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Background/Objectives: To determine the prevalence of amyloidosis through the analysis of synovial tissue and transverse carpal ligament (TCL) in patients undergoing surgery for carpal tunnel syndrome (CTS), detect predictive factors for the presence of amyloid, and assess cardiac involvement degree. Methods: A prospective study with longitudinal cohort follow-up at a teaching hospital. Patients undergoing CTS surgery from 1 January 2019 to 31 May 2021 were included. Samples from synovial and TCL tissues were examined for amyloid presence. Multivariate analysis was used to detect predictive factors of the presence of amyloid. Patients with amyloid underwent echocardiography, laboratory analyses, and scintigraphy. Results: Two hundred and forty-six patients were included. The prevalence of amyloid was 11.4% in TCL and 12.6% in synovial tissues. Age (p = 0.035; OR 1.123), bilateral CTS symptoms (p = 0.022; OR 3.647), and trigger finger (p < 0.001; OR 3.537) were predictors of the presence of amyloid. Seventeen patients were diagnosed with transthyretin amyloidosis (ATTR) located in the carpus (no scintigraphic cardiac uptake or grade 0), one with light chain amyloidosis, eight with ATTR with cardiac involvement (grades 2-3), and five with ATTR in the carpus and scintigraphic uptake grade 1 (with normal echocardiogram and blood and urine tests). Conclusions: We detected amyloid in 12.6% of unselected consecutive patients who underwent CTS surgery. Biopsy in patients with CTS for amyloid detection, especially in elderly patients with bilateral symptoms and trigger finger, may be useful for the early diagnosis of amyloidosis, primarily due to transthyretin.

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To determine the prevalence of myocardial uptake (MU) and to identify predictors of MU in patients undergoing scintigraphy. Retrospective single-center series of technetium-99 m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scans performed from March 2017 to March 2020. All patients undergoing scintigraphy were included, except those with preexisting amyloidosis. The features of MU, patients' characteristics and comorbidities were documented. Multivariate analysis was used to find items predicting MU. A total of 3,629 99mTc-DPD scans (total 11,444) were performed in patients aged > 70. The overall prevalence of MU was 2.7% (82/3,629); 1.2% in 2017-2018, to 2% in 2018-2019, and to 3.7% in 2019-2020. The prevalence of MU in patients without suspected cardiomyopathy was 1.2%; 1.1% in 2017-2018, 1.5% in 2018-2019 and 1% in 2019-2020. There is an increase in the number of requests due to suspected cardiomyopathy from 0.2% in 2017-2018 to 1.4% in 2018-2019 and to 4.8% in 2019-2020. Age, male sex, hypertension, heart failure, atrial fibrillation, atrioventricular block, aortic stenosis, and carpal tunnel syndrome were found to be predictors of MU. In patients without heart failure, only age, atrial fibrillation, and carpal tunnel syndrome were predicted MU. The prevalence of MU in scintigraphic studies surged over time due to the incremental referrals under the indication of cardiomyopathy workup. Atrial fibrillation and carpal tunnel syndrome were predictors for MU in patients without heart failure. Identifying patients with MU and no heart failure for extended screening for ATTR can lead to an earlier diagnosis and application of novel treatments.

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BACKGROUND: Currently available antiarrhythmic agents for the treatment of atrial fibrillation (AF) have important limitations, leaving an unmet need for safe and effective therapy. Ranolazine is an approved antianginal agent with a favorable safety profile and electrophysiologic properties suggesting a potential role in the treatment of AF. OBJECTIVE: The purpose of this study was to assess the safety and efficacy of ranolazine in the prevention of AF recurrence after successful electrical cardioversion and to ascertain the most appropriate dose of this agent. METHODS: This prospective, multicenter, randomized, double-blind, placebo-control parallel group phase II dose-ranging trial randomized patients with persistent AF (7 days to 6 months) 2 hours after successful electrical cardioversion to placebo, or ranolazine 375 mg, 500 mg, or 750 mg bid. Patients were monitored daily by transtelephonic ECG. The primary end-point was the time to first AF recurrence. RESULTS: Of 241 patients randomized, 238 took at least 1 drug dose. Ranolazine proved to be safe and tolerable. No dose of the drug significantly prolonged time to AF recurrence. AF recurred in 56.4%, 56.9%, 41.7%, and 39.7% of patients in the placebo, ranolazine 375 mg, ranolazine 500 mg, and ranolazine 750 mg groups, respectively. The reduction in overall AF recurrence in the combined 500-mg and 750-mg groups was of borderline significance compared to the placebo group (P = .053) and significant compared to 375-mg group (P = .035). CONCLUSION: No dose of ranolazine significantly prolonged time to AF recurrence. However, the 500-mg and 750 mg-groups combined reduced AF recurrences, suggesting a possible role for this agent in the treatment of AF.

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La fibrilación auricular es una arritmia que aumenta la probabilidad de sufrir un ictus por tromboembolia. Por ello, el control apropiado de la coagulación debe prevenir tanto estos efectos tromboembólicos como las complicaciones hemorrágicas derivadas del tratamiento anticoagulante. Se dispone ya de los datos clínicos de fase III con el nuevo anticoagulante oral dabigatrán. Los efectos de dos dosis (110mg/12h y 150mg/12h) de este fármaco se compararon con los de warfarina (estudio RE-LY). En este artículo se exponen los resultados principales de ese ensayo clínico. Los resultados indican que el fármaco en dosis de 110mg/12h es equivalente a la warfarina respecto a la eficacia y superior en cuanto a la seguridad. La dosis de 150mg/12h es más eficaz que la warfarina para la prevención de tromboembolias, con una seguridad parecida a la de la warfarina. Así pues, dabigatrán es una alternativa al tratamiento con warfarina (AU)

Atrial fibrillation is an arrhythmia that increases the risk of thromboembolic stroke. The goal of anticoagulation therapy is to prevent both thromboembolism and the bleeding complications associated with anticoagulant treatment. The results of a phase-III clinical trial of the new oral antithrombotic drug dabigatran have just become available. The effects of two doses of this drug (i.e. 110 mg and 150 mg every 12 hours) were compared with those of warfarin in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) study. This article presents the principal results of this study. They indicate that administering 110 mg of the drug every 12 hours is as effective as giving warfarin and is safer. Furthermore, 150 mg every 12 hours is more effective than warfarin in preventing thromboembolism and has a similar safety profile. Consequently, dabigatran is an alternative to warfarin treatment (AU)

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