Left Ventricular Thrombi and Embolic Events in Takotsubo Syndrome despite Therapeutic Anticoagulation

Stöllberger, Claudia; Finsterer, Josef; Schneider, B.

doi:10.1159/000506925

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…According to previous studies, the incidence of stroke among TTS patients admitted to the hospital, 30 days and 1 year after disease onset, were 1-1.7, 2.8, and 4.2%, respectively (17). The pathogenic mechanism of TTS-related stroke might be cardioembolism secondary to ventricular thrombosis, as left ventricular thrombi were detected in about 1.3-5.3% of TTS cases (38). Once the ventricle function returned to normal, the thrombi might dislodge from the ventricle wall after myocardial contraction and cause cerebral embolism.…”

Section: Takotsubo Syndromementioning

confidence: 96%

Uncommon Female-Predominant Etiologies of Cryptogenic Stroke

Dong

2022

Front. Neurol.

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The etiologies of cryptogenic stroke are complex and heterogeneous. A number of uncommon etiologies are not fully recognized, some of which predominantly affect females. Most of these etiologies are closely related to the hormonal level, reproductive factors, coagulation function, and medications of females. Moreover, once cryptogenic stroke is diagnosed, females tend to have worse outcomes. Therefore, prompt etiological recognition and treatment are crucial for good recovery. The aim of this article is to review advances in exploring uncommon female-predominant etiologies of cryptogenic stroke. These etiologies are categorized into arterial, cardiac, and venous sources. Arterial vasoconstrictive narrowing, intimal injury, and intimal developmental abnormality can cause brain ischemia or artery-to-artery cerebral embolism. Myocardial contraction dysfunction, cardiac wall injury, and developmental abnormality can induce intracardiac thrombosis and lead to cardiac embolism. In addition, cortical venous thrombosis and occult venous thromboembolism via intracardiac or extracardiac channels also account for cryptogenic stroke in females. Due to the lack of knowledge, in clinical practice, the above etiologies are seldom assessed. The low incidence rate of these etiologies can lead to missed diagnosis. This review will provide novel clinical clues for the etiological diagnosis of cryptogenic stroke and will help to improve the management and secondary prevention of stroke in the female population. In the future, more studies are needed to explore the etiology and prevention strategies of cryptogenic stroke.

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Section: Takotsubo Syndromementioning

confidence: 96%

Uncommon Female-Predominant Etiologies of Cryptogenic Stroke

Dong

2022

Front. Neurol.

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“…Finally, cardiac MRI is more sensitive than echocardiography for detection of LV thrombus, 10 which is important as thrombus may occur in 1.3–5.3% of stress cardiomyopathies even in those on anticoagulation therapy. 11 Extended vascular screening with CT angiography identified features of FMD. Importantly, this did not demonstrate evidence of intracerebral aneurysms that can affect as many as 14% of patients with FMD.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection, fibromuscular dysplasia, and biventricular stress cardiomyopathy: a case report

Blazak

Holland

Basso

et al. 2022

European Heart Journal - Case Reports

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Background Spontaneous coronary artery disease (SCAD) is an important cause of acute coronary syndrome and is associated with fibromuscular dysplasia (FMD). The diagnosis of stress cardiomyopathy in patients with SCAD and FMD is uncommon, though an important consideration given the shared risk profile. Complications of severe left ventricular (LV) dysfunction associated with stress cardiomyopathy, such as LV thrombus, complicate the management of SCAD where anticoagulation is controversial in the context of SCAD-associated intramural haematoma. Case Summary A 65-year-old female presented with non-ST elevation myocardial infarction with a recent diagnosis of hypertension but no other traditional cardiovascular risk factors. There was, however, a family history of early cardiac death from myocardial infarction affecting her mother. Echocardiography demonstrated severe biventricular dysfunction with circumferential akinesis of the mid to apical segments. Coronary angiography demonstrated type 2A SCAD involving the first diagonal artery. Cardiac magnetic resonance imaging (MRI) confirmed a diagnosis of stress cardiomyopathy with biventricular involvement, complicated by LV apical thrombus and a focal region of myocardial infarction. Vascular imaging confirmed the presence of FMD. Guideline-directed heart failure therapy in addition to clopidogrel and rivaroxaban was prescribed. Follow-up contrast echocardiography at six-weeks confirmed resolution of LV dysfunction and resolution of the LV thrombus with no adverse events. Discussion The dual diagnosis of SCAD and stress cardiomyopathy is uncommon. Cardiac MRI was useful for confirming the diagnosis of stress cardiomyopathy and the presence of LV thrombus, where anticoagulation may complicate the management of intramural haematoma in patients with concomitant SCAD and FMD.

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“…According to Santoro et al, only 6.6% of Takotsubo patients develop LV thrombi, and 2.2% develop a stroke [ 45 ]. In a recent study [ 46 ], the incidence of LV thrombus formation in Takotsubo patients was between 1.3 and 5.3% but the embolic risk appeared higher, with embolic strokes occurring mostly between 41 and 120 h after the onset of symptoms. Prior case series have suggested that there is a 1% to 3% risk of ischemic stroke following a TC [ 47 ].…”

Section: Tc and Strokementioning

confidence: 99%

“…Beta-blockers are also indicated and may be helpful in the long term [ 20 , 23 ]. Whether an anticoagulant therapy is mandatory in TC remains an open issue: anticoagulation should be initiated in case of intraventricular thrombus until its dissolution and the recovery of a normal LV function [ 46 , 60 ].…”

Section: Tc Outcome and Treatmentmentioning

confidence: 99%

The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

Canavero

Rifino

Bussotti

et al. 2022

JPM

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Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies.

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Left Ventricular Thrombi and Embolic Events in Takotsubo Syndrome despite Therapeutic Anticoagulation

Cited by 7 publications

References 29 publications

Uncommon Female-Predominant Etiologies of Cryptogenic Stroke

Uncommon Female-Predominant Etiologies of Cryptogenic Stroke

Spontaneous coronary artery dissection, fibromuscular dysplasia, and biventricular stress cardiomyopathy: a case report

The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

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