Usefulness of contrast computed tomography to detect left ventricular apical thrombus associated with takotsubo cardiomyopathy

Ouchi, Kotaro; Nakamura, Fúmitaka; Ikutomi, Masayasu; Oshima, Tomokazu; Ishiwata, Jumpei; Shinohara, Hiroki; Kouzaki, Tsunashi; Amaki, Toshihiro

doi:10.1007/s00380-015-0637-5

Cited by 15 publications

(14 citation statements)

References 13 publications

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“… 3 , 5 , 15 Cardiac MRI and computed tomography may also be used to identify and further characterize an LV or RV thrombus. 29 , 30 However, these imaging techniques are rarely used for this purpose since the sensitivity of TTE for detection of LV thrombus is >95%.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy With a Rapidly Resolved Left Ventricular Thrombus

Anabtawi

Roldan

2017

Journal of Investigative Medicine High Impact Case Reports

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This article presents the case of a 53-year-old man who presented with acute right superficial femoral and popliteal arterial thrombosis for which he underwent an emergent uncomplicated thrombectomy. He denied preceding cardiovascular or neurologic symptomatology and had no history of coronary or peripheral arterial disease, trauma, hypercoagulability, or malignancy. However, he reported having several days of intense emotional stress prior to presentation. His cardiac exam was normal, his electrocardiogram showed normal sinus rhythm and nonspecific ST-T wave abnormalities, and his troponin levels were normal. Transthoracic echocardiography (TTE) revealed a large (2.4 × 2 cm) apical left ventricle (LV) thrombus, LV apical akinesis, and LV ejection fraction of 40% to 45%. Coronary angiography revealed only luminal irregularities. A repeat TTE performed 3 days after initiating unfractionated heparin revealed complete resolution of the LV thrombus. The patient had an uneventful clinical course and was discharged home in stable condition on oral anticoagulants. The lower incidence of LV thrombus in takotsubo cardiomyopathy (TC) of 1.3% in comparison to 4% to 8% in acute myocardial infarction due to coronary artery disease in the current era of early reperfusion may be explained by the lower extent of ischemic myocardial necrosis associated with TC. This case suggests that the lower extent of myocardial necrosis in TC may also lead to faster resolution of LV thrombus. Therefore, earlier follow-up with TTE (within 2 weeks) and shorter duration of anticoagulation (<3 months) may be considered in patients with TC complicated by LV thrombus formation with or without systemic embolism.

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Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy With a Rapidly Resolved Left Ventricular Thrombus

Anabtawi

Roldan

2017

Journal of Investigative Medicine High Impact Case Reports

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“…CMR imaging 5 days after admission detected the LVT. Contrast computed tomography but not echocardiography has clearly depicted a LVT in a case report …”

Section: Detection Of Lvt and Treatment Of Thrombo‐embolism In Tsmentioning

confidence: 95%

Thrombo‐embolic complications in takotsubo syndrome: Review and demonstration of an illustrative case

Y‐Hassan

Holmin

Abdula

et al. 2019

Clinical Cardiology

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Thrombo‐embolism is one of the serious complications of takotsubo syndrome (TS) in addition to heart failure, pulmonary edema, cardiogenic shock, cardiac arrest, life‐threatening arrhythmias, left ventricular outlet tract obstruction, mitral regurgitation, cardiac rupture, and death. The most common cardio‐embolic events in TS are cerebral, renal, and peripheral embolism. Approximately, one‐third of patients with left ventricular thrombus (LVT) in TS develop embolic complications. Cardio‐embolism in TS may occur with or without the presence of detectable LVT. In the present report, the thrombo‐embolic complications in TS with the emphasis on the association of TS to both acute coronary syndrome (ACS) including coronary embolism and ischemic stroke including cerebral embolism are reviewed. This serious complication is elucidated by demonstration of the case of a 67‐year‐woman with mid‐apical TS complicated by LVT, left anterior descending artery (LAD) and left middle cerebral artery (segment M2) thrombo‐embolic occlusions. The cerebral artery thrombotic occlusion was treated successfully with endovascular thrombectomy with complete resolution of the neurological deficits. There was spontaneous recanalization of the apical LAD occlusion verified by cardiac computed tomography angiography.

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“…Haghi, D. et al, have stated that elevated serum CRP levels and thrombocytosis indicate higher risk of developing thrombi [8] and Ouchi, K. et al, have suggested D-dimer levels as a screening test for thrombosis [14]. In our patient, CRP was not significantly elevated and the platelet count was normal.…”

Section: Discussionmentioning

confidence: 47%

Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

Herath

Pahalagamage

Lindsay

et al. 2017

BMC Cardiovasc Disord

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BackgroundTakotsubo cardiomyopathy is characterized by transient systolic dysfunction of the apical and mid segments of the left ventricle in the absence of obstructive coronary artery disease. Intraventricular thrombus formation is a rare complication of Takotsubo cardiomyopathy and current data almost exclusively consists of isolated case reports and a few case series. Here we describe a case of Takotsubo cardiomyopathy with formation of an apical thrombus within 24 h of symptom onset, which has been reported in the literature only once previously, to the best of our knowledge. We have reviewed the available literature that may aid clinicians in their approach to the condition, since no published guidelines are available.Case presentationA 68-year-old Sri Lankan female presented to a local hospital with chest pain. Electrocardiogram (ECG) showed ST elevation, and antiplatelets, intravenous streptokinase and a high dose statin were administered. Despite this ST elevation persisted; however the coronary angiogram was negative for obstructive coronary artery disease. Echocardiogram revealed hypokinesia of the mid and apical segments of the left ventricle with typical apical ballooning and a sizable apical thrombus. She had recently had a viral infection and was also emotionally distressed as her sister was recently diagnosed with a terminal cancer. A diagnosis of Takotsubo cardiomyopathy was made and anticoagulation was started with heparin and warfarin. The follow up echocardiogram performed 1 week later revealed a small persistent thrombus, which had completely resolved at 3 weeks.ConclusionThough severe systolic dysfunction is observed in almost all the patients with Takotsubo cardiomyopathy, intraventricular thrombus formation on the first day of the illness is rare. The possibility of underdiagnosis of thrombus can be prevented by early echocardiogram in Takotsubo cardiomyopathy. The majority of reports found in the literature review were of cases that had formed an intraventriclar thrombus within the first 2 weeks, emphasizing the importance of follow up echocardiography at least 2 weeks later. The management of a left ventricular thrombus in Takotsubo cardiomyopathy is controversial and in most cases warfarin and heparin were used for a short duration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0616-0) contains supplementary material, which is available to authorized users.

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Usefulness of contrast computed tomography to detect left ventricular apical thrombus associated with takotsubo cardiomyopathy

Cited by 15 publications

References 13 publications

Takotsubo Cardiomyopathy With a Rapidly Resolved Left Ventricular Thrombus

Takotsubo Cardiomyopathy With a Rapidly Resolved Left Ventricular Thrombus

Thrombo‐embolic complications in takotsubo syndrome: Review and demonstration of an illustrative case

Takotsubo cardiomyopathy complicated with apical thrombus formation on first day of the illness: a case report and literature review

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