According to results from a study published recently in Amyloid: The Journal of Protein Folding Disorders, 16% of patients who received surgery for lumbar spinal stenosis (LSS) developed transthyretin amyloid cardiomyopathy (ATTR-CM) within six years.
LSS is a condition in which the spinal canal in the lower back narrows, putting pressure on the spinal cord. The study’s results suggest that LSS could be an early sign of wild-type ATTR-CM, highlighting the potential value of cardiac monitoring in these patients.
“This study further supports the hypothesis that LSS might be a manifestation of wild type systemic ATTR and a possible early risk marker for CA [ATTR-CM],” explained the authors of this study. They continued, “Screening for ATTR amyloid cardiomyopathy in patients with LSS, with histopathologic investigation of ligament tissue and subsequent cardiac follow-up of selected patients is a potential way to find very early stages of CA of ATTR origin.”
Researchers followed 21 individuals who had undergone surgery between 2016 and 2018 and had confirmed transthyretin amyloid deposits in their ligamentum flavum.
At follow-up, nearly half had experienced other tenosynovial conditions, such as carpal tunnel syndrome or tendon ruptures, which are also linked to transthyretin amyloidosis. Advanced imaging and biomarker testing revealed small but notable changes in cardiac function over time. Three individuals displayed cardiac uptake on scintigraphy, confirming ATTR-CM, despite having no prior diagnoses of heart failure.
Read more about signs and symptoms of ATTR-CM
This study examined heart health using echocardiography, cardiac magnetic resonance imaging and nuclear imaging. The results showed a slight increase in myocardial wall thickness and small reductions in left ventricular and left atrial strain. These changes may indicate early heart involvement in individuals with a history of LSS. In two of the three confirmed cases of ATTR-CM, patients had elevated levels of troponin T and NT-proBNP, biomarkers associated with cardiac stress.
Researchers also reviewed the medical records of five patients who passed away between their initial LSS surgery and the follow-up period. Though none had been explicitly evaluated for cardiac amyloidosis, three of these individuals died from cardiovascular causes, including heart failure and sudden cardiac death. This suggests that undiagnosed ATTR-CM could contribute to heart-related mortality in this population.
Results from this study support the idea that LSS may be an early sign of systemic ATTR amyloidosis, which can progress to cardiac involvement over time. Given the increased prevalence of ATTR-CM among these patients compared to the general population, early screening and follow-up could improve detection and management.
These findings provide valuable insight for patients with a history of spinal stenosis, particularly those with additional tendon-related conditions. While ATTR-CM remains underdiagnosed, this study suggests that monitoring individuals with LSS could help identify heart disease earlier, potentially leading to better outcomes.
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