Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights from the International Takotsubo Registry

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

doi:10.1161/ATVBAHA.119.313491

Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights from the International Takotsubo Registry

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 KoenigBehrouz 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

Cardiovascular Medicine

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

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 >10×10³cells/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.

Original language	English (US)
Pages (from-to)	279-287
Number of pages	9
Journal	Arteriosclerosis, thrombosis, and vascular biology
Volume	40
Issue number	1
DOIs	https://doi.org/10.1161/ATVBAHA.119.313491
State	Published - Jan 1 2020

Keywords

Takotsubo syndrome
embolism
outcome
risk score
thrombus

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1161/ATVBAHA.119.313491

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Ding, K. J., Cammann, V. L., Szawan, K. A., Stähli, B. E., Wischnewsky, M., Di Vece, D., Citro, R., Jaguszewski, M., Seifert, B., Sarcon, A., Knorr, M., Heiner, S., Gili, S., D'Ascenzo, F., Neuhaus, M., Napp, L. C., Franke, J., Noutsias, M., Burgdorf, C., ... Templin, C. (2020). Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights from the International Takotsubo Registry. Arteriosclerosis, thrombosis, and vascular biology, 40(1), 279-287. https://doi.org/10.1161/ATVBAHA.119.313491

Ding, KJ, Cammann, VL, Szawan, KA, Stähli, BE, Wischnewsky, M, Di Vece, D, Citro, R, Jaguszewski, M, Seifert, B, Sarcon, A, Knorr, M, Heiner, S, Gili, S, D'Ascenzo, F, Neuhaus, M, Napp, LC, Franke, J, Noutsias, M, Burgdorf, C, Koenig, W, Kherad, B, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Karakas, M, Pott, A, Meyer, P, Arroja, JD, Banning, A, Cuculi, F, Kobza, R, Fischer, TA, Vasankari, T, Airaksinen, KEJ, Paolini, C, Bilato, C, Carrilho-Ferreira, P, Opolski, G, Dworakowski, R, MacCarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Dichtl, W, Chan, C, Bridgman, P, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Gilyarova, E, Shilova, A, Gilyarov, M, Kozel, M, Tousek, P, Widimský, P, Winchester, DE, Galuszka, J, Ukena, C, Horowitz, JD, Di Mario, C, Prasad, A, Rihal, CS, Pinto, FJ, Crea, F, Borggrefe, M, Braun-Dullaeus, RC, Rottbauer, W, Bauersachs, J, Katus, HA, Hasenfuß, G, Tschöpe, C, Pieske, BM, Thiele, H, Schunkert, H, Böhm, M, Felix, SB, Münzel, T, Bax, JJ, Lüscher, TF, Ruschitzka, F, Ghadri, JR, Bossone, E & Templin, C 2020, 'Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights from the International Takotsubo Registry', Arteriosclerosis, thrombosis, and vascular biology, vol. 40, no. 1, pp. 279-287. https://doi.org/10.1161/ATVBAHA.119.313491

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title = "Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights from the International Takotsubo Registry",

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 >10×103cells/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.",

keywords = "Takotsubo syndrome, embolism, outcome, risk score, thrombus",

author = "Ding, {Katharina J.} and Cammann, {Victoria L.} and Szawan, {Konrad A.} and St{\"a}hli, {Barbara E.} and Manfred Wischnewsky and {Di Vece}, Davide and Rodolfo Citro and Milosz Jaguszewski and Burkhardt Seifert and Annahita Sarcon and Maike Knorr and Susanne Heiner and Sebastiano Gili and Fabrizio D'Ascenzo and Michael Neuhaus and Napp, {L. Christian} and Jennifer Franke and Michel Noutsias and Christof Burgdorf and Wolfgang Koenig and Behrouz Kherad and Lawrence Rajan and Guido Michels and Roman Pfister and Alessandro Cuneo and Claudius Jacobshagen and Mahir Karakas and Alexander Pott and Philippe Meyer and Arroja, {Jose D.} and Adrian Banning and Florim Cuculi and Richard Kobza and Fischer, {Thomas A.} and Tuija Vasankari and Airaksinen, {K. E.Juhani} and Carla Paolini and Claudio Bilato and Pedro Carrilho-Ferreira and Grzegorz Opolski and Rafal Dworakowski and Philip MacCarthy and Christoph Kaiser and Stefan Osswald and Leonarda Galiuto and Wolfgang Dichtl and Christina Chan and Paul Bridgman and Cl{\'e}ment Delmas and Olivier Lairez and Ibrahim El-Battrawy and Ibrahim Akin and Ekaterina Gilyarova and Alexandra Shilova and Mikhail Gilyarov and Martin Kozel and Petr Tousek and Petr Widimsk{\'y} and Winchester, {David E.} and Jan Galuszka and Christian Ukena and Horowitz, {John D.} and {Di Mario}, Carlo and Abhiram Prasad and Rihal, {Charanjit S.} and Pinto, {Fausto J.} and Filippo Crea and Martin Borggrefe and Braun-Dullaeus, {Ruediger C.} and Wolfgang Rottbauer and Johann Bauersachs and Katus, {Hugo A.} and Gerd Hasenfu{\ss} and Carsten Tsch{\"o}pe and Pieske, {Burkert M.} and Holger Thiele and Heribert Schunkert and Michael B{\"o}hm and Felix, {Stephan B.} and Thomas M{\"u}nzel and Bax, {Jeroen J.} and L{\"u}scher, {Thomas F.} and Frank Ruschitzka and Ghadri, {Jelena R.} and Eduardo Bossone and Christian Templin",

