Author + information
- Received April 12, 2019
- Accepted April 15, 2019
- Published online July 1, 2019.
- Emil L. Fosbøl, MD, PhDa,∗ (, )@Rigshospitalet@uni_copenhagen,
- Rasmus Rørth, MDa,
- Birgitte Pernille Leicht, MDb,
- Morten Schou, MD, PhDc,
- Mathew S. Maurer, MDd,
- Søren Lund Kristensen, MD, PhDe,
- Lars Kober, MD, DMSca and
- Finn Gustafsson, MD, PhD, DMSca
- aThe Heart Center, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, DenmarkThe Heart Center, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- bDepartment of Orthopedic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, DenmarkDepartment of Orthopedic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- cDepartment of Cardiology, Herlev and Gentofte University Hospital, Hellerup, DenmarkDepartment of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- dColumbia University Medical Center, New York, New YorkdColumbia University Medical Center, New York, New York
- eDepartment of Cardiology, Bispebjerg University Hospital, Copenhagen, DenmarkDepartment of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Emil L. Fosbøl, The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, 2100 KBH Ø, Copenhagen, Denmark.
Background Recent studies have suggested that transthyretin amyloidosis (ATTR) is a more common cause of heart failure (HF) than previously appreciated, and novel treatments for amyloidosis are emerging. About one-half of patients with ATTR cardiac amyloidosis have a history of carpal tunnel syndrome (CTS).
Objectives This study examined the risk of amyloidosis, HF, and other adverse cardiovascular outcomes associated with CTS relative to control subjects without CTS.
Methods Using Danish nationwide registries from 1996 to 2012, 56,032 patients were identified who underwent surgical treatment for CTS, and they were compared with a sex- and age-matched cohort (ratio 1:1) from the general population to examine their risk of amyloidosis, HF, and other adverse cardiovascular outcomes. Cumulative incidence curves and Cox proportional hazard models were used to assess differences.
Results As expected, CTS was associated with a future diagnosis of amyloidosis (hazard ratio: 12.12 [95% confidence interval: 4.37 to 33.60]). CTS was associated with a higher incidence of HF, and this held true in the adjusted analysis yielding a hazard ratio of 1.54 (95% confidence interval: 1.45 to 1.64). No significant interaction with sex was found (p = 0.5). Risk of other adverse outcomes was also associated with CTS (p < 0.0001 for atrial fibrillation, atrioventricular heart block, and pacemaker implantation).
Conclusions Patients who undergo surgical treatment for CTS are associated with a higher risk of amyloidosis and HF relative to matched control subjects from the general population. Other cardiovascular outcomes were also increased with CTS.
Dr. Maurer has served on the Advisory Board of Pfizer, Eidos, AKCEA, and Prothena; has served on the Steering Committee of Pfizer; has served as a consultant for Ionis; and has served on the Data and Safety Monitoring Board of Prothena. Dr. Gustafsson has served as an advisor to Pfizer, Corvia (unpaid), and Abbott; has served as a speaker for Novartis, Abbott Orion Pharma, and Boehringer Ingelheim; and has served as an investigator for Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received April 12, 2019.
- Accepted April 15, 2019.
- 2019 American College of Cardiology Foundation
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