… protocol at the Cleveland Clinic surgery centers for carpal tunnel release patients, according to Sperry and colleagues.
If a man older than 50 or a woman older than 60 has bilateral carpal tunnel symptoms or a prior carpal tunnel release, the protocol suggests they receive a tissue biopsy with Congo red (Thioflavin-S). Similarly, a tissue biopsy should be performed if a patient either meets the age criteria or has bilateral symptoms/prior release surgery, plus at least one of the following: spinal stenosis, biceps tendon rupture, history of atrial fibrillation or flutter, a pacemaker, congestive heart failure or a family history of ATTR.
“If Congo red staining is positive, prompt typing with mass spectrometry and referral to an amyloidosis specialist is recommended,” Sperry and coauthors recommended. “We believe that the low cost of screening patients for amyloidosis at the time of carpal tunnel release surgery may avert the expense of progressive heart failure care in patients diagnosed early.”
One limitation of the study is its low number of black participants—important considering that “3 percent to 4 percent of African Americans in the United States carry the V122I TTR gene mutation, which is a known cause of hereditary cardiac amyloidosis,” according to the authors.
Maurer and Ruberg said the study justifies larger screening efforts for cardiac amyloidosis.
“It remains to be determined which screening methodology will prove the best approach, but given the emerging nature of amyloidosis, a screening algorithm will likely be incorporated into everyday clinical practice in the near future,” they wrote.