title: Cardioembolic outcomes in stress-related cardiomyopathy complicated by ventricular thrombus: a systematic review of 26 clinical studies.
abstract: BACKGROUND
  The stress-related cardiomyopathy (SRC) is a relatively novel cardiac syndrome characterized by peculiar transient left ventricular dysfunction, which accounts for approximately 1-3% of patients with symptoms that initially appear to be an acute coronary syndrome. To date, the true incidence and clinical significance of left ventricular thrombus and related embolic outcomes in these patients have not been fully established.
  
  
  METHODS
  The present systematic review aimed to report updated case series of SRC patients with left ventricular thrombus and/or cardioembolic events complicating the course of syndrome, in an attempt to summarize their demographic and clinical characteristics.
  
  
  RESULTS
  Overall, 33 eligible studies (44 patients) were selected through the PubMed-Medline archives (December 2002-April 2009), but only 26 (36 patients) matched our inclusion criteria. Left ventricular thrombus was detected in 32 patients (89%), whereas thromboembolic events occurred in 12 (33%). Morphological characteristics of thrombi are described through the article. Women >65 years of age presenting with deep/giant negative T-waves on admission ECG seem more likely to have thrombus-related embolic complications.
  
  
  CONCLUSIONS
  Important findings from this updated review indicate that LVT approximately occurs in 5% of the estimated worldwide SRC population, similar to historical incidence in patients with myocardial infarction. In a third of cases (approximately 1.6% of above guesstimate) nonfatal cardioembolic outcomes (brain ischemia in 75% of cases) have been documented. It is worthy considering early anticoagulant therapy, especially in patients at a higher risk of thromboembolic disease, irrespective of the presence of LVT at admission.
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, Cardiology Unit, University Hospital of Messina, Messina, Italy. cesaredegregorio@tiscali.it
authors.forename: Cesare
authors.initials: C
authors.lastname: de Gregorio
mesh_terms: D000367:Age Factors; D009202:Cardiomyopathies / Q000150:complications / Q000523:psychology / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000379:methods / Q000523:psychology; D004617:Embolism / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D013315:Stress, Psychological / Q000150:complications / Q000628:therapy*; D013927:Thrombosis / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000523:psychology / Q000628:therapy*