Canadian Journal of Cardiology

Amyloidosis Tissue Confirmation for Tafamidis Eligibility Using Transverse Carpal Ligament and Tenosynovium Biopsy

      Tafamidis is a disease-modifying therapy recently approved for the treatment of transthyretin amyloidosis cardiomyopathy (ATTR-CM). Eligibility criteria for public reimbursement coverage in most Canadian provinces include the need for tissue biopsy confirmation of amyloidosis deposits. Carpal tunnel syndrome (CTS) is highly prevalent in ATTR-CM, and many patients require carpal tunnel release (CTR) surgery. We report our experience performing simultaneous transverse carpal ligament and flexor tenosynovium biopsy as potentially sparing endomyocardial biopsy for this indication. All patients undergoing this approach demonstrated biopsy samples positive for amyloid deposits, facilitating initiation of tafamidis therapy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fine N.M.
        • Davis M.K.
        • Anderson K.
        • et al.
        Canadian Cardiovascular Society/Canadian Heart Failure Society joint position statement on the evaluation and management of patients with cardiac amyloidosis.
        Can J Cardiol. 2020; 36: 322-334
        • Maurer M.S.
        • Schwartz J.H.
        • Gundapaneni B.
        • et al.
        Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy.
        N Engl J Med. 2018; 379: 1007-1016
        • CADTH Common Drug Review
        Canadian drug expert reimbursement recommendations: tafamidis meglumine.
        Canadian Agency for Drugs and Technology in Health, Ottawa, Ontario2020: 1-8
        • Cooper L.T.
        • Baughman K.L.
        • Feldman A.M.
        • et al.
        The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology.
        Circulation. 2007; 116: 2216-2233
        • Fine N.M.
        • Arruda-Olson A.M.
        • Dispenzieri A.
        • et al.
        Yield of noncardiac biopsy for the diagnosis of transthyretin cardiac amyloidosis.
        Am J Cardiol. 2014; 113: 1723-1727