Predictors of early left ventricular recovery in takotsubo syndrome: a single-center study
F Viveiros, M Vilela, J Cravo, S Esteves, R Afonso, R Figueiredo, D Ferreira, D Cazeiro, P Carrilho Ferreira, F J PintoAbstract
Introduction
Takotsubo syndrome (TTS) typically presents with acute, left ventricular systolic dysfunction characterized by wall motion abnormalities which are usually reversible over days to weeks. However, timing and completeness of left ventricular ejection fraction (LVEF) recovery are heterogeneous, and clinical predictors of early recovery remain only partially understood.
Purpose
To identify potential predictors of LVEF recovery at discharge in patients with TTS.
Methods
We conducted a retrospective, single-center study including patients diagnosed with TTS between 2008 and 2025. Demographic, clinical, echocardiographic, and laboratory data were collected from admission to discharge. Patients were categorized according to LVEF recovery status at discharge. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of LVEF recovery.
Results
A total of 137 patients (mean age 72±17 years, 85% female) were included, 85% of whom with the classical TTS pattern. An identifiable trigger was documented in 69% of cases, of which 53% were acute physical stressors. Overall, 58% of patients had reduced LVEF on admission, with recovery at discharge observed in 53% of them. On univariate analysis, younger age (69.5y vs 76.1 y, p=0.014; OR 1.053, 95% CI [1.009–1.099], p=0.018), higher LVEF on admission (40.2% vs. 32.5%, p<0.001; OR 1.207, 95% CI [1.096-1.330], p<0.001), and presence of an identifiable emotional stressor (OR 3.3, 95% CI [1.131-9.804]; p=0.029) were associated with LVEF recovery. Inflammatory and myocardial injury biomarkers (C-reactive protein, troponin T, and NT-proBNP) did not differ between groups. On multivariate analysis, only higher LVEF was as independent predictor of LVEF recovery at discharge (OR 1.39, 95% CI [1.136-1.704]; p=0.001).
Discussion and conclusion
In this cohort of TTS patients, higher baseline LVEF independently predicted early recovery of LVEF at discharge. Younger age and emotional stressors also appeared to favor recovery, though without independent significance. These findings suggest that initial LVEF is a key determinant of short-term ventricular improvement, underlining the potential importance of early echocardiographic assessment in prognostic evaluation.