Cardiac MRI documented left ventricular thrombus complicating acute takotsubo syndrome: an uncommon dilemma

Singh, Varun; Mayer, Thomas A.; Salanitri, John; Salinger, Michael H.

doi:10.1007/s10554-006-9178-4

Cited by 31 publications

(26 citation statements)

References 7 publications

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“…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%

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: 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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“…Then striking differences between LVABS and AMI help to manage patients adequately. Involvement of the right ventricle [10] and a left ventricular thrombus [14] have recently been reported in Takotsubo syndrome. They reinforce the value of using cardiac MR because of its capabilities in demonstrating these abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical syndrome mimics myocardial infarction and acute coronary syndrome although typically, normal or minimal findings are noted on coronary angiography. Several reports of MRI findings in LVABS in the western population have been published so far [10][11][12][13][14][15], but none has focused on differentiating MR findings of LVABS with those of myocardial infarction. Cardiac MRI provides information on regional left ventricular function, and detailed regional perfusion can be evaluated using first-pass and delayed gadolinium-enhancement [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

MRI for the diagnosis of left ventricular apical ballooning syndrome (LVABS)

et al. 2008

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To compare MRI findings of left ventricular apical ballooning syndrome (LVABS) with those of acute myocardial infarction (AMI). Fifteen patients with a LVABS (group 1) and 25 patients with an AMI (group 2) were explored by MRI within 24 h after admission. Comparison of both groups for the number and location of myocardial segments with abnormal wall motion and abnormal perfusion or delayed enhancement was performed. The number of involved segments was higher in group 1 than in group 2 (p<0.001). In group 1, segments with abnormal wall motion were distributed in more than one vascular territory in all patients and confined to the medial, distal, and apical regions of the left ventricle. Subendocardial hypoenhancement was observed in 16/25 patients (64%) in group 2 and in none of group 1 (p<0.001). All patients in group 2 demonstrated delayed-enhancement abnormalities in a vascular distribution, whereas none in group 1 presented this abnormality (p<0.001). Diffusely distributed segmental wall-motion abnormalities and absence of first-pass perfusion hypoenhancement and of delayed enhancement at MRI help to differentiate LVABS from AMI. In the acute phase or in some difficult cases, cardiac MRI should become routine to confirm the diagnosis of LVABS.

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“…Cardiac MRI was usefully performed in 4 studies [12,16,17,34], whereas ventriculography alone in another one [27]. A 4 hour time interval was the cut-off considered as the maximum time needed to perform TTE soon after hospitalization (n = 9 patients).…”

Section: Thrombus Morphologymentioning

confidence: 99%

Cardioembolic outcomes in stress-related cardiomyopathy complicated by ventricular thrombus: A systematic review of 26 clinical studies

Gregorio

2010

International Journal of Cardiology

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Cardiac MRI documented left ventricular thrombus complicating acute takotsubo syndrome: an uncommon dilemma

Cited by 31 publications

References 7 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

MRI for the diagnosis of left ventricular apical ballooning syndrome (LVABS)

Cardioembolic outcomes in stress-related cardiomyopathy complicated by ventricular thrombus: A systematic review of 26 clinical studies

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