Characteristics of Carpal Tunnel Syndrome in Wild-Type Transthyretin Amyloidosis (P11-8.007)

Abstract

<h3>Objective:</h3> The purpose of our study was to evaluate the prevalence, clinical features, severity, and disease course of carpal tunnel syndrome (CTS) in wild-type transthyretin amyloidosis (wtATTR) patients, as well as the risk of recurrence following carpal tunnel release (CTR). <h3>Background:</h3> Wild-type transthyretin amyloidosis is an important cause of infiltrative cardiomyopathy, particularly in older males. Carpal tunnel syndrome is one of the most common extra-cardiac manifestations of wtATTR and can predate cardiac symptoms by 5–10 years. The association between CTS and wtATTR has been described in several case series; however, the characteristics of CTS in this population remain poorly understood. <h3>Design/Methods:</h3> This retrospective cohort study reports findings from a single-center experience of routine neurological screening of newly diagnosed wtATTR patients including nerve conduction studies. Consecutive wtATTR patients between 2014 and 2021 were included. <h3>Results:</h3> Seventy-nine wtATTR patients were included; 73 (92%) males, mean age of 79 years. Seventy-one (90%) met electrodiagnostic criteria for median neuropathy at the wrist (MNW), 50% had a prior diagnosis and 50% were newly diagnosed at screening. The majority with MNW were symptomatic (53, 67%) with moderate or severe disease (66, 84%) bilaterally (42, 53%) on electrophysiologic testing. Fifty-six percent of our asymptomatic patients had moderate disease at the time of screening. Nineteen (24%) had recurrent CTS despite previous CTR. At the time of screening, 19 (24%) were prescribed wrist splinting and 36 (46%) were referred for CTR. <h3>Conclusions:</h3> Median neuropathy at the wrist affects the vast majority of wtATTR patients. CTS was confirmed in 67% of our patients, most had bilateral disease with moderate to severe MNW on electrophysiology at the time of wtATTR diagnosis. Recurrence after CTR was seen in 27% of our patients at the time of screening, which is higher than the rate of recurrence in the general population, estimated at 3–20%. <b>Disclosure:</b> Dr. Russell has nothing to disclose. Dr. Khayambashi has nothing to disclose. Nowell Fine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology: Case Reports. The institution of Nowell Fine has received research support from Pfizer, Akcea. The institution of Dr. Chhibber has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amylyx. Dr. Chhibber has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amylyx. Dr. Hahn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Akcea. Dr. Hahn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Anylim.