Diagnostic, Therapeutic, and Prognostic Implications of Carpal Tunnel Syndrome and Spinal Stenosis in Wild-type ATTR-Cardiomyopathy
Abstract
ackground: In wild-type transthyretin cardiac amyloidosis (ATTRwt-CM), the prognostic role of carpal tunnel syndrome (CTS) is unclear and that of lumbar spinal stenosis (SS) remains unexplored. Objectives: The aim was to examine the diagnostic, therapeutic, and prognostic relevance of bilateral CTS and SS in ATTRwt-CM, in relation to the tafamidis treatment. Methods: Clinical characteristics of 1,449 patients with ATTRwt-CM were evaluated in a multicenter cohort. The primary endpoint was all-cause mortality. Cox multivariable regression was used to assess mortality in patients with and without CTS and SS. Results: Preceding an ATTRwt-CM diagnosis, CTS and SS were present in 29% and 22% of patients, respectively, without sex-difference. CTS (P < 0.001), but not SS, was more prevalent among younger patients. Tenosynovial red flags and ATTRwt-CM diagnosis occurred approximately 4 years later in females vs males, with similar preceding time, suggesting later female ATTRwt-CM disease onset. Patients with vs without CTS and SS had lower National Amyloidosis Centre disease stage (P ≤ 0.001), despite similar symptomatic status. During a mean follow-up of 2.3 ± 1.8 years, 73% (1,052/1,449) of patients were initiated on tafamidis and 28% (406) died. Tafamidis was initiated more in CTS positive vs negative patients (78% vs 71%; P = 0.008), on average 2.3 years earlier (P < 0.001). More SS positive than negative patients received tafamidis (78% vs 71%; P = 0.018), but at similar age (P = 0.394). CTS (HR: 0.70; 95% CI: 0.52-0.95) and SS (HR: 0.68; 95% CI: 0.48-0.97) predicted lower mortality. Conclusions: 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.
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BibTeX
@article{debonnaire2026diagnostic,
title = {{Diagnostic, Therapeutic, and Prognostic Implications of Carpal Tunnel Syndrome and Spinal Stenosis in Wild-type ATTR-Cardiomyopathy}},
author = {Philippe Debonnaire and Karl Dujardin and Erwan Donal and Nicolas Verheyen and Matthias Dupont and Delphine Vervloet and Philippe Timmermans and Anne-Catherine Pouleur and Steven Droogmans and Victor Sarli Issa and Raluca Dulgheru and Ruxandra Jurcut and Madelien Regeer and Antoine Bondue and Emma Christiaen and Wouter l'Hoyes and Nicolas Wyseure and Mélanie Bézard and David Zach and Nora Schwegel and Robbe Knapen and Lars Buytaert and Nils de Marneffe and Robert Adam and Nina Ajmone Marsan and Francis Bonte and Nikolaas Vantomme and Ian Buysschaert and Rene Tavernier and Sander Trenson},
journal = {JACC. Advances},
year = {2026},
month = oct,
doi = {10.1016/j.jacadv.2026.102631},
url = {https://hal.science/hal-05830116v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Diagnostic, Therapeutic, and Prognostic Implications of Carpal Tunnel Syndrome and Spinal Stenosis in Wild-type ATTR-Cardiomyopathy
AU - Philippe Debonnaire
AU - Karl Dujardin
AU - Erwan Donal
AU - Nicolas Verheyen
AU - Matthias Dupont
AU - Delphine Vervloet
AU - Philippe Timmermans
AU - Anne-Catherine Pouleur
AU - Steven Droogmans
AU - Victor Sarli Issa
AU - Raluca Dulgheru
AU - Ruxandra Jurcut
AU - Madelien Regeer
AU - Antoine Bondue
AU - Emma Christiaen
AU - Wouter l'Hoyes
AU - Nicolas Wyseure
AU - Mélanie Bézard
AU - David Zach
AU - Nora Schwegel
AU - Robbe Knapen
AU - Lars Buytaert
AU - Nils de Marneffe
AU - Robert Adam
AU - Nina Ajmone Marsan
AU - Francis Bonte
AU - Nikolaas Vantomme
AU - Ian Buysschaert
AU - Rene Tavernier
AU - Sander Trenson
PY - 2026
DA - 2026/10/21
JO - JACC. Advances
DO - 10.1016/j.jacadv.2026.102631
UR - https://hal.science/hal-05830116v1
AB - ackground: In wild-type transthyretin cardiac amyloidosis (ATTRwt-CM), the prognostic role of carpal tunnel syndrome (CTS) is unclear and that of lumbar spinal stenosis (SS) remains unexplored. Objectives: The aim was to examine the diagnostic, therapeutic, and prognostic relevance of bilateral CTS and SS in ATTRwt-CM, in relation to the tafamidis treatment. Methods: Clinical characteristics of 1,449 patients with ATTRwt-CM were evaluated in a multicenter cohort. The primary endpoint was all-cause mortality. Cox multivariable regression was used to assess mortality in patients with and without CTS and SS. Results: Preceding an ATTRwt-CM diagnosis, CTS and SS were present in 29% and 22% of patients, respectively, without sex-difference. CTS (P < 0.001), but not SS, was more prevalent among younger patients. Tenosynovial red flags and ATTRwt-CM diagnosis occurred approximately 4 years later in females vs males, with similar preceding time, suggesting later female ATTRwt-CM disease onset. Patients with vs without CTS and SS had lower National Amyloidosis Centre disease stage (P ≤ 0.001), despite similar symptomatic status. During a mean follow-up of 2.3 ± 1.8 years, 73% (1,052/1,449) of patients were initiated on tafamidis and 28% (406) died. Tafamidis was initiated more in CTS positive vs negative patients (78% vs 71%; P = 0.008), on average 2.3 years earlier (P < 0.001). More SS positive than negative patients received tafamidis (78% vs 71%; P = 0.018), but at similar age (P = 0.394). CTS (HR: 0.70; 95% CI: 0.52-0.95) and SS (HR: 0.68; 95% CI: 0.48-0.97) predicted lower mortality. Conclusions: 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.
SN - 2772-963X
ER -