Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.

1st Department of Cardiology Medical University of Gdansk Poland

1st Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany

Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia

Berlin Institute of Health Berlin Germany

Cardiology Department Santa Maria University Hospital Lisbon School of Medicine Universidade de Lisboa Portugal

Cardiology Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom

Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany

Center for Molecular Cardiology Schlieren Campus University of Zurich Switzerland

Centro Cardiologico Monzino IRCCS Milan Italy

Charles University Prague and University Hospital Kralovske Vinohrady Prague Czech Republic

Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany

Department of Cardiology and Angiology Hannover Medical School Hannover Germany

Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France

Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Australia

Department of Cardiology Charité Campus Rudolf Virchow Berlin Germany

Department of Cardiology Christchurch Hospital Christchurch New Zealand

Department of Cardiology Heidelberg University Hospital Heidelberg Germany

Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford United Kingdom

Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland

Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland

Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom

Department of Cardiology Leiden University Medical Centre Leiden The Netherlands

Department of Cardiology Medical University of Warsaw Poland

Department of Cardiology University Hospital Basel Basel Switzerland

Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan

Department of Cardiovascular Sciences Catholic University of the Sacred Heart Rome Rome Italy

Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany

Department of Internal Medicine 1 Cardiology University Hospital Olomouc Olomouc Czech Republic

Department of Internal Medicine 2 Cardiology University of Ulm Medical Center Ulm Germany

Department of Internal Medicine 3 Heart Center University of Cologne Germany

Department of Internal Medicine B University Medicine Greifswald Greifswald Germany

Department of Internal Medicine Cardiology Heart Center Leipzig University Hospital Leipzig Germany

Department of Medicine College of Medicine University of Florida Gainesville FL

Deutsches Herzzentrum München Technische Universität München Munich Germany

Division of Cardiology Angiology and Intensive Medical Care Department of Internal Medicine 3 University Hospital Halle Martin Luther University Halle Halle Germany

Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Italy

Division of Cardiovascular Diseases Mayo Clinic Rochester MN

DZHK Partner Site Berlin Berlin Germany

DZHK Partner Site Greifswald Greifswald Germany

DZHK Partner Site Hamburg Kiel Luebeck Hamburg Germany

DZHK Partner Site Heidelberg Mannheim Mannheim Germany

DZHK Partner Site Munich Heart Alliance Munich Germany

Fondazione Policlinico Universitario A Gemelli IRCCS Roma Italy

Heart and Vascular Centre Bad Bevensen Bad Bevensen Germany

Heart Center Turku University Hospital and University of Turku Turku Finland

Heart Department University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno Italy

Intensive Coronary Care Unit Moscow City Hospital 1 named after N Pirogov Moscow Russia

Internal Medicine Cardiology Angiology and Pneumology Magdeburg University Magdeburg Germany

Klinik für Innere Medizin 3 Universitätsklinikum des Saarlandes Homburg Saar Germany

Krankenhaus Maria Hilf Medizinische Klinik Stadtlohn Germany

Local Health Unit n 8 Cardiology Unit Arzignano Vicenza Italy

Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland

TJ Health Partners Heart and Vascular Glasgow KY

University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland

University Hospital Careggi Florence Italy

University Hospital for Internal Medicine 3 Medical University Innsbruck Innsbruck Austria

University of Southern California Keck School of Medicine Los Angeles CA

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ClinicalTrials.gov
NCT01947621