Cardiac amyloidosis after lumbar spinal stenosis surgery - a comprehensive prospective cohort study.

IF 7.4 2区医学 Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY

Amyloid-Journal of Protein Folding Disorders Pub Date : 2025-03-25 DOI:10.1080/13506129.2025.2481310

Per Eldhagen, Antonios Tzortzakakis, Lars H Lund, Liselott Söderström, Svante Berg, Per Westermark, Peder Sörensson

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Abstract

Background: Wild-type transthyretin (ATTRwt) amyloidosis is underdiagnosed and generally diagnosed with manifest cardiac involvement. Lumbar spinal stenosis (LSS) might be an early sign of systemic transthyretin amyloidosis and a possible screening target for early diagnosis.

Objectives: To assess the prevalence of cardiac amyloidosis (CA) 6 years post-LSS surgery, among patients with transthyretin amyloid deposits in ligamentum flavum.

Methods: Twenty-one patients who had surgery for LSS in 2016-2018 and grade 3-4 ATTR amyloid deposits in ligamentum flavum were followed up in 2022-2023, including biomarkers, echocardiography, cardiac magnetic resonance (CMR) and nuclear imaging.

Results: At follow-up, median age was 79 years, 16% (3/19) displayed cardiac uptake on scintigraphy consistent with ATTR-CA. Forty-eight percent (10/21) had a history of other tenosynovial conditions associated with ATTRwt. We observed a small increase in tissue characteristics using CMR, and a decrease in left ventricular global longitudinal strain and left atrial strain on echocardiography.

Conclusions: In this prospective cohort study, 16% were diagnosed with ATTRwt cardiomyopathy, six years following surgery for LSS. History of other tenosynovial conditions associated with ATTRwt amyloidosis was common. These findings strengthen the hypothesis that LSS is a possible manifestation of ATTRwt amyloidosis and that in selected patients with LSS, cardiac follow-up is of value.

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腰椎管狭窄手术后的心脏淀粉样变性——一项全面的前瞻性队列研究。

背景：野生型甲状腺转蛋白（ATTRwt）淀粉样变诊断不足，通常诊断为明显的心脏累及。腰椎管狭窄症（LSS）可能是全身性甲状腺转维蛋白淀粉样变的早期征兆，也是早期诊断的可能筛查目标。目的：评估lss手术后6年心脏淀粉样变性（CA）在黄韧带转甲状腺素淀粉样沉积患者中的患病率。方法：对2016-2018年手术治疗LSS和2022-2023年黄韧带3-4级ATTR淀粉样蛋白沉积的21例患者进行随访，包括生物标志物、超声心动图、心脏磁共振（CMR）和核成像。结果：随访时，中位年龄为79岁，16%（3/19）的患者在显像上显示心脏摄取与atr - ca一致。48%（10/21）患者有与attrt相关的其他腱鞘疾病史。我们观察到CMR的组织特征略有增加，超声心动图显示左心室总纵应变和左心房应变下降。结论：在这项前瞻性队列研究中，16%的患者在LSS手术后6年被诊断为ATTRwt心肌病。与attrt淀粉样变相关的其他腱鞘疾病史是常见的。这些发现加强了LSS是ATTRwt淀粉样变可能表现的假设，并且在选定的LSS患者中，心脏随访是有价值的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Amyloid-Journal of Protein Folding Disorders 生物-生化与分子生物学

CiteScore

10.60

自引率

10.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Amyloid: the Journal of Protein Folding Disorders is dedicated to the study of all aspects of the protein groups and associated disorders that are classified as the amyloidoses as well as other disorders associated with abnormal protein folding. The journals major focus points are: etiology, pathogenesis, histopathology, chemical structure, nature of fibrillogenesis; whilst also publishing papers on the basic and chemical genetic aspects of many of these disorders. Amyloid is recognised as one of the leading publications on amyloid protein classifications and the associated disorders, as well as clinical studies on all aspects of amyloid related neurodegenerative diseases and major clinical studies on inherited amyloidosis, especially those related to transthyretin. The Journal also publishes book reviews, meeting reports, editorials, thesis abstracts, review articles and symposia in the various areas listed above.