Year: 2019
Type: article
Study design: Observational Study
Abstract: Objective: 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 >10×10 3 cells/μL emerged as independent predictors for thrombus formation or embolism. Conclusions: Intraventricular 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 Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01947621.
Authors: 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 Heiner, 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, K.E. Juhani Airaksinen, 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, Christian Templin
Institutions: University Hospital Zurich, University of Bremen, AOU San Giovanni di Dio e Ruggi d'Aragona, Gdańsk Medical University, University of Zurich, University of California, San Francisco, University Medical Center of the Johannes Gutenberg University Mainz, Centro Cardiologico Monzino, University of Turin, Kantonsspital Frauenfeld, Medizinische Hochschule Hannover, University Hospital Heidelberg, University Hospital in Halle, Martin Luther University Halle-Wittenberg, German Centre for Cardiovascular Research, Deutsches Herzzentrum München, Technical University of Munich, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin, University of Cologne, University Hospital Cologne, University of Göttingen, Universität Hamburg, Universität Ulm, University Hospital of Geneva, John Radcliffe Hospital, University of Oxford, Oxford University Hospitals NHS Trust, Luzerner Kantonsspital, Kantonsspital Winterthur, University of Turku, Turku University Hospital, University of Lisbon, Centro Cardiovascular da Universidade de Lisboa, Medical University of Warsaw, King's College Hospital, University Hospital of Basel, Università Cattolica del Sacro Cuore, Innsbruck Medical University, Christchurch Hospital, Hôpital Rangueil, Heidelberg University, University Medical Centre Mannheim, Medizinische Fakultät Mannheim, National Medical and Surgical Center named after N.I. Pirogov, Charles University, University Hospital Kralovske Vinohrady, University of Florida, University Hospital Olomouc, Universitätsklinikum des Saarlandes, Basil Hetzel Institute, Queen Elizabeth Hospital, The University of Adelaide, Azienda Ospedaliero-Universitaria Careggi, Mayo Clinic, Otto-von-Guericke-Universität Magdeburg, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Leipzig Heart Institute, University Hospital Leipzig, Universitätsmedizin Greifswald, Universität Greifswald, Leiden University, Leiden University Medical Center, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Imperial College London, Ospedale Antonio Cardarelli
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2990568130