TTR and heart failure: A recent prospective cohort study of men ≥ 50 years and woman ≥ 60 years who presented with bilateral carpel tunnel syndrome reported a 10.2% rate of amyloid deposits.2 In another study, carpel tunnel syndrome preceded clinical heart failure in ATTR by a mean of 6.1 years.3 Bilateral carpel tunnel syndrome should now be considered an early warning signal to occult amyloidosis.