AmyloidosisNCT02792790
Carpal Tunnel Syndrome and Amyloid Cardiomyopathy
An observational study of Amyloidosis and Cardiomyopathy, run by The Cleveland Clinic at 1 site in United States.
Trial summary
The investigators will prospectively evaluate tissue samples obtained from patients undergoing carpal tunnel release surgery for amyloid in the soft tissue that is removed. Patients who have tissue that stains positive for amyloid will undergo cardiac testing to look for evidence of cardiac involvement. Read more about this study
- Who is it for?
- Ages 50 years and older
- Conditions the study is for
- Amyloidosis, Cardiomyopathy, Transthyretin Amyloidosis
- How many people
- 96 participants
- Where
- 1 siteUnited States
- Study dates
- Mar 2016to 2 Dec 2021
- Phase
- Observational
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Adult patients undergoing carpal tunnel release surgery for idiopathic carpal tunnel syndrome not responding conservative and medical management.
Who may be able to join
- Males ≥ 50 years of age
- Females ≥ 60 years of age
- Undergoing carpal tunnel release surgery (adequate symptoms are not responding to conservative management requiring surgery)
- Able to consent
- Underwent carpal tunnel surgery and biopsy within last 30 days, if the study was discussed prior to surgery by one of the study physicians.
Who cannot join
- Secondary CTS (Hemodialysis, rheumatoid arthritis, trauma)
- Known diagnosis of amyloidosis
Trial locations and contacts
1 site in 1 country.
About this study
The investigators will prospectively evaluate tissue samples obtained from patients undergoing carpal tunnel release surgery for amyloid in the soft tissue that is removed. Patients who have tissue that stains positive for amyloid will undergo cardiac testing to look for evidence of cardiac involvement.
Read the detailed description
Since the 1970s, the connection between amyloidosis and carpal tunnel syndrome has been described, with tenosynovial tissue staining positive for amyloid fibril deposition. Up to 30% of patients in prior studies with idiopathic carpal tunnel syndrome have biopsy tissue that stains positive for amyloid deposition. However, the prevalence of cardiac involvement at the time of carpal tunnel syndrome surgery has not been established. Furthermore, the role of TTR kinetic stability in the disease progression of amyloidosis is unclear.
Diagnosing TTR amyloidosis at the time of carpal tunnel involvement could lead to an earlier identification of the disease at a stage where the cardiomyopathy may be occult or less advanced. In addition, abnormal TTR kinetics may even precede tissue deposition in the flexor tendon retinaculum. As several emerging pharmacological strategies are in development that may slow or even halt TTR amyloidosis, earlier diagnosis is advantageous. Identification and implementation of therapy for prevention or early disease treatment may alter the natural history of this progressive systemic disease.
- Conditions
- Amyloidosis, Cardiomyopathy, Transthyretin Amyloidosis, Senile Systemic Amyloidosis, Carpal Tunnel Syndrome
- Keywords
- Amyloidosis, Carpal tunnel syndrome
- Medical subject headings
- Amyloidosis, Cardiomyopathies, Amyloidosis, Hereditary, Transthyretin-Related, Carpal Tunnel Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Patients with carpal tunnel syndrome. | Patients undergoing carpal tunnel release surgery. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Incidence of transthyretin (TTR) amyloidosis in patients undergoing carpal tunnel release surgery
Identify the incidence of TTR amyloid deposits in the soft tissue of patients undergoing carpal tunnel surgery for idiopathic carpal tunnel syndrome
Measured: Biopsy completed on day of surgery
Cardiac progression of transthyretin (TTR) amyloidosis in carpal tunnel biopsy-positive patients
Assess the progression of cardiac disease in patients with TTR deposits found in soft tissue removed at the time of carpal tunnel surgery
Measured: 4 years from baseline cardiac assessment.
Secondary outcomes (2)
Prevalence of abnormal transthyretin (TTR) kinetics in patients undergoing carpal tunnel surgery
Identify the prevalence of abnormal TTR kinetics in patients undergoing carpal tunnel surgery for idiopathic carpal tunnel syndrome (develop a new test that aids identification of misfolded TTR intermediates that is more specific and sensitive to diagnosis this disease in the blood or tissue)
Measured: One-time kinetics test for biopsy-negative patients; baseline kinetics and annually for 4 years in biopsy-positive patients
Early transthyretin (TTR) amyloid cardiomyopathy identification in carpal tunnel biopsy-positive patients
Investigate whether early TTR cardiomyopathy can be identified in patients who have TTR amyloid deposits identified in the soft tissue removed at the time of carpal tunnel surgery using cardiac biomarkers, echocardiography with strain, and nuclear bone scintigraphy
Measured: Baseline and annual testing for 4 years in biopsy-positive patients
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Jun 2016 (estimated)
- Study startMar 2016
- Primary completion21 Jul 2021
- Study completion2 Dec 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for AmyloidosisStudies of the same condition, open and under way.
- More trials run by The Cleveland ClinicThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 96 participants (actual)
Sponsor and investigators
- Lead sponsor
- The Cleveland Clinic
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mazen Hanna MD, The Cleveland Clinic
- Investigators
- Mazen Hanna, MD, Principal investigator, The Cleveland Clinic
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02792790
- Sponsor's protocol ID
- 16-158
- Status last verified
- Dec 2021
- First submitted
- 20 Apr 2016
- Last updated
- 22 Dec 2021
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Sperry BW, Reyes BA, Ikram A, Donnelly JP, Phelan D, Jaber WA, Shapiro D, Evans PJ, Maschke S, Kilpatrick SE, Tan CD, Rodriguez ER, Monteiro C, Tang WHW, Kelly JW, Seitz WH Jr, Hanna M. Tenosynovial and Cardiac Amyloidosis in Patients Undergoing Carpal Tunnel Release. J Am Coll Cardiol. 2018 Oct 23;72(17):2040-2050. doi: 10.1016/j.jacc.2018.07.092.
PubMed 30336828