Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0-38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×103 cells/μL emerged as independent predictors for thrombus formation or embolism. ⋯ URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.
Katharina J Ding, Victoria L Cammann, Konrad A Szawan, Barbara E Stähli, Manfred Wischnewsky, Davide Di Vece, Rodolfo Citro, Milosz Jaguszewski, Burkhardt Seifert, Annahita Sarcon, Maike Knorr, Susanne Hei... more ner, Sebastiano Gili, Fabrizio D'Ascenzo, Michael Neuhaus, L Christian Napp, Jennifer Franke, Michel Noutsias, Christof Burgdorf, Wolfgang Koenig, Behrouz Kherad, Lawrence Rajan, Guido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Mahir Karakas, Alexander Pott, Philippe Meyer, Jose D Arroja, Adrian Banning, Florim Cuculi, Richard Kobza, Thomas A Fischer, Tuija Vasankari, AiraksinenK E JuhaniKEJHeart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)., Carla Paolini, Claudio Bilato, Pedro Carrilho-Ferreira, Grzegorz Opolski, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Wolfgang Dichtl, Christina Chan, Paul Bridgman, Clément Delmas, Olivier Lairez, Ibrahim El-Battrawy, Ibrahim Akin, Ekaterina Gilyarova, Alexandra Shilova, Mikhail Gilyarov, Martin Kozel, Petr Tousek, Petr Widimský, David E Winchester, Jan Galuszka, Christian Ukena, John D Horowitz, Carlo Di Mario, Abhiram Prasad, Charanjit S Rihal, Fausto J Pinto, Filippo Crea, Martin Borggrefe, Ruediger C Braun-Dullaeus, Wolfgang Rottbauer, Johann Bauersachs, Hugo A Katus, Gerd Hasenfuß, Carsten Tschöpe, Burkert M Pieske, Holger Thiele, Heribert Schunkert, Michael Böhm, Stephan B Felix, Thomas Münzel, Jeroen J Bax, Thomas F Lüscher, Frank Ruschitzka, Jelena R Ghadri, Eduardo Bossone, and Christian Templin. less
From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin).
Arterioscler. Thromb. Vasc. Biol. 2020 Jan 1; 40 (1): 279-287.
ObjectiveTakotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0-38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×103 cells/μL emerged as independent predictors for thrombus formation or embolism.ConclusionsIntraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.