Evaluation of strain echocardiography and atrial electromechanical delay in patients with idiopathic carpal tunnel syndrome

Year 2022, Volume: 5 Issue: 5, 1385 - 1389, 25.09.2022

Bekir Çalapkorur , Mustafa Gök , Ömer Faruk Bolattürk , Erkan Demirci , Yücel Yılmaz

https://doi.org/10.32322/jhsm.1143836

Abstract

Aim: Carpal tunnel syndrome (CTS) could be an early marker for amyloidosis before developing of overt symptoms of cardiac amyloidosis (CA). CA characterized with left ventricular (LV) diastolic dysfunction and impairment of LV deformation-based parameters. There is limited data about echocardiographic parameters such as strain value of LV, diastolic parameters and atrial EMD in patients with idiopathic CTS. In this study, we investigated LV strain values, diastolic parameters of LV and atrial EMD in patients with idiopathic CTS. Then, we compared these parameters in CTS patients to control group.
Material and Method: Thirty-four patients with idiopathic CTS and twenty-four aged and sex matched volunteers were enrolled to study. Patients with known amyloidosis, heart failure, diabetes mellitus and secondary etiologic states for CTS such as trauma or rheumatologic disease were excluded from the study. ECG and echocardiographic examination of each patient were performed and recorded by cardiology specialist. Conventional and strain imaging echocardiography were performed. Atrial electromechanical delays (EMD) were measured.
Results: Baseline characteristics features were not different in groups. Mitral inflow velocities (mitral E and A wave), mitral E wave deceleration time, tissue Doppler velocities (lateral annular E’ and A wave), E/A and E/E’ ratios were similar in two groups. Septal basal strain values increased in CTS group (-21.3±4.83% vs -25.7±2.96%, p<0.001). Septal apical to base ratio (SAB) and relative apical sparing (RELAPS) were increased in CTS group compared to control group (0.94±0.43 vs 0.66±0.12, 0.90±0.31 vs 0.73±0.08, p=0.004, p=0.013, respectively). PA lateral, PA septal, inter-atrial EMD and intra-atrial EMD were significantly higher in CTS group compared to control group (78.2±12.3 ms vs 70.6±9.9 ms, 64.1±8.42 ms vs 58.3±10.1 ms, 25.8±9.09 ms vs 20.7±5.31 ms, 11.68±5.11 ms vs 8.46±3.02 ms, p=0.015, p=0.023, p=0.009 and p=.008, respectively).
Conclusion: In CTS group, mean basal strain decreased compared to control group. SAB and RELAPS which associate with CA, decreased in CTS group. Atrial EMD prolonged in CTS group. These changes may associate with increased risk of CA and AF in patients with CTS.

Keywords

Carpal tunnel syndrome, strain echocardiography, atrial electromechanical delay

References

• Sperry BW, Reyes BA, Ikram A, et al. Tenosynovial and cardiac amyloidosis in patients undergoing carpal tunnel release. J Am Coll Cardiol 2018; 72: 2040–50.
• González-López E, Gallego-Delgado M, Guzzo-Merello G, et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J 2015; 36: 2585–94.
• Anon. Updated Clinical Practice Guidelines on Heart Failure: An International Alignment. Eur Heart J Oxford Academic. Available at: https://academic.oup.com/eurheartj/article/37/27/2096/1749531. Accessed June 20, 2022.
• Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2017; 14: 591–602.
• Fosbøl EL, Rørth R, Leicht BP, et al. Association of carpal tunnel syndrome with amyloidosis, heart failure, and adverse cardiovascular outcomes. J Am Coll Cardiol 2019; 74: 15–23.
• Falk RH, Quarta CC. Echocardiography in cardiac amyloidosis. Heart Fail Rev 2015; 20: 125–31.
• Phelan D, Collier P, Thavendiranathan P, et al. Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis. Heart 2012; 98: 1442–8.
• Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73: 1961–77.
• Calapkorur B, Kelesoglu S, Sarli B, Turasan A, Arinc H, Kaya MG. Atrial electromechanical delay is impaired in patients with psoriasis. Med Princ Pract 2015; 24: 30–5.
• Katz JN, Stirrat CR. A self-administered hand diagram for the diagnosis of carpal tunnel syndrome. J Hand Surg Am 1990; 15: 360–3.
• Westermark P, Sletten K, Johansson B, Cornwell GG. Fibril in senile systemic amyloidosis is derived from normal transthyretin. Proc Natl Acad Sci USA 1990; 87: 2843–5.
• Nakagawa M, Sekijima Y, Yazaki M, et al. Carpal tunnel syndrome: a common initial symptom of systemic wild-type ATTR (ATTRwt) amyloidosis. Amyloid 2016; 23: 58–63.
• Bishop E, Brown EE, Fajardo J, Barouch LA, Judge DP, Halushka MK. Seven factors predict a delayed diagnosis of cardiac amyloidosis. Amyloid 2018; 25: 174–9.
• Deniz A, Yavuz B, Aytemir K, et al. Intra-left atrial mechanical delay detected by tissue Doppler echocardiography can be a useful marker for paroxysmal atrial fibrillation. Echocardiography 2009; 26: 779–84.
• Yavuz B, Deniz A, Ertugrul DT, et al. A novel echocardiographic marker in hypertensive patients: is diastolic dysfunction associated with atrial electromechanical abnormalities in hypertension? J Clin Hypertens (Greenwich) 2010; 12: 687–92.
• Özkan S, Yılmaz ÖÇ, Yavuz B. Evaluation of atrial electromechanical properties in patients with masked hypertension. Clin Exp Hypertens 2020; 42: 527–30.
• Karabag T, Aydin M, Dogan SM, et al. Investigation of the atrial electromechanical delay duration in Behcet patients by tissue Doppler echocardiography. Eur Heart J Cardiovasc Imag 2012; 13: 251–6.
• Levy D, Anderson KM, Savage DD, Balkus SA, Kannel WB, Castelli WP. Risk of ventricular arrhythmias in left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987; 60: 560–5.
• Sood RF, Kamenko S, McCreary E, et al. Diagnosing systemic amyloidosis presenting as carpal tunnel syndrome: a risk nomogram to guide biopsy at time of carpal tunnel release. J Bone Joint Surg Am 2021; 103: 1284–94.
• Bilgin M, Yıldız BS, Tülüce K, et al. Evaluating functional capacity, and mortality effects in the presence of atrial electromechanical conduction delay in patients with systolic heart failure. Anatol J Cardiol 2016; 16: 579–86.
• Sata N, Hamada N, Horinouchi T, et al. C-reactive protein and atrial fibrillation. Is inflammation a consequence or a cause of atrial fibrillation? Jpn Heart J 2004; 45: 441–5.
• Karimi N, AbedianKenari S, Darvari F. Serum levels of inflammatory cytokines in patients with idiopathic carpal tunnel syndrome. Int J Neurosci 2021; 131: 228–32