Advanced Echocardiography and Myocardial Work in Idiopathic Carpal Tunnel Syndrome with Presumptive Concurrent Cardiac Amyloidosis: An Exploratory Cross-Sectional Study.
5 affiliations
- 1Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal.
- 2Escola Superior de Saúde, Universidade Técnica do Porto, 4200-072 Porto, Portugal.
- 3Department of Cardiology, Centro Hospitalar Universitário do São João, 4200-319 Porto, Portugal.
- 4Department of Rheumatology, Centro Hospitalar Universitário do São João, 4200-319 Porto, Portugal.
- 5RISE-Health, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal.
Abstract
Background/Objectives: Idiopathic carpal tunnel syndrome (CTS) can frequently precede the clinical diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to comprehensively characterize the standard and advanced echocardiographic phenotype in a screening cohort of patients with CTS assessed for concurrent ATTR-CA. Methods: Thirty-three patients with idiopathic CTS underwent comprehensive standard and advanced echocardiography. The presence of concurrent ATTR-CA was assessed using 99mTc-DPD scintigraphy, allowing the stratification of the cohort into an amyloidosis group and a non-amyloidosis control group for comparative analysis. Results: Based on scintigraphy, 8 patients (24.2%) were diagnosed with presumptive ATTR-CA, acknowledging that AL amyloidosis was not systematically excluded, while 25 served as scintigraphy-negative controls. Standard echocardiography revealed greater wall thickness and worse diastolic function (p < 0.001) in the scintigraphy-positive group. Advanced imaging demonstrated profound left ventricular (LV) mechanical dysfunction, with severely reduced global longitudinal strain (p < 0.001) and a high prevalence of apical sparing (p < 0.001). Non-invasive myocardial work (MW) analysis showed a marked reduction in Global Constructive Work (p = 0.005) and Global Work Index (p = 0.017) in scintigraphy-positive patients, despite a relatively preserved LV ejection fraction. Multi-chamber strain analysis unmasked a pan-cardiac myopathy in the amyloid group, characterized by severe impairment of right ventricular (RV) global strain (p = 0.004) and profound depression of both left (p = 0.002) and right (p < 0.001) atrial reservoir strains. Conclusions: In patients with CTS, positive scintigraphy is characterized by severe, afterload-adjusted LV mechanical failure and profound biatrial and RV dysfunction. Advanced multi-chamber strain and MW indices show potential as non-invasive markers to help identify previously unrecognized pan-cardiac amyloid infiltration, guiding prompt diagnostic referral.
Related
- Cardiac Tamponade From Lymphocytic Constrictive Pericarditis in Primary AL Amyloidosis Without Myocardial Involvement
- Myocardial work in light-chain and transthyretin-related amyloidosis with preserved ejection fraction: a cardiovascular magnetic resonance study
- An online, open-access, cost comparison tool for presumptive tuberculosis testing using low complexity, automated, nucleic acid amplification tests (LCaNAAT) versus near point-of-care (NPOCs) molecular tests
- A Progressive 99mTc-MDP Uptake in Transthyretin Cardiac Amyloidosis
- The Progressive Cardiac Uptake of 99mTc-MDP as a Clue to Transthyretin Amyloidosis
BibTeX
@article{machado2026advanced,
title = {{Advanced Echocardiography and Myocardial Work in Idiopathic Carpal Tunnel Syndrome with Presumptive Concurrent Cardiac Amyloidosis: An Exploratory Cross-Sectional Study.}},
author = {Raquel Machado and Sara Maia and Emanuel Oliveira and Pedro Palma and Helena Moreira and Laura Vieira and Manuela Fonseca and Carla Sousa and Ana Martins and Sofia Pimenta and Janete Santos and Elisabete Martins},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diagnostics16193124},
url = {https://europepmc.org/article/MED/42882279},
note = {CC BY},
}
RIS
TY - JOUR
TI - Advanced Echocardiography and Myocardial Work in Idiopathic Carpal Tunnel Syndrome with Presumptive Concurrent Cardiac Amyloidosis: An Exploratory Cross-Sectional Study.
AU - Raquel Machado
AU - Sara Maia
AU - Emanuel Oliveira
AU - Pedro Palma
AU - Helena Moreira
AU - Laura Vieira
AU - Manuela Fonseca
AU - Carla Sousa
AU - Ana Martins
AU - Sofia Pimenta
AU - Janete Santos
AU - Elisabete Martins
PY - 2026
DA - 2026/09/25
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193124
UR - https://europepmc.org/article/MED/42882279
AB - Background/Objectives: Idiopathic carpal tunnel syndrome (CTS) can frequently precede the clinical diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to comprehensively characterize the standard and advanced echocardiographic phenotype in a screening cohort of patients with CTS assessed for concurrent ATTR-CA. Methods: Thirty-three patients with idiopathic CTS underwent comprehensive standard and advanced echocardiography. The presence of concurrent ATTR-CA was assessed using 99mTc-DPD scintigraphy, allowing the stratification of the cohort into an amyloidosis group and a non-amyloidosis control group for comparative analysis. Results: Based on scintigraphy, 8 patients (24.2%) were diagnosed with presumptive ATTR-CA, acknowledging that AL amyloidosis was not systematically excluded, while 25 served as scintigraphy-negative controls. Standard echocardiography revealed greater wall thickness and worse diastolic function (p < 0.001) in the scintigraphy-positive group. Advanced imaging demonstrated profound left ventricular (LV) mechanical dysfunction, with severely reduced global longitudinal strain (p < 0.001) and a high prevalence of apical sparing (p < 0.001). Non-invasive myocardial work (MW) analysis showed a marked reduction in Global Constructive Work (p = 0.005) and Global Work Index (p = 0.017) in scintigraphy-positive patients, despite a relatively preserved LV ejection fraction. Multi-chamber strain analysis unmasked a pan-cardiac myopathy in the amyloid group, characterized by severe impairment of right ventricular (RV) global strain (p = 0.004) and profound depression of both left (p = 0.002) and right (p < 0.001) atrial reservoir strains. Conclusions: In patients with CTS, positive scintigraphy is characterized by severe, afterload-adjusted LV mechanical failure and profound biatrial and RV dysfunction. Advanced multi-chamber strain and MW indices show potential as non-invasive markers to help identify previously unrecognized pan-cardiac amyloid infiltration, guiding prompt diagnostic referral.
SN - 2075-4418
ER -