Biopsies taken during carpal tunnel decompression surgery may help doctors better detect patients at early risk of transthyretin amyloid cardiomyopathy (ATTR-CM), according to a study recently published in JACC: Heart Failure.
Scientists have known that a history of carpal tunnel syndrome makes the presence of ATTR-CM more likely. Therefore, the study’s authors wanted to learn if taking a biopsy during surgery to treat carpal tunnel could help diagnose ATTR-CM at earlier stages.
The researchers conducted a study across various medical centers in the United Kingdom that treated patients over 50 years of age who required carpal tunnel decompression and were able to provide biopsy samples for amyloid analysis.
What are amyloid fibrils?
In ATTR-CM, amyloid fibrils are clumps of faulty, misfolded TTR proteins that are deposited in the heart, nerves and internal organs. In the heart, fibrils affect the left ventricle, causing the heart tissue to thicken and stiffen. This makes it more difficult for the heart to pump blood around the body and can lead to heart failure.
A total of 555 patients were included in this study. The majority of patients (60.3%) who required carpal tunnel decompression had symptoms in both hands. After biopsies were extracted and analyzed, amyloid fibrils were identified in 216 cases (39%).
Read more about ATTR-CM testing and diagnosis
Of these 216 patients, 116 consented to undergo assessments for heart health. Heart scintigraphy — an imaging test that shows how well blood flows through the heart — found amyloid fibrils in the heart muscle tissues in 32 (28%) of these patients. A total of 10 patients were offered treatment for ATTR-CM after test results confirmed they had significant signs of the disease, and 22 patients suspected to have an earlier stage of ATTR-CM began close annual monitoring.
In addition, two patients were diagnosed with light-chain amyloidosis (a form of amyloidosis caused by a different protein misfolding than in ATTR-CM), enabling them to receive chemotherapy at a timely manner.
“Biopsies obtained at decompressive carpal tunnel surgery in a cohort of patients >50 years of age identified a substantial proportion of individuals with ATTR deposition,” allowing “better understanding of the initial natural history and enable early diagnosis of ATTR-CM,” the study’s authors concluded.
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