Incidence and treatment of left ventricular apical thrombosis in Tako-tsubo cardiomyopathy

Kurisu, Satoshi; Inoue, Ichiro; Kawagoe, Takuji; Ishihara, Masaharu; Sakai, Yuji; Nakama, Yasuharu; Maruhashi, Tatsuya; Kagawa, Eisuke; Dai, Kazuoki

doi:10.1016/j.ijcard.2008.12.208

Cited by 82 publications

(71 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thrombus in the akinetic ventricular apex is observed in 2-8% of TTC patients, occasionally leading to the occurrence of stroke or arterial embolism (65,67,68). It takes 2-5 days to develop thrombi after symptom onset, which is evaluated by using cardiac magnetic resonance imaging in early post-contrast acquisition sequences when LV function is still depressed.…”

Section: Thrombus Formationmentioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology.TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications. Owing to its widespread availability, even in emergency settings, transthoracic echocardiography plays a key role in the diagnostic assessment of TTC and contributes to an increased number of disease detection and incidence reports in contemporary clinical practice. This review focuses on the role of echocardiography in understanding the clinical prognostic implications in patients with TTC.

show abstract

Section: Thrombus Formationmentioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

show abstract

“…In our practice, it was found in 5.3% of Japanese patients during the early stage. 36 There are 2 types of apical thrombus: mural and protruding (Figure 3). The clinical importance is that the apical thrombosis is a potential source of emboli.…”

Section: Apical Thrombosismentioning

confidence: 99%

Clinical Management of Takotsubo Cardiomyopathy

Kurisu

Kihara

2014

Circ J

Self Cite

View full text Add to dashboard Cite

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp stress such as asthma attack or non-cardiac surgery have been identified in previous cases. 3 These stressors are common events that anyone may experience. Men account for a minority of cases; reports range from 4% to 13%. 6-8 In men, physical stress rather than emotional stress is much more associated with the occurrence. 7,8 ElectrocardiographyCommon abnormalities on the initial ECG are ST-segment elevation, negative T wave and subsequent QT interval prolongation (Figure 2). 3-5,9-11 There is a significant variability in frequency because these ECG changes are time-dependent. 12, 13 The typical time course of the ECG is as follows. 12 ST-segment elevation usually occurs shortly after onset. Negative T wave deepens progressively to its first negative peak, which occurs at approximately 3 days. The negative T wave becomes shallow for several days and then deepens, the second negative peak occurring at approximately 2 weeks. QT interval becomes prolonged progressively as the negative T wave deepens. These ECG changes are found in takotsubo cardiomyopathy as well as AMI, and the differential diagnosis is clinically important for appropriate management. Ogura et al reported that the absence of reciprocal changes, the absence of abnormal Q wave and the sum of ST-segment elevation in leads V4-6 more than the sum of ST-segment elevation in leads V1-3 identified takotsubo cardiomyopathy with a high sensitivity and specificity. 14 Kosuge et al recently reported that the combination of ST-segment depression in lead aVR and no STsegment elevation in lead V1, or the combination of positive T wave in lead aVR and no negative T wave in lead aVR, was more useful in identifying takotsubo cardiomyopathy. 15,16 EchocardiographyEchocardiography plays a central role in the diagnosis of takotsubo cardiomyopathy. Typically, RWMA is found in the apical to mid segments of the left ventricle, extending beyond a single coronary territory. Relative compensatory hypercontractility is often found in the basal segment. Other patterns akotsubo cardiomyopathy is an acute cardiac syndrome mimicking acute myocardial infarction (AMI), and is characterized by chest symptoms, electrocardiographic (ECG) changes and reversible regional wall motion abnormality (RWMA) in the apical to mid segments of the left ventricle. 1-5 In contrast to AMI, takotsubo cardiomyopathy exhibits RWMA independent of acute plaque rupture or myocardial ischemia with coronary atherosclerosis during the early stage. RWMA occurs in the apical to mid segments of the left ventricle, extending beyond a single coronary territory (Figure 1), and it usually resolves spontaneously within a matter of days to a few weeks.Takotsubo cardiomyopathy was first reported by Sato et al at Hiroshima City Hospital in 1990, 1-3 since when it has become increasingly recognized worldwide. Several mechanisms, including multivessel coronary artery spasm, coronary microvascular dysfunction or catecholami...

show abstract

“…Major predisposing factors associated with LV thrombosis are blood stasis, endothelial injury, and hypercoagulability. During the acute phase of Takotsubo syndrome (TTS), LV thrombi can also occur with a rate of 1.3% to 5% because of the presence of distinct transient LV regional akinesia and increased catecholamine levels 2, 3. However, there is a lack of data regarding the natural history of LV thrombi in TTS and their optimal short‐term and long‐term pharmacological management.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundLeft ventricular (LV) thrombi during Takotsubo syndrome represent a potential complication and can be associated with cerebrovascular embolic events. The aim of this study was to evaluate the exact incidence, predictors, and management strategies of LV thrombi in patients with Takotsubo syndrome.Methods and ResultsWe enrolled 541 consecutive patients in a multicenter international registry. Clinical features and echocardiographic data at admission, during hospitalization, and after 3 months were evaluated. Survival rates for long‐term follow‐up (mean 984±908 days) were recorded. Twelve Takotsubo syndrome patients (2.2%) developed LV thrombi (all female presenting with apical ballooning pattern). All patients with LV thrombi were treated with oral anticoagulation therapy; however, 2 (17%) had a stroke before treatment initiation. These patients were characterized by a higher prevalence of ST‐elevation (56% versus 16%; P<0.001) and higher troponin I levels (10.8±18.3 ng/mL versus 3.5±4.3 ng/mL; P=0.001) as compared with those without LV thrombi. At multivariate analysis including age, sex, LV ejection fraction, ST‐elevation at admission, and apical ballooning pattern, troponin I level >10 ng/mL was the only predictor for LV thrombosis (hazard ratio 6.6, confidence interval, 1.01–40.0; P=0.04). After 3 months all LV thrombi disappeared. Oral anticoagulation therapy was interrupted in all patients except 1. At long‐term follow‐up, the survival rate was not different between patients with and without LV thrombi (84% versus 85%; P=0.99).Conclusions LV thrombi have a relatively low incidence among patients with Takotsubo syndrome and were detected in female patients with apical ballooning pattern and increased troponin levels. Oral anticoagulation therapy for 3 months seems reasonable in these high‐risk patients.

show abstract

Incidence and treatment of left ventricular apical thrombosis in Tako-tsubo cardiomyopathy

Cited by 82 publications

References 13 publications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Clinical Management of Takotsubo Cardiomyopathy

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Contact Info

Product

Resources

About