maz_hanna in @JACCJournals https://t.co/6m1hQIbqPm

— Javid Moslehi (@CardioOncology) October 16, 2018

Should we screen carpal tunnel patients for cardiac amyloidosis?

– exciting study in @JACCJournals https://t.co/pX7tdWiudP#Cardiology #Cardiotwitter #Amyloidosis pic.twitter.com/V5NBBh0VfF

— Konstantin Krychtiuk (@krychtiukmd) October 16, 2018

Brilliant paper @BrettSperryMD @maz_hanna Tenosynovial and Cardiac Amyloidosis in Patients Undergoing Carpal Tunnel Release https://t.co/6chGs3KsKU

— Ashish Aneja MD FACC FAHA FASE FSCMR (@ash71us) October 16, 2018

Source: JACC