Guideline Recommendations for Statin Therapy-Reply.

Discussion | In this study of patients with HF, RBT was found in 33.3% of patients with ATTRwt and only 2.5% of patients with other causes of HF. Based on the histologic studies of tendons and ligaments in older patients, RBT may represent ATTR deposition in the biceps tendon, similar to carpal tunnel syndrome.3 This study has several limitations. Recall bias may account for some error in estimating the onset of RBT, and histologic confirmation of amyloid deposition in the tendon was not available, but it is the presence of this finding, not the precise onset, that is important. The control group included HF patients with reduced and preserved EF, but the nature of the HF should not affect RBT. Precise estimates of the prevalence of ATTRwt as a cause of HF are lacking and would affect the positive predictive value. The study was conducted at a single referral clinic and the results should be confirmed. Early diagnosis of ATTRwt is important because trials are under way investigating therapies to halt disease progression. The finding of RBT, an easily elicited diagnostic sign, in a patient with HFpEF should raise suspicion for ATTRwt. This observation underscores the continued importance of physical examination in an era of extensive diagnostic testing.