year = "2020",

month = jan,

day = "1",

doi = "10.1161/ATVBAHA.119.313491",

language = "English (US)",

volume = "40",

pages = "279--287",

journal = "Arteriosclerosis, thrombosis, and vascular biology",

issn = "1079-5642",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome

T2 - Insights from the International Takotsubo Registry

AU - Ding, Katharina J.

AU - Cammann, Victoria L.

AU - Szawan, Konrad A.

AU - Stähli, Barbara E.

AU - Wischnewsky, Manfred

AU - Di Vece, Davide

AU - Citro, Rodolfo

AU - Jaguszewski, Milosz

AU - Seifert, Burkhardt

AU - Sarcon, Annahita

AU - Knorr, Maike

AU - Heiner, Susanne

AU - Gili, Sebastiano

AU - D'Ascenzo, Fabrizio

AU - Neuhaus, Michael

AU - Napp, L. Christian

AU - Franke, Jennifer

AU - Noutsias, Michel

AU - Burgdorf, Christof

AU - Koenig, Wolfgang

AU - Kherad, Behrouz

AU - Rajan, Lawrence

AU - Michels, Guido

AU - Pfister, Roman

AU - Cuneo, Alessandro

AU - Jacobshagen, Claudius

AU - Karakas, Mahir

AU - Pott, Alexander

AU - Meyer, Philippe

AU - Arroja, Jose D.

AU - Banning, Adrian

AU - Cuculi, Florim

AU - Kobza, Richard

AU - Fischer, Thomas A.

AU - Vasankari, Tuija

AU - Airaksinen, K. E.Juhani

AU - Paolini, Carla

AU - Bilato, Claudio

AU - Carrilho-Ferreira, Pedro

AU - Opolski, Grzegorz

AU - Dworakowski, Rafal

AU - MacCarthy, Philip

AU - Kaiser, Christoph

AU - Osswald, Stefan

AU - Galiuto, Leonarda

AU - Dichtl, Wolfgang

AU - Chan, Christina

AU - Bridgman, Paul

AU - Delmas, Clément

AU - Lairez, Olivier

AU - El-Battrawy, Ibrahim

AU - Akin, Ibrahim

AU - Gilyarova, Ekaterina

AU - Shilova, Alexandra

AU - Gilyarov, Mikhail

AU - Kozel, Martin

AU - Tousek, Petr

AU - Widimský, Petr

AU - Winchester, David E.

AU - Galuszka, Jan

AU - Ukena, Christian

AU - Horowitz, John D.

AU - Di Mario, Carlo

AU - Prasad, Abhiram

AU - Rihal, Charanjit S.

AU - Pinto, Fausto J.

AU - Crea, Filippo

AU - Borggrefe, Martin

AU - Braun-Dullaeus, Ruediger C.

AU - Rottbauer, Wolfgang

AU - Bauersachs, Johann

AU - Katus, Hugo A.

AU - Hasenfuß, Gerd

AU - Tschöpe, Carsten

AU - Pieske, Burkert M.

AU - Thiele, Holger

AU - Schunkert, Heribert

AU - Böhm, Michael

AU - Felix, Stephan B.

AU - Münzel, Thomas

AU - Bax, Jeroen J.

AU - Lüscher, Thomas F.

AU - Ruschitzka, Frank

AU - Ghadri, Jelena R.

AU - Bossone, Eduardo

AU - Templin, Christian

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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 >10×103cells/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.

AB - 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 >10×103cells/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.

KW - Takotsubo syndrome

KW - embolism

KW - outcome

KW - risk score

KW - thrombus

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UR - http://www.scopus.com/inward/citedby.url?scp=85077225375&partnerID=8YFLogxK

U2 - 10.1161/ATVBAHA.119.313491

DO - 10.1161/ATVBAHA.119.313491

M3 - Article

C2 - 31766870

AN - SCOPUS:85077225375

SN - 1079-5642

VL - 40

SP - 279

EP - 287

JO - Arteriosclerosis, thrombosis, and vascular biology

JF - Arteriosclerosis, thrombosis, and vascular biology

IS - 1

ER -

Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights from the International Takotsubo Registry

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