Intraventricular thrombus in Takotsubo syndrome: Incidence, predictors, management, and prognosis. Insights from the RETAKO registry.

BACKGROUND

Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and wall motion abnormalities without culprit coronary artery disease. LV thrombus (LVT) formation during the acute phase is a fearsome complication.

OBJECTIVES

To identify factors associated with LVT and its prognostic impact in TTS patients.

METHODS

Data from the nationwide REgistry on TAKOtsubo syndrome (RETAKO), which combines retrospective (2002-2012) and prospective (2012 onwards) recruitment with prospective follow-up, were reviewed to assess patient characteristics, imaging findings, and clinical outcomes according to the presence of LVT.

RESULTS

Of 1478 TTS consecutive patients (median age 72 years, 13.5 % men), 42 patients (2.8 %) presented with LVT. Presentation with syncope, a typical "apical ballooning" pattern, the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging, and elevated high sensitivity-C reactive protein (hs-CRP), were associated with LVT. On multivariable analysis, elevated hs-CRP at admission and LGE persisted as independent predictors of LV thrombus. Patients with LVT had higher rates of in-hospital major bleeding (9.5 % vs. 3.1 %, p = 0.023) and major adverse cardiovascular events (26.8 % vs. 15.2 %, p = 0.035), mainly driven by stroke (14.6 % vs. 2.5 %, p < 0.001) and systemic embolism (19 % vs. 1.3 %, p < 0.001). At a median follow-up of 18 months, there were no differences in mortality, cardiac readmissions, or TTS recurrence between groups.

CONCLUSIONS

In TTS patients, elevated hs-CRP and LGE are associated with a higher risk of LVT. Although LVT is rare, it is associated with increased in-hospital thromboembolic events and bleeding, while long-term outcomes are comparable to those without LVT.