What does this research mean for the field?

Patients with physical triggers in Takotsubo syndrome had lower event-free survival and a higher risk of all-cause mortality compared to those with emotional or no triggers. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This study aims to understand the influence of physical triggers on outcomes in Takotsubo syndrome patients.

February 8, 2026Open Access

Physical Triggers in Takotsubo Syndrome: A High-Risk Phenotype? Insights from the EVOLUTION Registry

Key Result

Takotsubo syndrome patients with physical triggers (30.5%) had longer hospital stays, more complications, and worse event-free survival (p=0.003) than other trigger groups.

Key Points

This study aims to understand the influence of physical triggers on outcomes in Takotsubo syndrome patients.
Retrospective analysis of 399 Takotsubo syndrome patients from the EVOLUTION registry.
Assessment of physical and emotional triggers impacting clinical features and outcomes.
Evaluation of cardiovascular magnetic resonance findings and laboratory values.
30.5% of patients had a physical trigger, with 38.8% having an emotional trigger.
Patients with physical triggers displayed higher C-reactive protein levels and lower troponin values.
Kaplan-Meier analysis showed significantly lower event-free survival for patients with physical triggers.

Structured PICO

Does the presence of a physical trigger worsen outcomes in patients with Takotsubo syndrome?

Population

399 patients with Takotsubo syndrome, mean age 70.1 ± 11.8 years, 91% female.

Intervention

Presence of a physical trigger

Comparator

Emotional trigger or no trigger

Outcome

All-cause mortality and post-discharge adverse eventshard clinical

Takotsubo syndrome patients with physical triggers represent a high-risk phenotype with worse in-hospital outcomes and increased long-term mortality and adverse events.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Physical triggers (PT) are increasingly recognized as important determinants of outcomes in Takotsubo syndrome (TS). This multicenter study investigated the prevalence, clinical features, cardiovascular magnetic resonance (CMR) findings, and prognostic impact of PT in patients with TS Methods and results In this retrospective registry, 399 TS patients (mean age 70.1 ± 11.8 years, 91% female) were included with a median follow-up of 26.7 months. A PT was identified in 30.5% of cases, an emotional trigger in 38.8%, and no trigger in 30.5%. Patients with PT showed higher C-reactive protein levels (p=0.008), lower troponin values (p=0.018), less frequent and less extensive T2-STIR abnormalities (p=0.007 and p=0.005, respectively) and LGE (p=0.002 and p=0.005, respectively), longer hospital stays (p=0.002), and more frequent in-hospital complications (p=0.001). Kaplan–Meier analysis demonstrated significantly lower event-free survival in the PT group compared with patients in the emotional or no-trigger groups (log-rank p=0.003). In multivariable Cox regression analysis, the presence of a physical trigger (p=0.037) and pre-existing neurological disease (p=0.027) were independently associated with a higher risk of all-cause mortality and post-discharge adverse events. 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.