Heart failure & cardiomyopathiesCohort study
Diagnostic, Therapeutic, and Prognostic Implications of Carpal Tunnel Syndrome and Spinal Stenosis in Wild-type ATTR-Cardiomyopathy
- multicenter cohort
Authors' conclusion
Both CTS and SS not only enable early ATTRwt-CM diagnosis and treatment initiation, but independently relate to improved survival, potentiating a role for opportunistic screening.
Study context
- Population
- Patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CM)patients with ATTRwt-CM
- Participants
- 1,449 patients
- Exposure
- patients with and without carpal tunnel syndrome (CTS) and spinal stenosis (SS)
- Outcome
- All-cause mortality
- Follow-up
- Mean 2.3 ± 1.8 years
Main finding
As reported in the abstract
Hazard ratio (95% CI)
CTS vs without CTS
0.70(0.52–0.95)
SS vs without SS
0.68(0.48–0.97)
- died
- 28% (406)
Observational data: associations, not effects.
Further findings
Tafamidis initiation
| Outcome | CTS | without CTS | SS | without SS |
|---|---|---|---|---|
| Prevalence of CTS and SS preceding ATTRwt-CM diagnosis | 29% | Not reported in the abstract | 22% | Not reported in the abstract |
- Prevalence of CTS and SS preceding ATTRwt-CM diagnosis — CTS, but not SS, more prevalent among younger patients
- P < 0.001
- Tafamidis initiation — initiated on tafamidis overall
- 73% (1,052/1,449)
- Tafamidis initiation — CTS vs without CTS
- P = 0.008
- Tafamidis initiation — CTS: on average earlier
- 2.3 years earlier (P < 0.001)
- Tafamidis initiation — SS vs without SS
- P = 0.018
- Tafamidis initiation — SS: at similar age
- P = 0.394
Prevalence of CTS and SS preceding ATTRwt-CM diagnosis
- without sex-difference
Timing by sex
- Tenosynovial red flags and ATTRwt-CM diagnosis occurred later in females vs males
- approximately 4 years
National Amyloidosis Centre disease stage
- Lower in patients with vs without CTS and SS, despite similar symptomatic status
- P ≤ 0.001
Original publication
Diagnostic, Therapeutic, and Prognostic Implications of Carpal Tunnel Syndrome and Spinal Stenosis in Wild-type ATTR-Cardiomyopathy. JACC Adv. doi:10.1016/j.jacadv.2026.102631
Summarised from the published abstract; every number is checked against it