Left ventricular thrombus in Takotsubo syndrome: incidence, management, and unmet clinical needs

Left ventricular thrombus (LVT) is an uncommon but potentially devastating complication of Takotsubo syndrome (TTS). Although its incidence is relatively low, the associated risk of embolic events, including stroke and systemic infarctions, warrants special attention. This review synthesizes the available evidence on LVT in TTS, from the first case reported in the literature to data from mechanistic studies and large international registries. Incidence, pathophysiology, clinical predictors, diagnostic tools, management strategies, and clinical outcomes will be addressed. While LVT typically resolves with anticoagulation within weeks, its occurrence is strongly associated with acute complications. Identification of high-risk patients remains key to optimizing monitoring and prevention. Standardized risk scores and prospective studies are needed to better define preventive and therapeutic strategies in this uniquely challenging population.