Clinical Report: CTS Surgery Biopsies May Identify Early ATTR-CM

Overview

A multicenter cohort study indicates that biopsy-guided screening during carpal tunnel surgery can detect transthyretin amyloid cardiomyopathy (ATTR-CM) earlier in older patients. Among 52 patients with amyloid-positive biopsies, 17% were diagnosed with ATTR-CM, primarily in asymptomatic stages.

Background

Transthyretin amyloid cardiomyopathy (ATTR-CM) is often underdiagnosed, particularly in older adults. Early identification is crucial for managing the disease effectively, as it can lead to better patient outcomes. This study explores the potential of surgical biopsies during carpal tunnel syndrome procedures to facilitate earlier diagnosis.

Data Highlights

Key Findings

• 17% of patients with amyloid-positive biopsies were diagnosed with ATTR-CM.
• 89% of screening-detected patients were classified as National Amyloidosis Centre stage I.
• Most patients identified through screening were asymptomatic (78% in NYHA class I).
• Screening identified a higher proportion of women compared to usual clinical pathways (22% vs. 4%).
• Lower biomarker levels and less structural cardiac involvement were noted in screening-detected patients.

Clinical Implications

The findings suggest that implementing biopsy-guided screening during carpal tunnel surgery could enhance early detection of ATTR-CM, particularly in older patients. Clinicians should consider this approach in high-risk populations to potentially improve management strategies.

Conclusion

This study highlights the utility of surgical biopsies in identifying early-stage ATTR-CM, emphasizing the need for awareness and screening in older patients undergoing carpal tunnel surgery.

References

1. Sie Kronborg Fensman, JACC: Advances, 2023 -- CTS Surgery Biopsies May Identify Early ATTR-CM
2. Clinical Research in Cardiology, 2022 -- Early Detection of Cardiac Transthyretin Amyloidosis: Evaluating Imaging Techniques
3. Clinical Research in Cardiology, 2020 -- Evaluating the Diagnostic Utility of Cardiovascular Magnetic Resonance Versus Endomyocardial Biopsy in Cardiac Amyloidosis
4. Clinical Research in Cardiology, 2016 -- Rare instance of cardiac ATTR amyloidosis associated with situs inversus totalis
5. 2023 ACC Expert Consensus on Cardiac Amyloidosis: Key Points - American College of Cardiology
6. Clinical Research in Cardiology — Association of RV-PA Uncoupling with Elevated Mortality in Patients with Transthyretin Amyloid Cardiomyopathy Undergoing Tafamidis Treatment
7. Tenosynovial and Cardiac Amyloidosis in Patients Undergoing Carpal Tunnel Release
8. Tafamidis in Transthyretin Cardiomyopathy Clinical Trial - American College of Cardiology
9. 2023 ACC Expert Consensus on Cardiac Amyloidosis: Key Points - American College of Cardiology