Letter to the Editor
Incidence and treatment of left ventricular apical thrombosis in Tako-tsubo cardiomyopathy

https://doi.org/10.1016/j.ijcard.2008.12.208Get rights and content

Abstract

Among 95 patients with tako-tsubo cardiomyopathy, left ventricular (LV) apical thrombus was documented in 5 (5.3%) patients. The thrombus was mural in 2 (40%), and protruding in 3 (60%) patients. In 4 patients, LV apical thrombus disappeared after anticoagulant therapy. In one patient with protruding thrombus, brain infarction occurred. LV dysfunction was resolved during follow-up in all patients.

Introduction

Tako-tsubo cardiomyopathy is characterized by transient left ventricular (LV) apical aneurysm with chest symptom, electrocardiographic changes and minimal myocardial enzymatic release [1], [2], [3], [4]. Its prognosis is well known to be favorable because LV dysfunction is usually transient. However, LV apical thrombosis can occur during early phase due to LV apical aneurysm [3], [4].

In this study, we assessed the incidence and treatment of LV apical thrombosis in tako-tsubo cardiomyopathy.

Section snippets

Patients

A total of 95 patients were diagnosed as having tako-tsubo cardiomyopathy in Hiroshima City Hospital. Tako-tsubo cardiomyopathy was defined as (1) basal normokinesia and apical akinesia extending beyond one coronary artery region and (2) absence of obstructive coronary artery disease or angiographic evidence of plaque rupture. Patients with coronary artery disease inconsistent with LV apical aneurysm were included. Patients with idiopathic cardiomyopathy, prior myocardial infarction,

Patient characteristics

Of 95 patients, 5 (5.3%) had LV apical thrombus during their hospital stay. Patient characteristics were listed in Table 1. On admission, heart rate was 95 ± 16 bpm, and systolic blood pressure was 130 ± 21 mmHg. Electrocardiogram showed ST-segment elevation in all patients especially in leads V3-5.

Echocardiography

On admission, left ventricular diastolic and systolic diameters were 41 ± 5 mm and 27 ± 3 mm, respectively. Ejection fraction was 45 ± 6%. LV apical thrombus was documented on admission in one patient, and on

Discussion

In this study, we demonstrated that LV apical thrombosis occurred in 5.3% of patients with tako-tsubo cardiomyopathy during early phase.

Tako-tsubo cardiomyopathy mimics anterior acute myocardial infarction (AMI) on LV apical contraction abnormality [1], [2], [3], [4]. Previous studies have demonstrated that LV thrombosis can occur after anterior AMI and can be accurately recognized with 2-dimensional echocardiography. Its incidence is 30% to 43% of patients with anterior AMI before the era of

Acknowledgement

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [13].

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