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Should we perform cardiac scintigraphy with bone tracers in patients with idiopathic carpal tunnel? Preliminary Results of CarPos Study
Session:
Posters (Sessão 5 - Écran 3) - Imagem multimodal 2
Speaker:
Sofia Pimenta
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Sofia Pimenta; Ana Martins; Bárbara Pereira; Micaela Gonçalves; Miguel Martins de Carvalho; Elsa Fonseca; Isabel Pinto; Pedro Madureira; Luís Santos; Lúcia Costa; Teresa Faria; Jorge G. Pereira; Elisabete Martins
Abstract
<p>Background: Carpal Tunnel Syndrome (CTS) in patients with left ventricular hypertrophy is a recognized red flag for cardiac amyloidosis diagnosis, particularly of the transthyretin (ATTR) subtype. In this sense, in patients with the first manifestation of CTS, the risk of future cardiac amyloidosis should be considered. However, it is not yet established if cardiac evaluation should be performed in these patients, neither when or how to do it.</p> <p>Methods: In this prospective study (NCT05409833), we include patients aged ≥ 60 years old with symptomatic CTS proposed for hand surgery. Exclusion criteria include diabetes mellitus, hypothyroidism, hemodialysis, rheumatoid arthritis, other inflammatory arthropathies, multiple myeloma, gout, chondrocalcinosis, Colles fracture, space-occupying lesions, and infectious synovitis. Basal ECG and cardiac scintigraphy with Technetium-99m-DPD were performed at the time of the preoperative study. Low voltage was defined as a QRS amplitude <5mm in the limb leads or <10 mm in the precordial leads. Synovial tissue for amyloid screening was also collected whenever possible for amyloid screening.</p> <p>Results: Until now, 16 patients were included: 6 (38%) men, mean age of 72 (± 8) years old. In three (19%) patients, cardiac scintigraphy revealed a Perugini grade 2 in one patient and a Perugini 3 in two patients. In six patients, synovial tissue was collected during surgery and in three (50%) the staining with Congo red was positive for amyloidosis. One of these 3 patients had a Perugini grade of 3 in cardiac scintigraphy. Troponin was normal except for one patient (1/11). Of the patients with amyloid protein in the synovial tissues, two had low voltage in the ECG. Of the patients with positive cardiac scintigraphy, one had a pseudo-infarction pattern. No patient had conduction abnormalities.</p> <p>Conclusion: Although these results are still preliminary, they support the need for amyloidosis screening in patients undergoing CTS surgery. In this screening, the role of synovial biopsy and/or cardiac imaging still needs more evidence before formal recommendations are implemented. Prospective studies are especially required in this subject.</p>
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