To evaluate the effectiveness of biopsy-guided screening during surgery for idiopathic carpal tunnel syndrome in identifying early transthyretin amyloid cardiomyopathy (ATTR-CM) specifically in older patients undergoing this surgery.
Approach:
Key Findings:
17% of patients with amyloid-positive biopsies were diagnosed with ATTR-CM, mostly with mild, asymptomatic disease.
Tenosynovial amyloid deposition was found in 56% of patients.
Screening identified a higher proportion of women with ATTR-CM compared to usual clinical pathways.
Patients identified through screening had less advanced disease and lower biomarker levels.
No cases of ATTR-CM were identified during a mean follow-up of 2.3 years among patients without cardiomyopathy.
Interpretation:
Age- and biopsy-guided screening during carpal tunnel surgery may facilitate earlier detection of ATTR-CM, particularly in high-risk populations, but earlier detection does not imply improved prognosis.
Limitations:
Absence of a screening log limits assessment of selection bias.
Lack of long-term follow-up to determine progression to cardiomyopathy.
All patients were White, limiting generalizability.
Conclusion:
Systematic age- and biopsy-guided screening during CTS surgery identified a high proportion of carpal amyloid deposition and enabled detection of predominantly early-stage ATTR-CM, highlighting the need for such screening in high-risk populations.
In a 76-week randomized trial, patients with obesity without diabetes who received survodutide achieved greater weight loss and favorable changes in several metabolic measures compared with those who received placebo.
Federal prosecutors allege that a Florida physician and research staff fabricated clinical trial records that were submitted into database systems used to evaluate investigational drugs.
