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: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.

中文翻译：

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Takotsubo综合征的脑室内血栓形成和栓塞：国际Takotsubo注册中心的见解。

目的Takotsubo综合征（TTS）的特征是急性左心功能不全，可导致脑室内血栓和栓塞。尽管如此，血栓形成和栓塞事件对TTS患者预后的普遍性和临床影响尚不清楚。这项研究旨在调查有无脑室内血栓或栓塞的患者的临床特征和结局。此外，还确定了与血栓形成或栓塞相关的因素，以及死亡率的预测因子。方法和结果：根据脑室内血栓或栓塞的发生/不存在，将进入国际Takotsubo注册表的28个位于澳大利亚，欧洲和美国的TTS患者一分为二。脑室内血栓或栓塞的患者被定义为ThrombEmb组。在1676名TTS患者中，有56名（3.3％）患者在TTS诊断后出现脑室内血栓和/或栓塞（中位时间间隔为2.0天，范围为0-38天）。ThrombEmb组的患者具有不同的临床特征，包括较低的左心室射血分数，较高的心尖型患病率，肌钙蛋白和炎性标志物水平升高以及较高的血管疾病患病率。在Firth偏倚减少的惩罚似然Logistic回归模型的心尖型中，左心室射血分数≤30％，先前的血管疾病和入院时白细胞计数> 10×103细胞/μL成为血栓形成或形成的独立预测因子。栓塞。结论在TTS急性期，有3.3％的患者发生脑室内血栓或栓塞。一个简单的风险评分包括与脑室内血栓形成或栓塞相关的临床参数，可以识别出风险增加的患者。临床试验注册网址：http://www.clinicaltrials.gov。唯一标识符：NCT01947621。