This article reports a prospective 1-year study of peripheral nerve involvement in wild-type transthyretin amyloidosis (ATTRwt) cardiomyopathy.
Key findings from the provided abstract:
- 23 patients with ATTRwt were compared with healthy controls.
- Small-fiber loss was common: abnormal intra-epidermal nerve fiber density occurred in 47.8% of patients vs. 4.3% of controls (p = 0.002).
- Quantitative sensory testing was abnormal for nearly all measures except cold detection.
- Sensory-predominant axonal polyneuropathy was identified in 82.6% of patients.
- Greater neurological impairment was associated with higher symptom burden and fatigue.
- The study used a multimodal evaluation including:
- Neuropathy Impairment Score–Lower Limb
- Nerve conduction studies
- Quantitative sensory testing
- Serum neurofilament light chain
- Skin-biopsy assessment of intra-epidermal nerve fiber density
- Norfolk QoL-DN and Chalder Fatigue scales
Overall implication: Peripheral nerve involvement—particularly sensory and small-fiber neuropathy—may be substantially more frequent in ATTRwt than traditionally recognized, even when cardiomyopathy is the dominant clinical presentation.
