Sugiura Kenta, Kozuki Hiroki, Ueba Hiroaki, Kubo Toru, Ochi Yuri, Baba Yuichi, Miyagawa Kazuya, Noguchi Tatsuya, Hirota Takayoshi, Yamasaki Naohito, Wada Noriko, Nakashima Junko, Murakami Ichiro, Ikeuchi Masahiko, Kitaoka Hiroaki
Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan.
Department of Orthopedic Surgery, Kochi Medical School, Kochi University Nankoku Japan.
Circ Rep. 2021 May 27;3(6):338-344. doi: 10.1253/circrep.CR-21-0046.
Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is a life-threatening progressive disease. Recent studies have shown that the detection of transthyretin (TTR) amyloid in tenosynovial tissue may play an important role in the diagnosis of cardiac amyloidosis. The aim of this study was to determine the prevalence of TTR amyloid deposits in surgical tissue of patients undergoing carpal tunnel surgery and to clarify the clinical significance of concomitant cardiac examination with Tc-labeled pyrophosphate (Tc-PYP) scintigraphy in those patients with TTR deposition. We evaluated 79 consecutive patients undergoing carpal tunnel release surgery and biopsy of tenosynovial tissue. The mean (±SD) age of the patients at surgery was 71.6±12.5 years (range 30-95 years); 32 patients (41%) were male. TTR amyloid deposition in tenosynovial tissue was observed in 27 patients (34%). Sixteen of those 27 patients underwent Tc-PYP scintigraphy. Of those 16 patients, 3 (19%) had Grade 2 uptake on Tc-PYP scintigraphy. None of the 3 patients with a diagnosis of ATTRwt-CA had apparent cardiac symptoms and left ventricular wall thickness >13 mm. Concomitant cardiac examination with Tc-PYP scintigraphy in patients who had TTR amyloid deposition in tenosynovial tissue resulted in the identification of 19% of patients with a diagnosis of ATTRwt-CA. This diagnostic approach seems to be useful for the early diagnosis of the disease.
野生型转甲状腺素蛋白心脏淀粉样变性（ATTRwt-CA）是一种危及生命的进行性疾病。最近的研究表明，在腱鞘组织中检测转甲状腺素蛋白（TTR）淀粉样蛋白可能在心脏淀粉样变性的诊断中发挥重要作用。本研究的目的是确定接受腕管手术患者手术组织中TTR淀粉样蛋白沉积的患病率，并阐明在那些有TTR沉积的患者中，用锝标记焦磷酸盐（Tc-PYP）闪烁扫描进行心脏检查的临床意义。我们评估了79例连续接受腕管松解手术和腱鞘组织活检的患者。手术时患者的平均（±标准差）年龄为71.6±12.5岁（范围30-95岁）；32例患者（41%）为男性。在27例患者（34%）的腱鞘组织中观察到TTR淀粉样蛋白沉积。这27例患者中有16例接受了Tc-PYP闪烁扫描。在这16例患者中，3例（19%）在Tc-PYP闪烁扫描中有2级摄取。3例诊断为ATTRwt-CA的患者均无明显心脏症状，左心室壁厚度>13 mm。在腱鞘组织中有TTR淀粉样蛋白沉积的患者中，用Tc-PYP闪烁扫描进行心脏检查，结果发现19%的患者诊断为ATTRwt-CA。这种诊断方法似乎对该疾病的早期诊断有用。
