Long-term multimodal study reveals peripheral nerve involvement in wild-type transthyretin amyloidosis

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.