title: Prevalence, Clinical Characteristics, and Predictors of Patients with Thromboembolic Events in Takotsubo Cardiomyopathy.
abstract: BACKGROUND
  Several acute complications related to takotsubo cardiomyopathy (TTC) have been documented recently. However, the incidence and clinical significance of acute thromboembolic events in TTC is not well established.
  
  
  METHODS
  A detailed investigation of the clinical characteristics and in-hospital complications of 114 consecutive patients diagnosed with TTC between January 2003 and September 2015 was carried out. This study was initiated to reveal the predictors, clinical significance, and short-term and long-term outcomes of patients with TTC associated with acute thromboembolic events on index presentation.
  
  
  RESULTS
  The incidence of acute thromboembolic events related to TTC was around 12.2%, and these included ventricular thrombi, cerebrovascular events, retinal and brachial artery pathologies, renal, splenic, and aortic involvement. The most frequent complication on initial presentation was cardiogenic shock (20%) accompanied with pulmonary congestion (20%). Interestingly, patients experiencing thromboembolic events had higher C-reactive protein (CRP) levels as compared to the non-thromboembolic group (P = 0.02). Certain thromboembolic events were characterized by the presence of ST-segment elevation in electrocardiogram (P = 0.02). Chest pain was the primary symptom in these patients (P = 0.09). Furthermore, there was significant right ventricular involvement (as assessed by transthoracic echocardiography) in patients presenting with an acute thromboembolic event (P = 0.08). A Kaplan-Meier analysis indicated a significantly higher mortality rate over a mean follow-up of three years in the thromboembolic group than the non-thromboembolic group (log-rank, P = 0.02).
  
  
  CONCLUSIONS
  Our results confirmed the relative common occurrence of thromboembolic events in the setting of TTC. Inflammation might play an important role in the development of thromboembolic events, and a right ventricular involvement and ST-segment elevation could be positive predictors for this occurrence. In order to circumvent the risk of a negative outcome, it is recommended that an anticoagulation therapy be initiated in all high-risk patients.
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: El-Battrawy
authors.affiliation: DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hillenbrand
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Darius
authors.initials: D
authors.lastname: Haghi
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany.
authors.forename: Theano
authors.initials: T
authors.lastname: Papavassiliu
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fastner
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Becher
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baumann
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Heggemann
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kuschyk
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: First Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
keywords: LV thrombus; stroke; takotsubo cardiomyopathy; thromboembolic events