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September 10, 2026International Journal of Cardiology0 citationsOpen Access

Left ventricular outflow tract obstruction and myocardial edema burden in Takotsubo syndrome: acute and long-term outcomes—insights from the EVOLUTION registry

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Why the study?

To evaluate clinical and CMR characteristics, as well as in-hospital and long-term outcomes, in patients with Takotsubo syndrome and left ventricular outflow tract obstruction.

Does the presence of LVOTO increase the risk of in-hospital complications and long-term MACE in patients with Takotsubo syndrome?

Population

249 patients with Takotsubo syndrome undergoing CMR within 5 days of echocardiography

Comparison

Presence vs absence of LVOTO

Design

Multicenter retrospective registry sub-analysis

Key result

In patients with Takotsubo syndrome, left ventricular outflow tract obstruction was associated with increased in-hospital complications (34.6% vs 15.8%; OR 3.16, 95% CI 1.08-9.26, p=0.035).

Authors

RCRiccardo CauFSFrancesco SantoroGPGianluca Pontone

Discussion

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Overview

LVOTO in TTS may require tailored acute management to avoid worsening gradients; leaves open whether CMR features independently predict outcomes.

Study Design

Type

Cohort (n=249)

Multicenter

Yes

Structured PICO

Does the presence of LVOTO increase the risk of in-hospital complications and long-term MACE in patients with Takotsubo syndrome?

P
Population
249 patients (90.8% female, mean age 70.6 years) with Takotsubo syndrome who underwent CMR within 5 days of echocardiographic assessment.
E
Exposure
Presence of left ventricular outflow tract obstruction (LVOTO)
C
Comparator
Absence of left ventricular outflow tract obstruction (LVOTO)
O
Outcome
In-hospital complications (including pulmonary edema and cardiogenic shock) and long-term MACEcomposite

In patients with Takotsubo syndrome, LVOTO is associated with greater myocardial edema and a higher risk of in-hospital complications, but not long-term MACE.

Main Result

Odds Ratio: 3.16 (95% CI 1.08–9.26)

Absolute Event Rate: 34.6% vs 15.8%

p-value: p=0.035

Limitations

  • Limited number of events
  • Wide confidence interval
  • limited number of events
  • wide confidence interval

Cite This Study

Cau et al. (2026) conducted a cohort in Takotsubo syndrome (n=249). Left ventricular outflow tract obstruction (LVOTO) vs. Absence of LVOTO was evaluated on In-hospital complications (OR 3.16, 95% CI 1.08-9.26, p=0.035). In patients with Takotsubo syndrome, left ventricular outflow tract obstruction was associated with increased in-hospital complications (34.6% vs 15.8%; OR 3.16, 95% CI 1.08-9.26, p=0.035).

synapsesocial.com/papers/6aa928ef6dc8754dbe62e1a6https://doi.org/10.1016/j.ijcard.2026.134777
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