New insights into takotsubo syndrome: results from a multicenter cohort

Abstract Background Takotsubo syndrome has long been deemed a benign condition following sudden emotional stress. While current mechanisms explaining the acute cardiac dysfunction are not fully understood, current evidence suggests certain takotsubo populations are at higher risk of adverse course. Acute neurologic emergencies commonly precede the takotsubo syndrome and new insights into the role of the brain–heart axis and central autonomic regions driving excess sympathetic activation have come about. Methods and results This multicenter analysis included 595 patients admitted between January 2013 and December 2024 with takotsubo syndrome across 13 German tertiary care centers. The aim of this study was to (I) assess whether acute brain pathology influences severity of cardiac dysfunction differently in comparison to other nonneurologic forms of physical or emotional stress, (II) investigate short-term recovery of cardiac function, and (III) improve identification of vulnerable patients susceptible to critical in-hospital course. Marginal odds ratios were estimated for cardiac complications of takotsubo syndrome across trigger groups using generalized estimating equations. Multivariable mixed-effects logistic regression models were fit to analyze the association between prespecified variables for short-term recovery of wall motion and systolic abnormalities as well as critical in-hospital course. Acute neurologic emergencies (47.5%) and common physical triggers (37.9%) were associated with higher risk of cardiac complications in takotsubo syndrome compared to emotional triggers (12.5%). Nonapical forms of takotsubo syndrome showed improved recovery of wall motion abnormalities (OR 2.70, 95% CI 1.34–5.45), while older patients had worse recovery of systolic function to discharge (OR 0.67, 95% CI 0.48–0.93). Conversely, younger male patients in which disease was triggered by neurologic emergencies or physical triggers presented with higher odds of critical in-hospital course. Conclusion Results of this study challenge the assumption of uniform reversibility of cardiac dysfunction and emphasize the need for early risk stratification and awareness of high-risk features as well as varying clinical presentations.

Authors

Institutions

Publication Details

Journal
Clinical Research in Cardiology
Published
2026-10-19
DOI
https://doi.org/10.1007/s00392-026-03037-8
Primary Topic
Takotsubo Cardiomyopathy and Associated Phenomena
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

New insights into takotsubo syndrome: results from a multicenter cohort

Lisa Reinhardt, Lisa Crusius, David M. Leistner, Malte Kelm et al.
Clinical Research in Cardiology
Takotsubo Cardiomyopathy and Associated Phenomena
article

New insights into takotsubo syndrome: results from a multicenter cohort

Lisa Reinhardt, Lisa Crusius, David M. Leistner, Malte Kelm, Rafael Henrique Rangel, Marcus Brugger, Christian Jung, Enzo Lüsebrink, Benjamin Meder, Norman Mangner, Franz Haertel, Tienush Rassaf, Dirk Westermann, Lucas Bacmeister, Loubna Yahsaly, Sebastian Zimmer, Sabine Hoffmann, Christian Schulze, Hugo Lanz, Johannes Terporten, Fabian Heindl, Lars Michel, Georg Nickenig, Victoria Pfeiffer, Endrit Cekaj, Mostafa Salem, Samuel Muli, Daniel Hoyer, Marcelo Galdos-Bejar, Stephan Baldus, Matthias Schmid
article en

Abstract

Abstract Background Takotsubo syndrome has long been deemed a benign condition following sudden emotional stress. While current mechanisms explaining the acute cardiac dysfunction are not fully understood, current evidence suggests certain takotsubo populations are at higher risk of adverse course. Acute neurologic emergencies commonly precede the takotsubo syndrome and new insights into the role of the brain–heart axis and central autonomic regions driving excess sympathetic activation have come about. Methods and results This multicenter analysis included 595 patients admitted between January 2013 and December 2024 with takotsubo syndrome across 13 German tertiary care centers. The aim of this study was to (I) assess whether acute brain pathology influences severity of cardiac dysfunction differently in comparison to other nonneurologic forms of physical or emotional stress, (II) investigate short-term recovery of cardiac function, and (III) improve identification of vulnerable patients susceptible to critical in-hospital course. Marginal odds ratios were estimated for cardiac complications of takotsubo syndrome across trigger groups using generalized estimating equations. Multivariable mixed-effects logistic regression models were fit to analyze the association between prespecified variables for short-term recovery of wall motion and systolic abnormalities as well as critical in-hospital course. Acute neurologic emergencies (47.5%) and common physical triggers (37.9%) were associated with higher risk of cardiac complications in takotsubo syndrome compared to emotional triggers (12.5%). Nonapical forms of takotsubo syndrome showed improved recovery of wall motion abnormalities (OR 2.70, 95% CI 1.34–5.45), while older patients had worse recovery of systolic function to discharge (OR 0.67, 95% CI 0.48–0.93). Conversely, younger male patients in which disease was triggered by neurologic emergencies or physical triggers presented with higher odds of critical in-hospital course. Conclusion Results of this study challenge the assumption of uniform reversibility of cardiac dysfunction and emphasize the need for early risk stratification and awareness of high-risk features as well as varying clinical presentations.

Clinical Research in Cardiology
Goethe University Frankfurt (DE), University of Bonn (DE), University of Freiburg (DE), Heidelberg University (DE), University Hospital Bonn (DE), University Medical Center Freiburg (DE), University Hospital Heidelberg (DE), TUM Klinikum (DE), University Hospital Schleswig-Holstein (DE), Klinikum Frankfurt Höchst (DE), Essen University Hospital (DE), German Centre for Cardiovascular Research (DE), Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE), Jena University Hospital (DE), University Hospital in Halle (DE), University Hospital Cologne (DE), West German Heart and Vascular Center Essen (DE), Klinik und Poliklinik für Psychotherapie und Psychosomatik (DE), Chirurgische Universitätsklinik Heidelberg (DE), Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (DE), Heinrich Heine University Düsseldorf (DE), Friedrich Schiller University Jena (DE), Technische Universität Dresden (DE), Ludwig-Maximilians-Universität München (DE), University of Lübeck (DE)
Openalex Percentile: Top 12%
Takotsubo Cardiomyopathy and Associated Phenomena
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.