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Characterization of patients with cardiac amyloidosis diagnosed at the time of idiopathic carpal tunnel surgery
Session:
Sessão de Posters 14 - Amiloidose Cardíaca
Speaker:
Luís Santos
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Luís Daniel Santos; Ana Martins; Bárbara Pereira; Micaela Gonçalves; Mariana Vasconcelos; Isabel Fidalgo; Isabel Pinto; Pedro Madureira; Janete Santos; Teresa Faria; Sofia Pimenta; Elisabete Martins
Abstract
<p>ATTR amyloidosis is a multisystemic disease caused by the accumulation of misfolded proteins in various tissues. Two sites known to be prone to amyloid deposition are the heart and the tenosynovial tissue in the wrist, potentially leading to carpal tunnel syndrome (CTS). Early detection is key to initiating timely treatment.</p> <p>The CarPoS study is an ongoing clinical study which attempts to better understand how the presence of ATTR cardiac amyloidosis is associated with idiopathic CTS. In this study, patients with bilateral and idiopathic CTS enrolled for CTS surgery performed a 99mTc-DPD scintigraphy to detect possible heart involvement. So far, out of the 25 patients included, 4 (16.0%) had high myocardial uptake (Perugini grades 2 or 3) on scintigraphy. Here we present the clinical characteristics of these patients.</p> <p>All four patients were male, and their ages ranged from 76 to 87 years. All had hypertension and dyslipidemia. One patient had a history of myocardial infarction (AMI) and coronary artery bypass surgery. All patients were currently asymptomatic, with no heart failure manifestations. On electrocardiogram (EKG), two patients had a pseudo infarction pattern; the patient with previous AMI had pathological Q waves. All patients presented left ventricular hypertrophy, with maximum myocardial thickness ranging from 13 to 21mm, with an infiltrative appearance. All but one patient had a dilated left atrium. All patients had a preserved biventricular systolic function; Global Longitudinal Strain was normal in two patients and diminished in the other two. One patient had mild to moderate aortic regurgitation and another had mild to moderate aortic stenosis. On cardiac magnetic resonance, all patients presented late gadolinium enhancement, two of them with a suggestive amyloidosis pattern. Regarding biomarkers, one patient had elevated troponin I.</p> <p>Conclusion: Despite the small number of cases, our study reveals that even at an early stage of CTS, asymptomatic patients can already manifest significant cardiac changes associated with amyloidosis. These results reinforce the importance of cardiac screening in patients with CTS, who are most often evaluated by other medical specialties.</p>
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