Katharina J Ding1, Victoria L Cammann1, Konrad A Szawan1, Barbara E Stähli1, Manfred Wischnewsky2, Davide Di Vece1, Rodolfo Citro3, Milosz Jaguszewski4, Burkhardt Seifert5, Annahita Sarcon6, Maike Knorr7, Susanne Heiner7, Sebastiano Gili8, Fabrizio D'Ascenzo9, Michael Neuhaus10, L Christian Napp11, Jennifer Franke12, Michel Noutsias13, Christof Burgdorf14, Wolfgang Koenig15,16, Behrouz Kherad17,18, Lawrence Rajan19, Guido Michels20, Roman Pfister20, Alessandro Cuneo21, Claudius Jacobshagen22, Mahir Karakas23,24, Alexander Pott25, Philippe Meyer26, Jose D Arroja26, Adrian Banning27, Florim Cuculi28, Richard Kobza28, Thomas A Fischer29, Tuija Vasankari30, K E Juhani Airaksinen30, Carla Paolini31, Claudio Bilato31, Pedro Carrilho-Ferreira32, Grzegorz Opolski33, Rafal Dworakowski34, Philip MacCarthy34, Christoph Kaiser35, Stefan Osswald35, Leonarda Galiuto36, Wolfgang Dichtl37, Christina Chan38, Paul Bridgman38, Clément Delmas39, Olivier Lairez39, Ibrahim El-Battrawy40,41, Ibrahim Akin40,41, Ekaterina Gilyarova42, Alexandra Shilova42, Mikhail Gilyarov42, Martin Kozel43, Petr Tousek43, Petr Widimský43, David E Winchester44, Jan Galuszka45, Christian Ukena46, John D Horowitz47, Carlo Di Mario48, Abhiram Prasad49, Charanjit S Rihal49, Fausto J Pinto32, Filippo Crea36, Martin Borggrefe40,41, Ruediger C Braun-Dullaeus50, Wolfgang Rottbauer25, Johann Bauersachs11, Hugo A Katus12, Gerd Hasenfuß22, Carsten Tschöpe17,18, Burkert M Pieske17,18,51,52, Holger Thiele53, Heribert Schunkert15,16, Michael Böhm46, Stephan B Felix54,55, Thomas Münzel7, Jeroen J Bax56, Thomas F Lüscher57,58, Frank Ruschitzka1, Jelena R Ghadri1, Eduardo Bossone59, Christian Templin1. 1. From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin). 2. Department of Mathematics and Computer Science, University of Bremen, Germany (M.W.). 3. Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy (R.C.). 4. First Department of Cardiology, Medical University of Gdansk, Poland (M.J.). 5. Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (B.S.). 6. Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco (A. Sarcon). 7. Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.). 8. Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.G.). 9. Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Italy (F.D.). 10. Department of Cardiology, Kantonsspital Frauenfeld, Switzerland (M. Neuhaus). 11. Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.). 12. Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.). 13. Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Germany (M. Noutsias). 14. Heart and Vascular center Bad Bevensen, Germany (C. Burgdorf). 15. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K., H.S.). 16. German center for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., H.S.). 17. Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.). 18. Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.). 19. T.J. Health Partners Heart and Vascular, Glasgow, KY (L.R.). 20. Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.). 21. Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany (A.C.). 22. Clinic for Cardiology and Pneumology, Georg August University Goettingen, Germany (C.J., G.H.). 23. Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (M. Karakas). 24. German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck (M. Karakas). 25. Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Germany (A. Pott, W.R.). 26. Service de cardiologie, Hôpitaux Universitaires de Genève, Switzerland (P. Meyer, J.D.A.). 27. Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom (A.B.). 28. Department of Cardiology, Kantonsspital Lucerne, Switzerland (F. Cuculi, R.K.). 29. Department of Cardiology, Kantonsspital Winterthur, Switzerland (T.A.F.). 30. Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.). 31. Local Health Unit No. 8, Cardiology Unit, Arzignano, Vicenza, Italy (C.P., C. Bilato). 32. Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine, Universidade de Lisboa, Portugal (P.C.-F., F.J.P.). 33. Department of Cardiology, Medical University of Warsaw, Poland (G.O.). 34. Department of Cardiology, King's College Hospital, London, United Kingdom (R.D., P. MacCarthy). 35. Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.). 36. Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F. Crea). 37. University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Austria (W.D.). 38. Department of Cardiology, Christchurch Hospital, New Zealand (C.C., P.B.). 39. Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.). 40. First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe). 41. German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe). 42. Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.). 43. Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.). 44. Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville (D.E.W.). 45. Department of Internal Medicine I-Cardiology, University Hospital Olomouc, Czech Republic (J.G.). 46. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M. Böhm). 47. Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Australia (J.D.H.). 48. Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.). 49. Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A. Prasad, C.S.R.). 50. Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Germany (R.C.B.-D.). 51. German Center for Cardiovascular Research, Partner Site Berlin (B.M.P.). 52. Berlin Institute of Health, Germany (B.M.P.). 53. Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Germany (H.T.). 54. Department of Internal Medicine B, University Medicine Greifswald, Germany (S.B.F.). 55. German Centre for Cardiovascular Research, Partner Site Greifswald (S.B.F.). 56. Department of Cardiology, Leiden University Medical Centre, the Netherlands (J.J.B.). 57. Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland (T.F.L.). 58. Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom (T.F.L.). 59. A. Cardarelli Hospital, Naples, Italy (E.B.).
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 >10×103 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.
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 TTSpatients 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:TTSpatients 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 TTSpatients, 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 >10×103 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: Anil Mathew Philip; Lina James George; Kevin John John; Anu Anna George; Jemimah Nayar; Kamal Kant Sahu; Vijairam Selvaraj; Amos Lal; Ajay Kumar Mishra Journal: J Clin Transl Res Date: 2021-11-06
Authors: Anastasiia V Bairashevskaia; Sofiya Y Belogubova; Mikhail R Kondratiuk; Daria S Rudnova; Susanna S Sologova; Olga I Tereshkina; Esma I Avakyan Journal: Int J Cardiol Heart Vasc Date: 2022-03-07