Abstract 13708: Left Ventricular Thrombus in Patients With Takotsubo Cardiomyopathy in the US Veteran Affairs Healthcare System

Abstract

Introduction: Takotsubo cardiomyopathy is characterized by significant transient left ventricular (LV) dysfunction that is not due to obstructive coronary artery disease. LV thrombus is a known complication of Takotsubo cardiomyopathy, but the outcomes of these patients are not well described in the literature. The aim of our study was to investigate the rates and outcomes of patients diagnosed with Takotsubo cardiomyopathy with LV thrombus in the Veteran Affairs (VA) system. Methods: We performed a retrospective study using chart review for patients diagnosed with Takotsubo cardiomyopathy between 2005 and 2018 in the VA national database. We included patients who met the Mayo Clinic diagnostic criteria for Takotsubo cardiomyopathy. We collected data for demographics, clinical course, and outcomes. Results: 320 patients (69% males) were included. Median age was 64 years, 20.3% were known to have coronary artery disease, 34.7% had Diabetes and 61.3% had hypertension. 96.8% of patients had Apical variant of Takotsubo cardiomyopathy. LV thrombus was diagnosed in 8.8% of patients, all of those patients had apical variant of Takotsubo cardiomyopathy. There were no significant differences in the mortality rates in the hospital (14.3% vs 7.4%, p=0.15) and at 30-day follow up (4.2% vs 1.9%, p=0.45) in patients who developed LV thrombus compared to patients who did not. For patients who developed LV thrombus, only 1 patient developed a stroke on 30-day follow up; that patient was on therapeutic doses of warfarin for anticoagulation at the time of the stroke. Conclusions: In patients diagnosed with Takotsubo cardiomyopathy with LV thrombus, there was no significant difference in mortality rates in the hospital or at 30 day follow up when compared to patients with no LV thrombus. Only one of those patients developed a stroke during follow up, suggesting that the embolic risk is low with appropriate treatment.