# Spinal Stenosis and Carpal Tunnel Syndrome as Surrogates of Transthyretin Amyloid Cardiomyopathy

## TL;DR

This study shows that spinal stenosis and carpal tunnel syndrome are linked to higher rates of heart problems and amyloidosis, suggesting a need for cardiovascular screening in these patients.

## Contribution

The study identifies spinal stenosis and carpal tunnel syndrome as early indicators of transthyretin amyloid cardiomyopathy.

## Key findings

- LSS patients had worse survival and higher cardiovascular event rates compared to controls.
- Both LSS and CTS patients had significantly higher amyloidosis diagnosis rates than controls.
- Patients with both LSS and CTS had a 10-year amyloidosis incidence rate of 1.45%.

## Abstract

Lumbar spinal stenosis (LSS) and carpal tunnel syndrome (CTS) often predate transthyretin amyloid cardiomyopathy.

The aim of this study was to determine if patients with LSS/CTS have higher rates of cardiovascular events and worse survival, even in the absence of recognized transthyretin amyloid cardiomyopathy and the incidence of amyloidosis in patients with LSS/CTS.

Retrospective population-based cohort study of patients (cases) with LSS/CTS diagnosis between 1995 and 2015 (50-90 years old) identified through Rochester Epidemiology Project (Minnesota, USA). Cases were matched with 3 age- and sex-matched controls. Outcomes—investigated with comprehensive regression models—were heart failure, atrial arrhythmias, device implantation, composite endpoint, survival, and incident amyloidosis.

A total of 6,076 LSS cases and 16,205 controls and 6,664 CTS cases and 17,462 controls were included. Compared to controls, LSS and CTS cases had more comorbidities at baseline and higher likelihood of cardiac events. Survival was worse in LSS cases vs controls (HR: 1.26; 95% CI: 1.19-1.33; P < 0.001) but similar in CTS cases vs controls (HR: 0.95; 95% CI: 0.90-1.01; P = 0.10). For LSS and CTS groups, respectively, the 10-year rate of amyloidosis diagnosis was 1.1% (vs 0.5% for controls, cause-specific HR: 2.18; P < 0.001) and 0.9% (vs 0.3%, cause-specific HR: 2.87; P < 0.001). Patients with both LSS and CTS had a 10-year incidence rate of amyloidosis of 1.45%.

LSS and CTS were associated with increased likelihood of cardiovascular events and amyloidosis diagnosis. This highlight the importance of a dedicated assessment of cardiovascular symptoms for LSS/CTS patients, particularly if both conditions are present.