CMR findings across disease phases in Takotsubo syndrome: insights from the multicenter EVOLUTION registry

Takotsubo syndrome (TS) is characterized by transient left ventricular dysfunction accompanied by dynamic changes in myocardial tissue; however, differences in cardiac magnetic resonance (CMR) findings across disease phases remain incompletely characterized, particularly in large multicenter cohorts. This retrospective analysis from the multicenter EVOLUTION registry included 439 consecutive patients with TS (400 females; mean age 70.01 ± 11.59 years), stratified according to the time from symptom onset to CMR into acute (1-72 hours), subacute (4-21 days), and late (≥22 days) acquisition groups. Among these, 146 (33%) were classified as acute, 266 (60%) as subacute, and 27 (6%) as late. Biventricular systolic function was higher in patients imaged at later time points (both p = 0.001). Myocardial edema and late gadolinium enhancement (LGE) were more prevalent and extensive in patients imaged earlier and less evident in those imaged later. In multivariable analysis, T2-mapping Z-score and LGE extent were independently associated with earlier timing of CMR. T2-mapping Z-score decreased by approximately 0.22 units per day, corresponding to an average relative decline of 3-4% per day. In conclusion, cross-sectional CMR assessment in TS demonstrates that patients imaged at later time points exhibit more preserved systolic function and lower prevalence of myocardial edema and LGE, supporting the dynamic and reversible nature of myocardial injury in this condition; however, longitudinal studies with serial imaging are needed to confirm these findings.

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Publication Details

Journal
The American Journal of Cardiology
Published
2026-05-01
DOI
https://doi.org/10.1016/j.amjcard.2026.04.057
Primary Topic
Takotsubo Cardiomyopathy and Associated Phenomena
Type
article
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article

CMR findings across disease phases in Takotsubo syndrome: insights from the multicenter EVOLUTION registry

Roberta Montisci, Federica Ciolina, Francesco Negri, Tommaso D’Angelo et al.
The American Journal of Cardiology
Takotsubo Cardiomyopathy and Associated Phenomena
article

CMR findings across disease phases in Takotsubo syndrome: insights from the multicenter EVOLUTION registry

Roberta Montisci, Federica Ciolina, Francesco Negri, Tommaso D’Angelo, Sébastien Normant, Nicola Galea, Alberto Clemente, J Luetkens, Alfredo Blandino, Maria Francesca Marchetti, Costanza Lisi, Federica Catapano, Luca Arcari, Leon Bischoff, Alessandra Volpe, Giacomo Pambianchi, Antonella Meloni, Riccardo Cau, Gianluca Pontone, Giuseppe Muscogiuri, Riccardo Faletti, Luca Saba, Marco Gatti, Antonio Esposito, Jean Nicolas Dacher, Anna Palmisano, Massimo Imazio
article en

Abstract

Takotsubo syndrome (TS) is characterized by transient left ventricular dysfunction accompanied by dynamic changes in myocardial tissue; however, differences in cardiac magnetic resonance (CMR) findings across disease phases remain incompletely characterized, particularly in large multicenter cohorts. This retrospective analysis from the multicenter EVOLUTION registry included 439 consecutive patients with TS (400 females; mean age 70.01 ± 11.59 years), stratified according to the time from symptom onset to CMR into acute (1-72 hours), subacute (4-21 days), and late (≥22 days) acquisition groups. Among these, 146 (33%) were classified as acute, 266 (60%) as subacute, and 27 (6%) as late. Biventricular systolic function was higher in patients imaged at later time points (both p = 0.001). Myocardial edema and late gadolinium enhancement (LGE) were more prevalent and extensive in patients imaged earlier and less evident in those imaged later. In multivariable analysis, T2-mapping Z-score and LGE extent were independently associated with earlier timing of CMR. T2-mapping Z-score decreased by approximately 0.22 units per day, corresponding to an average relative decline of 3-4% per day. In conclusion, cross-sectional CMR assessment in TS demonstrates that patients imaged at later time points exhibit more preserved systolic function and lower prevalence of myocardial edema and LGE, supporting the dynamic and reversible nature of myocardial injury in this condition; however, longitudinal studies with serial imaging are needed to confirm these findings.

The American Journal of Cardiology
Humanitas University (IT), Vita-Salute San Raffaele University (IT), University Hospital Bonn (DE), Martin University (US), Centro Cardiologico Monzino (IT), Fondazione Ricerca Molinette (IT), Ospedale Papa Giovanni XXIII (IT), Azienda Ospedaliero-Universitaria Cagliari (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Centre Hospitalier Universitaire de Rouen (FR), Fondazione Toscana Gabriele Monasterio (IT), IRCCS Humanitas Research Hospital (IT), Regione Toscana, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Université de Rouen Normandie (FR), Sapienza University of Rome (IT)
Openalex Percentile: Top 8%
Takotsubo Cardiomyopathy and Associated Phenomena
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