{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:55:33Z","timestamp":1790571333434,"version":"4.1.0"},"reference-count":26,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["59852013"],"award-info":[{"award-number":["59852013"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Idiopathic carpal tunnel syndrome (CTS) can frequently precede the clinical diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to comprehensively characterize the standard and advanced echocardiographic phenotype in a screening cohort of patients with CTS assessed for concurrent ATTR-CA. Methods: Thirty-three patients with idiopathic CTS underwent comprehensive standard and advanced echocardiography. The presence of concurrent ATTR-CA was assessed using 99mTc-DPD scintigraphy, allowing the stratification of the cohort into an amyloidosis group and a non-amyloidosis control group for comparative analysis. Results: Based on scintigraphy, 8 patients (24.2%) were diagnosed with presumptive ATTR-CA, acknowledging that AL amyloidosis was not systematically excluded, while 25 served as scintigraphy-negative controls. Standard echocardiography revealed greater wall thickness and worse diastolic function (p &lt; 0.001) in the scintigraphy-positive group. Advanced imaging demonstrated profound left ventricular (LV) mechanical dysfunction, with severely reduced global longitudinal strain (p &lt; 0.001) and a high prevalence of apical sparing (p &lt; 0.001). Non-invasive myocardial work (MW) analysis showed a marked reduction in Global Constructive Work (p = 0.005) and Global Work Index (p = 0.017) in scintigraphy-positive patients, despite a relatively preserved LV ejection fraction. Multi-chamber strain analysis unmasked a pan-cardiac myopathy in the amyloid group, characterized by severe impairment of right ventricular (RV) global strain (p = 0.004) and profound depression of both left (p = 0.002) and right (p &lt; 0.001) atrial reservoir strains. Conclusions: In patients with CTS, positive scintigraphy is characterized by severe, afterload-adjusted LV mechanical failure and profound biatrial and RV dysfunction. Advanced multi-chamber strain and MW indices show potential as non-invasive markers to help identify previously unrecognized pan-cardiac amyloid infiltration, guiding prompt diagnostic referral.<\/jats:p>","DOI":"10.3390\/diagnostics16193124","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:31:14Z","timestamp":1790353874000},"page":"3124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advanced Echocardiography and Myocardial Work in Idiopathic Carpal Tunnel Syndrome with Presumptive Concurrent Cardiac Amyloidosis: An Exploratory Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3708-4529","authenticated-orcid":false,"given":"Raquel","family":"Machado","sequence":"first","affiliation":[{"name":"Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"},{"name":"Escola Superior de Sa\u00fade, Universidade T\u00e9cnica do Porto, 4200-072 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9778-7951","authenticated-orcid":false,"given":"Sara","family":"Maia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9718-2047","authenticated-orcid":false,"given":"Emanuel","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Palma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Moreira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0048-5290","authenticated-orcid":false,"given":"Laura","family":"Vieira","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5871-7552","authenticated-orcid":false,"given":"Manuela","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7581-4074","authenticated-orcid":false,"given":"Ana","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Pimenta","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janete","family":"Santos","sequence":"additional","affiliation":[{"name":"RISE-Health, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6944-2953","authenticated-orcid":false,"given":"Elisabete","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1016\/j.jacc.2019.04.003","article-title":"Transthyretin Amyloid Cardiomyopathy","volume":"73","author":"Ruberg","year":"2019","journal-title":"J. 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Heart Fail."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1016\/j.jacc.2018.07.092","article-title":"Tenosynovial and Cardiac Amyloidosis in Patients Undergoing Carpal Tunnel Release","volume":"72","author":"Sperry","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.jcmg.2019.07.015","article-title":"How to Image Cardiac Amyloidosis: A Practical Approach","volume":"13","author":"Dorbala","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s44156-023-00028-7","article-title":"British Society of Echocardiography guideline for the transthoracic echocardiographic assessment of cardiac amyloidosis","volume":"10","author":"Moody","year":"2023","journal-title":"Echo Res. 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