Heart failure & cardiomyopathiesCohort study
Physical triggers in takotsubo syndrome: a high-risk phenotype? insights from the eVOLUTION registry
- retrospective registry
- multicenter
Authors' conclusion
TS patients with PT represent a high-risk subgroup with worse in-hospital outcomes and increased post-discharge events. Careful identification of the trigger type may therefore help stratify risk, allowing for closer monitoring during hospitalization and more vigilant long-term management in the outpatient setting.
Study context
- Population
- Patients with Takotsubo syndrome (TS)TS patients (mean age 70.1 ± 11.8 years, 91% female), median follow-up 26.7 months
- Participants
- 399 patients
- Exposure
- Physical triggers (PT) group compared with patients in the emotional or no-trigger groups
Main finding
As reported in the abstract
Clinical, laboratory and cardiovascular magnetic resonance (CMR) features, PT vs other patients
- Higher C-reactive protein levels with PT
- P = 0.008
- Lower troponin values with PT
- P = 0.018
- Less frequent T2-STIR abnormalities with PT
- P = 0.007
- Less extensive T2-STIR abnormalities with PT
- P = 0.005
- Less frequent LGE with PT
- P = 0.002
- Less extensive LGE with PT
- P = 0.005
- Longer hospital stays with PT
- P = 0.002
- More frequent in-hospital complications with PT
- P = 0.001
Observational data: associations, not effects.
Further findings
Event-free survival (Kaplan-Meier) · median follow-up 26.7 months
- Significantly lower event-free survival in the PT group compared with patients in the emotional or no-trigger groups
- log-rank P = 0.003
All-cause mortality and post-discharge adverse events (multivariable Cox regression)
- Presence of a physical trigger independently associated with higher risk
- P = 0.037
- Pre-existing neurological disease independently associated with higher risk
- P = 0.027
- multivariable Cox regression
Original publication
Physical triggers in takotsubo syndrome: a high-risk phenotype? insights from the eVOLUTION registry. Eur Heart J Cardiovasc Imaging. Published 5 February 2026. doi:10.1093/ehjci/jeag017
Summarised from the published abstract; every number is checked against it