It has been suggested that systemic deposition of TTR occurs years before the onset of cardiac dysfunction.23–24 In our series, 48% of ATTRwt patients gave a history of carpal tunnel syndrome that preceded the onset of clinical symptoms of heart failure in 77%, a median of 8 years before the diagnosis of amyloidosis being made, consistent with a slowly evolving disease. This evidence concerns the gene TTR and carpal tunnel syndrome.