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Screening for Transthyretin Cardiac Amyloidosis in Patients with bilateral carpal tunnel syndrome: Identifying Missed Opportunities for Early Detection and Treatment

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World Journal of Cardiovascular Diseases 2023年第7期13卷 366-376页

作者： Ayman Alsaadi Renato Cerna-Viacava Liyan Obeidat Shing Chao Johnathan Stephan Charles S. Day Jennifer Cowger Celeste Williams Karthikeyan Ananthasubramaniam Department of Internal Medicine Henry Ford Hospital Detroit USA Department of Orthopedic Surgery Henry Ford Hospital Detroit USA Heart and Vascular Institute Henry Ford Hospital Detroit USA Heart and Vascular Institute Henry Ford West Bloomfield Hospital West Bloomfield Township USA

Purpose: Transthyretin cardiac amyloidosis (ATTR-CA) has been linked to many extra-cardiac manifestations including bilateral carpal tunnel syndrome (CTS). The aim of this study is to analyze patients with bilateral CTS to identify patients with high-risk features or “red flags” for ATTR-CA, identify if systematic screening was done for ATTR-CA and define opportunities for improved detection. Methods: Out of >5000 patients with bilateral CTS evaluated in a single tertiary care center in Southeast Michigan (2010-2016), we retrospectively studied a focused population of patients: men > 50 years and women > 60 years old with bilateral CTS and atrial fibrillation (n = 295). Baseline demographic, comorbidities, and electrocardiographic and echocardiographic findings were analyzed. A high-risk group suspicious for ATTR-CA was identified as patients with bilateral CTS, atrial fibrillation, and concomitant “red flags” including heart failure and left ventricular hypertrophy. Results: Out of 295 patients, 51.2% were female, 75.6% were White, and 22.4% were African American. Upon comparing the high-risk group (n = 67) with the remaining study population (n = 228), both diagnosis of ATTR-CA and mortality were higher among the high-risk group (7.5% vs 0.4% and 43.3% vs 24.6%, respectively, P = 0.003). Conclusions: A substantial number of bilateral CTS patients had additional “red flags” warranting formal evaluation for ATTR-CA;however, systematic evaluation for cardiac amyloidosis was not performed in many patients. This emphasizes that Multidisciplinary collaboration is needed to create a systematic workflow and to raise awareness amongst cardiologists and other physicians for suspecting ATTR-CA in bilateral CTS patients who have additional “red flags”.

关键词： bilateral carpal tunnel syndrome Morality Prevalence Red Flags Transthyretin Cardiac Amyloidosis

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