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.
