Abstract：
BACKGROUND: Amyloid deposition in tenosynovial structures precedes cardiac involvement up to 20 years. Therefore, a cardiological screening in patients with a history of tenosynovial manifestations of cardiac amyloidosis (CA) could lead to an increased number of early diagnoses.
METHODS: Patients with tenosynovial manifestations of CA (carpal tunnel syndrome, atraumatic biceps tendon rupture, lumbar spinal stenosis) have been identified by general practitioners and evaluated in a Referral Center for CA. Patients with a high suspicion of CA underwent the CA diagnostic pathway.
RESULTS: Among 50 General Practitioners (GP) contacted, 10 (20%) agreed to participate in the study for a total of 5615 patients ≥60 years. One hundred forty-five patients met the inclusion criteria, 2 of them already had a diagnosis of CA, and 57 agreed to undergo a cardiological evaluation (electrocardiography, echocardiography, NTproBNP assay). The median age was 73 [67-80] years and 31 (54%) were women. Eight patients were suggested to start the CA diagnostic pathway, five of them underwent a complete diagnostic evaluation for CA, three refused to complete the diagnostic exams and no new diagnoses were made.
CONCLUSIONS: A screening program for CA in patients with tenosynovial manifestations identified by general practitioners is feasible, but may not yield a high rate of new diagnosis. In this study, we identified two patients who already had a diagnosis of CA, and among patients at high risk for CA, 37% refused to complete the diagnostic pathway. Increased awareness of CA among patients might increase participation and diagnostic yield in screening studies. Further validation of this protocol is needed to evaluate its diagnostic performance.
METHODS: Patients with tenosynovial manifestations of CA (carpal tunnel syndrome, atraumatic biceps tendon rupture, lumbar spinal stenosis) have been identified by general practitioners and evaluated in a Referral Center for CA. Patients with a high suspicion of CA underwent the CA diagnostic pathway.
RESULTS: Among 50 General Practitioners (GP) contacted, 10 (20%) agreed to participate in the study for a total of 5615 patients ≥60 years. One hundred forty-five patients met the inclusion criteria, 2 of them already had a diagnosis of CA, and 57 agreed to undergo a cardiological evaluation (electrocardiography, echocardiography, NTproBNP assay). The median age was 73 [67-80] years and 31 (54%) were women. Eight patients were suggested to start the CA diagnostic pathway, five of them underwent a complete diagnostic evaluation for CA, three refused to complete the diagnostic exams and no new diagnoses were made.
CONCLUSIONS: A screening program for CA in patients with tenosynovial manifestations identified by general practitioners is feasible, but may not yield a high rate of new diagnosis. In this study, we identified two patients who already had a diagnosis of CA, and among patients at high risk for CA, 37% refused to complete the diagnostic pathway. Increased awareness of CA among patients might increase participation and diagnostic yield in screening studies. Further validation of this protocol is needed to evaluate its diagnostic performance.
摘要：
背景：腱膜结构中的淀粉样蛋白沉积先于心脏受累长达20年。因此,在有心脏淀粉样变性(CA)腱鞘表现的患者中进行心脏筛查可能导致早期诊断的数量增加.
方法：具有CA（腕管综合征，无创伤肱二头肌肌腱断裂，腰椎管狭窄）已由全科医生鉴定，并在CA转诊中心进行了评估。高度怀疑CA的患者接受了CA诊断途径。
结果：在联系的50名全科医生中，10名（20％）同意参加该研究，共有5615名≥60岁的患者。一百四十五名病人符合纳入标准,其中2人已经被诊断为CA,和57同意接受心脏病评估(心电图，超声心动图,NTproBNP测定)。中位年龄为73[67-80]岁，31（54%）为女性。八名患者被建议启动CA诊断途径，其中五人接受了CA的完整诊断评估，三人拒绝完成诊断检查，也没有做出新的诊断。
结论：对全科医生确定的有腱鞘表现的患者进行CA筛查是可行的，但可能不会产生高的新诊断率。在这项研究中,我们确定了两名已经诊断为CA的患者，在CA高危患者中，37%拒绝完成诊断途径。提高患者对CA的认识可能会增加筛查研究的参与度和诊断率。需要进一步验证该方案以评估其诊断性能。
方法：具有CA（腕管综合征，无创伤肱二头肌肌腱断裂，腰椎管狭窄）已由全科医生鉴定，并在CA转诊中心进行了评估。高度怀疑CA的患者接受了CA诊断途径。
结果：在联系的50名全科医生中，10名（20％）同意参加该研究，共有5615名≥60岁的患者。一百四十五名病人符合纳入标准,其中2人已经被诊断为CA,和57同意接受心脏病评估(心电图，超声心动图,NTproBNP测定)。中位年龄为73[67-80]岁，31（54%）为女性。八名患者被建议启动CA诊断途径，其中五人接受了CA的完整诊断评估，三人拒绝完成诊断检查，也没有做出新的诊断。
结论：对全科医生确定的有腱鞘表现的患者进行CA筛查是可行的，但可能不会产生高的新诊断率。在这项研究中,我们确定了两名已经诊断为CA的患者，在CA高危患者中，37%拒绝完成诊断途径。提高患者对CA的认识可能会增加筛查研究的参与度和诊断率。需要进一步验证该方案以评估其诊断性能。
