Substantial early morbidity and incomplete left ventricular recovery in Takotsubo syndrome: A single-center cohort study

AIMS: Takotsubo syndrome is an acute cardiac syndrome that mimics myocardial infarction. Despite its transient nature, substantial early morbidity may occur, while predictors of short-term recovery and adverse in-hospital outcomes remain incompletely characterized. METHODS: We performed a retrospective study of consecutive adults diagnosed with Takotsubo syndrome at a tertiary center between 2011 and 2024. Patients with pre-existing cardiomyopathy or heart failure with reduced ejection fraction were excluded. Clinical, electrocardiographic, echocardiographic, and laboratory data, as well as in-hospital outcomes, were analyzed. Early left ventricular recovery was defined as achieving an ejection fraction ≥50% at discharge. Associations with recovery and major in-hospital complications were evaluated using univariate and exploratory multivariable analyses. RESULTS: A total of 189 patients were included (median age 69 years; 99% women). ST-segment elevation was present in 32%, and QTc prolongation exceeding 20% from baseline occurred in 18%. Median ejection fraction improved from 35% (IQR 30-45%) on admission to 45% (IQR 35-60%) at discharge (p < 0.01). Moderate-to-severe mitral regurgitation declined from 5.8% to 1.6% by discharge. Early left ventricular recovery during hospitalization was observed in only 31% of patients. Shorter QT and PR intervals at discharge were associated with concurrent myocardial recovery. In-hospital arrhythmias occurred in 12%, vasopressor use in 21%, and mechanical support in 1%. Mortality was 2.6% in-hospital and 4.9% at one year. Older age, higher admission troponin levels, prolonged QTc interval, and lower admission LVEF were independently associated with major in-hospital complications. CONCLUSIONS: Takotsubo syndrome is associated with substantial early morbidity and incomplete in-hospital recovery in most patients. These findings reinforce the concept that recovery may be incomplete during the early in-hospital phase and highlight the need for closer monitoring and early risk stratification during the acute phase.