Left ventricular thrombus formation and cardioembolic complications in patients with Takotsubo-like syndrome: A systematic review

Gregorio, Cesare de; Grimaldi, Patrizia; Lentini, Concetta

doi:10.1016/j.ijcard.2008.05.060

Cited by 136 publications

(123 citation statements)

References 28 publications

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“…CMR represents the criterion standard for thrombus detection and should be considered for optimized thrombus detection among high‐risk TTS patients for thrombus formation 17. As reported in a previous review by De Gregorio et al, LV thrombi can be mural and protruding, respectively, with a prevalence of 40% and 60% and can cause cerebrovascular thromboembolic events in 20% of patients 18. According to previous literature, protruding and mobile thrombi have been associated with an increased risk of ischemic stroke.…”

Section: Discussionmentioning

confidence: 96%

“…Angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers could have some benefit in term of improved survival at 1 year 3. β‐Blockers showed no effect on survival and recurrence rate,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 whereas calcium antagonists could be used if coronary vasospasm has been proven during coronary angiogram or with acetylcholine test 32…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

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

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“…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.

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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.

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“…16 Acute thromboembolism has also been encountered in 3 out of 21 affected individuals in a small European series. 17 Two of these 3 patients experienced embolic stroke within the first 48 hours. Very rarely, episodes of late sudden death due to cardiac rupture have been recorded.…”

Section: Syndrome Presentationmentioning

confidence: 99%

“…32 A recent systematic review reported the incidence of 2.5% for LV thrombus formation in patients with TCBS, but the thromboembolic complications were 0.8% and did not result in any fatal outcomes or the need for surgery. 17 Although life threatening, ventricular arrhythmias have been reported acutely, 15,16 there is no data incorporating the use of antiarrhythmic therapy or intracardiac defibrillator (ICD). The decision to implant an ICD could be considered based on other risk factors if the LVEF is still low after 6 to 8 weeks on maximal medical therapy.…”

Section: Treatment and Follow-upmentioning

confidence: 99%

Transient Cardiac Ballooning—The Syndrome

Gupta

Sech

Lazzara

2009

Clinical Cardiology

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Transient cardiac ballooning is usually a reversible clinical entity. A patient typically presents with chest pain, electrocardiogram (ECG) abnormalities like ST‐segment elevation (most commonly reported) or depression, and elevated cardiac enzymes, but has no or nonobstructive coronary artery disease. Left ventriculography reveals transient akinesis of the involved portion of the myocardial wall with compensatory hyperkinesis of the remaining myocardium, leading to ballooning of the noncontracting myocardial wall during systole. Acute regional myocardial dysfunction ensues, which normalizes on average within 1 to 6 weeks. The hypotheses for these pathophysiologic changes range from direct cardiac myocyte injury to postischemic myocardial stunning to neurotransmitter actions. The objective of this article is to present a succinct description of a small case series accompanied with various recently reported presentations and morphology by left ventriculogram and a detailed review of available data on underlying pathophysiology. In addition, a discussion on current diagnostic guidelines, treatment, prognosis, and potential future investigations is included. Copyright © 2009 Wiley Periodicals, Inc.

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Left ventricular thrombus formation and cardioembolic complications in patients with Takotsubo-like syndrome: A systematic review

Cited by 136 publications

References 28 publications

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

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

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Transient Cardiac Ballooning—The Syndrome

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