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Tenosynovial complications identify TTR cardiac amyloidosis among patients with hypertrophic cardiomyopathy phenotype |
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| Authors: | F Cappelli M Zampieri C Fumagalli G Nardi G Del Monaco M Matucci Cerinic M Allinovi G Taborchi R Martone M Gabriele A Ungar A Moggi Pignone N Marchionni C Di Mario I Olivotto F Perfetto |
| Affiliation: | 1. From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy;2. From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy Contribution: Conceptualization (equal), Data curation (equal), Writing - original draft (equal);3. Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy Contribution: Data curation (equal), Formal analysis (equal), Investigation (equal);4. Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy Contribution: Data curation (equal), Investigation (equal), Project administration (equal);5. Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy Contribution: Data curation (equal), Formal analysis (equal), Investigation (equal), Software (equal);6. Dipartimento di Medicina Sperimentale e Clinica, Careggi University Hospital, Florence, Italy Contribution: Supervision (equal), Visualization (equal), Writing - review & editing (equal);7. From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy Contribution: Project administration (equal), Supervision (equal), Writing - review & editing (equal);8. From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy Contribution: Conceptualization (equal), Formal analysis (equal), Project administration (equal);9. From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy Contribution: Data curation (equal), Formal analysis (equal), Investigation (equal);10. From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy Contribution: Conceptualization (equal), Data curation (equal), Methodology (equal), Project administration (equal);11. Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy Contribution: Supervision (equal), Visualization (equal), Writing - review & editing (equal);12. IV Internal Medicine Division, Careggi University Hospital, Florence, Italy Contribution: Validation (equal), Visualization (equal), Writing - review & editing (equal);13. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy Division of General Cardiology, Careggi University Hospital, Florence, Italy;14. Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy Contribution: Supervision (equal), Visualization (equal), Writing - original draft (equal);15. Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy IV Internal Medicine Division, Careggi University Hospital, Florence, Italy Contribution: Conceptualization (equal), Methodology (equal), Writing - original draft (equal);16. From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy Contribution: Conceptualization (equal), Data curation (equal), Methodology (equal), Writing - original draft (equal) |
| Abstract: | Recent evidence suggests that carpal tunnel syndrome (CTS) and brachial biceps tendon rupture (BBTR) represent red flags for ATTR cardiac amyloidosis (ATTR-CA). The prevalence of upper limb tenosynovial complications in conditions entering differential diagnosis with CA, such as HCM or Anderson–Fabry disease (AFD), and hence their predictive accuracy in this setting, still remains unresolved. Objective: To investigate the prevalence of CTS and BBTR in a consecutive cohort of ATTR-CA patients, compared with patients with HCM or AFD and with individuals without cardiac disease history. Participants: Consecutive patients with a diagnosis of ATTR-CA, HCM and AFD were evaluated. A control group of consecutive patients was recruited among subjects hospitalized for noncardiac reasons and no cardiac disease history. The presence of BBTR, CTS or prior surgery related to these conditions was ascertained. Results: 342 patients were prospectively enrolled, including 168 ATTR-CA (141 ATTRwt, 27 ATTRm), 81 with HCM/AFD (N = 72 and 9, respectively) and 93 controls. CTS was present in 75% ATTR-CA patients, compared with 13% and 10% of HCM/AFD and controls (P = 0.0001 for both comparisons). Bilateral CTS was present in 60% of ATTR-CA patients, while it was rare (2%) in the other groups. BBTR was present in 44% of ATTR-CA patients, 8% of controls and 1% in HCM/AFD. Conclusions: CTS and BBTR are fivefold more prevalent in ATTR-CA patients compared with cardiac patients with other hypertrophic phenotypes. Positive predictive accuracy for ATTR-CA is highest when involvement is bilateral. Upper limb assessment of patients with HCM phenotypes is a simple and effective way to raise suspicion of ATTR-CA. |
| Keywords: | brachial biceps tendon rupture cardiac amyloidosis carpal tunnel syndrome popeye sign transthyretin |
