Incidence and clinical significance of left ventricular thrombus in tako-tsubo cardiomyopathy assessed with echocardiography

Haghi, Dariusch; Papavassiliu, Theano; Heggemann, Felix; Kaden, Jens J.; Borggrefe, Martin; Süselbeck, Tim

doi:10.1093/qjmed/hcn017

Cited by 101 publications

(114 citation statements)

References 18 publications

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“…This is significantly higher then what is reported in the International Takotsubo Registry, 1.3% (6). It is important to point out that the International Takotsubo Registry identified patients with a follow-up diagnosis of stroke and/or transient ischemic attack.…”

Section: Resultsmentioning

confidence: 58%

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Stress-induced thrombus: prevalence of thromboembolic events and the role of anticoagulation in Takotsubo cardiomyopathy

Heckle¹,

McCoy²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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Background: Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy has a favorable prognosis with expected recovery in weeks. Left ventricular (LV) thrombus is a known complication of TCM, which can lead to embolization and potentially a stroke. The prevalence of LV thrombus and the role of anticoagulation have yet to be fully defined in this condition. Methods:We performed a search of published literature through PubMed and Scopus, which identified 282 patients with TCM in whom the incidence of LV thrombus and/or thromboembolic event was reported.In order to contrast this to the current anticoagulation strategy of atrial fibrillation, the occurrence of LV thrombus was compared to the adjusted stroke rate using the CHADS2 score.Results: Of the 282 patients identified through a literature search, 26 (9.2%) were noted to have a thromboembolic event in the setting of TCM. The incidence of thromboembolic event ranged from 5.3% to as high as 14.3%. When compared to the CH2sDS2-VASc score, the average incidence of LV thrombus in our study equated to a score between 4 and 5.Conclusions: While the occurrence of LV thrombus in TCM is variable among studies, the average incidence remains relatively high. Thus, making LV thrombus a significant complication of stress-induced cardiomyopathy. Prophylactic anticoagulation until recovery may have a role in reducing the rate of LV thrombus. Further studies will be needed to determine the rate of embolization and utility of anticoagulation in TCM.

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Section: Resultsmentioning

confidence: 58%

“…Overall, TCM is felt to be a benign process, with a similar in hospital mortality of patients with ACS (6). However, it is associated with several significant complications such as heart failure, arrhythmias, left ventricular (LV) outflow obstruction, thromboembolic events and rarely cardiac rupture.…”

Section: Introductionmentioning

confidence: 99%

Stress-induced thrombus: prevalence of thromboembolic events and the role of anticoagulation in Takotsubo cardiomyopathy

Heckle¹,

McCoy²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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“…Ischemic CVA and other cardioembolic complications are seen in patients with takotsubo cardiomyopathy due to left ventricular thrombus formation (documented in up to 8% of patients [7]). However, ischemic CVA can also precipitate takotsubo cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Followed by Neurogenic Stunned Myocardium in the Same Patient: Gradations of the Same Disease?

Dande

Pandit²,

Galin³

2011

Cardiology

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Takotsubo cardiomyopathy is a phenomenon of transient acute left ventricular dysfunction without obstructive coronary disease seen predominantly in postmenopausal women in the setting of acute emotional or physical stress. Neurocardiogenic injury from acute neurologic events such as intracranial bleeding can precipitate transient left ventricular dysfunction (termed ‘neurogenic stunned myocardium’) that may be indistinguishable from takotsubo cardiomyopathy. There is controversy about the diagnosis of takotsubo cardiomyopathy in the setting of acute neurologic disorders. We describe a case of a 67-year-old female who initially presented with takotsubo cardiomyopathy due to an acute gastrointestinal illness and 4 years later developed a recurrence in the setting of an ischemic cerebrovascular accident that was associated with more prominent EKG changes and much higher cardiac biomarker release but similar degree of left ventricular dysfunction. This case suggests that susceptibility to this disorder is likely due to patient-specific factors rather than etiology, and acute neurologic disorders should be included as precipitants of takotsubo cardiomyopathy. We also theorize that there may be patients with milder forms of stress-related cardiac injury who do not develop left ventricular dysfunction, being similar to the wide range of cardiac manifestations in patients with acute neurologic disorders. We review published literature on neurologic precipitants of takotsubo cardiomyopathy.

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“…Thrombus formation in TS is not confined to the left ventricular apex. In fact, cases where the thrombus was adjacent to one of the papillary muscles have been reported [6] . Obviously, thrombus formation can be seen in any segment with a significant degree of akinesia/dyskinesia.…”

Section: Discussionmentioning

confidence: 99%

Tako-Tsubo Syndrome: A Cardioembolic Cause of Brain Infarction

Jabiri

Mazighi

Meimoun³

et al. 2010

Cerebrovasc Dis

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Incidence and clinical significance of left ventricular thrombus in tako-tsubo cardiomyopathy assessed with echocardiography

Abstract: Our findings suggest that LV thrombus is a noteworthy complication in TC. It can occur both at initial presentation or at anytime later during the disease course. Elevated CRP levels and thrombocytosis may indicate a higher risk of thrombus formation.

Cited by 101 publications

References 18 publications

Stress-induced thrombus: prevalence of thromboembolic events and the role of anticoagulation in Takotsubo cardiomyopathy

Stress-induced thrombus: prevalence of thromboembolic events and the role of anticoagulation in Takotsubo cardiomyopathy

Takotsubo Cardiomyopathy Followed by Neurogenic Stunned Myocardium in the Same Patient: Gradations of the Same Disease?

Tako-Tsubo Syndrome: A Cardioembolic Cause of Brain Infarction

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