{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:59:19Z","timestamp":1791345559360,"version":"4.3.1"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The frequent association between transthyretin wild\u2010type (TTRwt) cardiac amyloidosis (CA) and aortic stenosis (AS) suggests a bidirectional relationship: TTRwt\u2010CA could induce AS and vice versa. Systemic manifestations may highlight this interaction: systemic amyloidogenesis would lead to systemic symptoms, CA, and AS, whereas the myocardial stresses induced by degenerative AS might promote local amyloidogenesis without systemic symptoms. Carpal tunnel syndrome (CTS) is the most frequently reported extracardiac symptom. Through a comparison of TTRwt\u2010CA patients with and without CTS, we sought to determine whether CTS serves as a reliable indicator of systemic involvement and its impact on cardiac and valvular characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>A total of 411 consecutive patients with TTRwt\u2010CA were included. CTS, present in 70.3%, was associated with a younger age (80 vs. 84 years, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), more extracardiac symptoms, and advanced CA, with greater cardiac remodeling and a higher heart\u2010to\u2010mediastinum ratio (1.63 vs. 1.54; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.012) compared to patients without CTS. AS was present in 21% and 31% of patients with and without CTS, respectively (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.024). Except for AS, these associations remained significant after adjusting for confounding factors. In severe AS, patients with CTS exclusively exhibited low\u2010flow low\u2010gradient (LFLG) AS and less severe class of aortic valvular calcium score (5.6% vs. 60%; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.006) compared to those without CTS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings suggest that CTS may delineate two phenotypes in TTRwt\u2010CA: a systemic phenotype associated with advanced CA and poorly calcified LFLG AS, and a cardiac phenotype characterized by less severe CA and a mixed pattern of highly calcified AS, suggesting disparate pathophysiologies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.20042","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T02:34:47Z","timestamp":1732847687000},"page":"186-200","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Wild\u2010type transthyretin cardiac amyloidosis and aortic stenosis: Can carpal tunnel syndrome help distinguish the chicken from the egg?"],"prefix":"10.1111","volume":"297","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2141-0821","authenticated-orcid":false,"given":"Marc\u2010Antoine","family":"Delbarre","sequence":"first","affiliation":[{"name":"Department of Internal Medicine CHU Amiens  Amiens France"},{"name":"UR 7517, MP3CV Jules Verne University of Picardie  Amiens France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gagan Deep","family":"Chadha","sequence":"additional","affiliation":[{"name":"Referral Center for Cardiac Amyloidosis Mondor Amyloidosis Network GRC Amyloid Research Institute and Cardiology Department APHP Henri Mondor Hospital  Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed\u2010Salah","family":"Annabi","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie Universit\u00e9 Laval  Qu\u00e9bec 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