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. 2016 Jul 12:10:117-22.
doi: 10.4137/CMC.S38151. eCollection 2016.

Prevalence, Clinical Characteristics, and Predictors of Patients with Thromboembolic Events in Takotsubo Cardiomyopathy

Ibrahim El-Battrawy  1 , Michael Behnes  2 , Dennis Hillenbrand  3 , Darius Haghi  3 , Ursula Hoffmann  3 , Theano Papavassiliu  1 , Siegfried Lang  1 , Christian Fastner  3 , Tobias Becher  3 , Stefan Baumann  3 , Felix Heggemann  3 , Jürgen Kuschyk  3 , Martin Borggrefe  1 , Ibrahim Akin  1
Affiliations

Prevalence, Clinical Characteristics, and Predictors of Patients with Thromboembolic Events in Takotsubo Cardiomyopathy

Ibrahim El-Battrawy et al. Clin Med Insights Cardiol. .

Abstract

Background: Several acute complications related to takotsubo cardiomyopathy (TTC) have been documented recently. However, the incidence and clinical significance of acute thromboembolic events in TTC is not well established.

Methods: A detailed investigation of the clinical characteristics and in-hospital complications of 114 consecutive patients diagnosed with TTC between January 2003 and September 2015 was carried out. This study was initiated to reveal the predictors, clinical significance, and short-term and long-term outcomes of patients with TTC associated with acute thromboembolic events on index presentation.

Results: The incidence of acute thromboembolic events related to TTC was around 12.2%, and these included ventricular thrombi, cerebrovascular events, retinal and brachial artery pathologies, renal, splenic, and aortic involvement. The most frequent complication on initial presentation was cardiogenic shock (20%) accompanied with pulmonary congestion (20%). Interestingly, patients experiencing thromboembolic events had higher C-reactive protein (CRP) levels as compared to the non-thromboembolic group (P = 0.02). Certain thromboembolic events were characterized by the presence of ST-segment elevation in electrocardiogram (P = 0.02). Chest pain was the primary symptom in these patients (P = 0.09). Furthermore, there was significant right ventricular involvement (as assessed by transthoracic echocardiography) in patients presenting with an acute thromboembolic event (P = 0.08). A Kaplan-Meier analysis indicated a significantly higher mortality rate over a mean follow-up of three years in the thromboembolic group than the non-thromboembolic group (log-rank, P = 0.02).

Conclusions: Our results confirmed the relative common occurrence of thromboembolic events in the setting of TTC. Inflammation might play an important role in the development of thromboembolic events, and a right ventricular involvement and ST-segment elevation could be positive predictors for this occurrence. In order to circumvent the risk of a negative outcome, it is recommended that an anticoagulation therapy be initiated in all high-risk patients.

Keywords: LV thrombus; stroke; takotsubo cardiomyopathy; thromboembolic events.

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Figures

Figure 1
Figure 1
Survival rate in TTC patients with and without thromboembolic events.
See this image and copyright information in PMC

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