Prior Carpal Tunnel Syndrome and Early Concomitant Echocardiographic Findings Among Patients with Systemic Amyloidosis

Background: Amyloid deposits are found in the carpal tunnel of the hand prior to the diagnosis of immunoglobulin light chain (AL) or transthyretin (ATTR) systemic amyloidosis, thus raising the potential for early diagnosis.

Objectives: To describe early echocardiographic parameters coincident with the diagnosis of carpal tunnel syndrome (CTS).

Methods: Single-center retrospective analysis of diagnosed AL and ATTR patients. Echocardiographic examinations performed concomitant with CTS diagnosis were reviewed for parameters suggestive of cardiac amyloidosis. Patients with known or suspected amyloidosis at the time of the echocardiography exam were excluded from the cohort.

Results: Included were 108 patients with confirmed AL (n=82) and ATTR (n=26) amyloidosis in whom CTS was previously diagnosed in 25% and 62%, respectively. The median age at the diagnosis of CTS was 63 (IQR 56, 73) years, approximately 5 (IQR 2.9, 7) years before the diagnosis of systemic amyloidosis. Echocardiographic findings at the time of CTS diagnosis showed increased thickness of the interventricular septum [1.3 (IQR 1.1, 1.5) cm], increased relative wall thickness [0.46 (IQR 0.40, 0.50)] and increased left ventricular mass [234 (IQR 177, 292) grams]. Mitral flow evaluation by pulsed wave Doppler was supportive of abnormal left ventricular diastolic function in 55% (n=11) of the study group.

Conclusion: Early echocardiographic findings coincident with CTS diagnosis and preceding the diagnosis of systemic amyloidosis are suggestive of concentric hypertrophy and diastolic dysfunction. Larger-scale prospective studies are warranted to define screening algorithms.