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

Leonarda Galiuto, Filippo Crea, 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 NoutsiasChristof 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, 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, 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

Research output: Contribution to journalArticle

7 Citations (Scopus)


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: Unique identifier: NCT01947621.
Original languageEnglish
Pages (from-to)279-287
Number of pages9
JournalArteriosclerosis, Thrombosis, and Vascular Biology
Publication statusPublished - 2020


  • Aged
  • Australia
  • Coronary Angiography
  • Electrocardiography
  • Embolism
  • Europe
  • Female
  • Follow-Up Studies
  • Heart Diseases
  • Heart Ventricles
  • Humans
  • Incidence
  • Magnetic Resonance Imaging, Cine
  • Male
  • Radionuclide Ventriculography
  • Registries
  • Risk Assessment
  • Risk Factors
  • Survival Rate
  • Takotsubo Cardiomyopathy
  • Takotsubo syndrome
  • Thrombosis
  • Time Factors
  • United States
  • embolism
  • outcome
  • risk score
  • thrombus


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