{
  "abstract": "Background Prognostic relevance of cardiac magnetic resonance (CMR) in takotsubo syndrome (TTS) is not fully elucidated. We aimed to assess the prognostic value of CMR-derived left ventricular stroke volume indexed (LVSVi) in patients with TTS.Methods Consecutive patients with TTS underwent CMR at median 5 days (3–7) after admission. CMR analysis was centralised, patients were categorised by LVSVi (<35 vs ≥35 mL/m²). Median follow-up was 360 days. Primary endpoint was a composite of major adverse cardiovascular events and all-cause-death, secondary endpoint was all-cause-death.Results This observational study included 376 patients (mean age 70±11 years; 9% male). Average left ventricular ejection fraction (LVEF) on admission was 43%, increasing to 48% at CMR imaging. 172 (46%) patients had CMR-derived LVSVi <35 mL/m²; these were older and showed higher prevalence of hypertension and dyspnoea and a lower LVEF at admission. On CMR, low LVSVi patients demonstrated smaller LV end-diastolic volumes, lower biventricular systolic function and larger myocardial oedema. Kaplan-Meier analyses showed higher primary and secondary endpoint rates in the low-LVSVi group (both log-rank p<0.01) and lowest event rates in patients having both high LVSVi and normal LVEF (both log-rank p<0.01). Multivariable Cox-regression analysis identified LVSVi as an independent predictor of both the primary (HR 0.96; 95% CI 0.92 to 0.98) and secondary (HR 0.95; 95% CI 0.90 to 0.99) endpoint.Conclusions Early CMR after admission in patients with TTS highlights recovering LVEF with relatively low LVSVi. Low LVSVi independently predicted mid-term outcomes, and the presence of both high LVSVi and recovered LVEF identified a low-risk subgroup.",
  "authors": [
    {
      "affiliations": [
        "Cardiology Unit, Ospedale Generale di Zona Madre Giuseppina Vannini, Rome, Italy"
      ],
      "name": "Luca Arcari"
    },
    {
      "affiliations": [
        "University of Cagliari, Cagliari, Italy"
      ],
      "name": "Riccardo Cau"
    },
    {
      "affiliations": [
        "Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy",
        "Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy"
      ],
      "name": "Gianluca Pontone"
    },
    {
      "affiliations": [
        "ASST Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Guiseppe Muscogiuri"
    },
    {
      "affiliations": [
        "Radiology Unit, University of Turin Department of Surgical Sciences, Torino, Italy"
      ],
      "name": "Marco Gatti"
    },
    {
      "affiliations": [
        "Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy"
      ],
      "name": "Roberta Montisci"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany"
      ],
      "name": "Leon Marcel Bischoff"
    },
    {
      "affiliations": [
        "Department of Radiology CHU, University of Rouen Normandy, Mont-Saint-Aignan, France"
      ],
      "name": "Sébastien Normant"
    },
    {
      "affiliations": [
        "IRCCS Humanitas Research Hospital, Rozzano, Italy",
        "Department of Biomedical Sciences, Humanitas University, Sosnowiec, Poland"
      ],
      "name": "Federica Catapano"
    },
    {
      "affiliations": [
        "BIOMORF Department, G Martino University Hospital of Messina, Messina, Italy"
      ],
      "name": "Tommaso D’Angelo"
    },
    {
      "affiliations": [
        "Radiology Unit, University of Turin Department of Surgical Sciences, Torino, Italy"
      ],
      "name": "Riccardo Faletti"
    },
    {
      "affiliations": [
        "Experimental Imaging Center, San Raffaele Hospital, Milan, Italy",
        "School of Medicine, Vita-Salute San Raffaele University, Milan, Italy"
      ],
      "name": "Antonio Esposito"
    },
    {
      "affiliations": [
        "U.O.C. RMI, Gabriele Monasterio Foundation for the Medical and Public Health Research, Pisa, Italy"
      ],
      "name": "Antonella Meloni"
    },
    {
      "affiliations": [
        "Radiology Unit, Ospedale Generale di Zona Madre Giuseppina Vannini, Rome, Italy"
      ],
      "name": "Federica Ciolina"
    },
    {
      "affiliations": [
        "Santa Maria della Misericordia University Hospital, Udine, Italy"
      ],
      "name": "Francesco Negri"
    },
    {
      "affiliations": [
        "Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy"
      ],
      "name": "Nicola Galea"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Udine, Udine, Italy"
      ],
      "name": "Massimo Imazio"
    },
    {
      "affiliations": [
        "Department of Medical Sciences and Public Health, IT, Elgin, Illinois, USA"
      ],
      "name": "Maria Francesca Marchetti"
    },
    {
      "affiliations": [
        "Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy",
        "Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy"
      ],
      "name": "Alessandra Volpe"
    },
    {
      "affiliations": [
        "School of Medicine, Vita-Salute San Raffaele University, Milan, Italy",
        "IRCCS San Raffaele Hospital Cardiac Surgery Unit, Milan, Italy"
      ],
      "name": "Anna Palmisano"
    },
    {
      "affiliations": [
        "IRCCS Humanitas Research Hospital, Rozzano, Italy",
        "Department of Biomedical Sciences, Humanitas University, Sosnowiec, Poland"
      ],
      "name": "Costanza Lisi"
    },
    {
      "affiliations": [
        "BIOMORF Department, G Martino University Hospital of Messina, Messina, Italy"
      ],
      "name": "Alfredo Blandino"
    },
    {
      "affiliations": [
        "Department of Radiology, Gabriele Monasterio Foundation for the Medical and Public Health Research, Pisa, Italy"
      ],
      "name": "Alberto Clemente"
    },
    {
      "affiliations": [
        "Radiology, University of Rouen Normandy, Mont-Saint-Aignan, France"
      ],
      "name": "Jean-Nicolas Dacher"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany"
      ],
      "name": "Julian A Luetkens"
    },
    {
      "affiliations": [
        "Department of Radiology, University Hospital of Cagliari, Cagliari, Italy"
      ],
      "name": "Luca Saba"
    }
  ],
  "title": "Independent prognostic value of left ventricular stroke volume index in patients with takotsubo syndrome: insights from the EVOLUTION registry",
  "uid": "6b39e10e-215e-514b-82f1-f7d2a7bbbc76"
}