title: Prevalence of thrombophilic disorders in takotsubo patients: the (ThROmbophylia in TAkotsubo cardiomyopathy) TROTA study.
abstract: Takotsubo cardiomyopathy (TTC) pathophysiology is still unclear. A transient intracoronary thrombosis dissolved at the time of angiography has been hypothesized. We aimed to evaluate the prevalence of thrombophilic disorders in TTC patients. In 75 TTC women, 75 age- and sex-matched acute coronary syndrome (ACS) patients, both enrolled during the acute phase, and in 75 control subjects, we compared the prevalence of congenital and acquired thrombophilic alterations and the values of clotting and endothelial activation biomarkers. Some parameters were re-assessed 1 month after the acute phase in TTC patients. No significant difference between the three groups was observed in factor II (G20210A) and V (G1691A) polymorphisms prevalence. Homocysteine levels were significantly higher in ACS patients vs. TTC and control subjects. Lipoprotein(a) values trended to be higher in TTC patients vs. control subjects, though not significantly. Other thrombophilic alterations in TTC patients were similar to that previously reported in healthy women. Von Willebrand factor and plasminogen activator inhibitor-1 were significantly higher in TTC and in ACS patients than controls. Clotting activation biomarkers were not statistically different between TTC patients and controls. During follow-up, in TTC patients, endothelial damage indices significantly decreased while clotting activation biomarkers remained unchanged. In conclusion, our results, showing a rate of thrombophilic alterations in TTC patients similar to control subjects, do not support the transient intracoronary thrombus hypothesis. However, several endothelial damage markers and lipoprotein(a) were higher in TTC patients vs. controls suggesting a role of endothelial dysfunction and of other factors concurring to hyperviscosity, as recently hypothesized.
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy. emanuelececchi@virgilio.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cecchi
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Fatucchi
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Angelotti
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giglioli
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.|Centro S. Maria agli Ulivi, Fondazione Don Carlo Gnocchi Onlus IRCCS, Florence, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Gori
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Brunella
authors.initials: B
authors.lastname: Bandinelli
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bellandi
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Sticchi
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Romagnuolo
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mannini
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, Florence, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000235:genetics; D001780:Blood Coagulation Tests; D001809:Blood Viscosity; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007558:Italy / Q000453:epidemiology; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D015995:Prevalence; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics
chemical_list: D015415:Biomarkers; D017270:Lipoprotein(a)
keywords: Clotting activation; Endothelial dysfunction; Takotsubo cardiomyopathy; Thrombophilia