Right Ventricular Impairment Prevalence in Takotsubo Syndrome and Associated Clinical Characteristics and Outcomes: EVOLUTION Registry Results

Purpose To evaluate the prevalence, clinical correlates, and long-term prognostic impact of right ventricular (RV) impairment at cardiac MRI in patients with Takotsubo syndrome (TS). Materials and Methods Patients with TS were included in this secondary analysis of the Exploring the eVolution in PrognOstic capabiLity of mUltisequence Cardiac MagneTIc ResOnance in patieNts Affected by Takotsubo Cardiomyopathy (EVOLUTION) registry (ClinicalTrials.gov identifier no. NCT06277297) (November 2007-December 2024). RV impairment was defined as an RV ejection fraction <44% in male patients and <47% in female patients at cardiac MRI. Median follow-up was 13 months (IQR, 2.2-37 months). The primary end point was a composite of death due to any cause and major cardiovascular or cerebrovascular adverse events. Event-free survival was evaluated using Kaplan-Meier estimates, and univariable and multivariable Cox regression analysis identified predictors of the primary end point. Results Overall, 419 patients with TS (mean age, 69.9 years ± 12 [SD]; 383 female) were included. RV impairment was observed in 18.1% (76 of 419) of patients. Patients with RV impairment had longer hospitalization (13.7 days ± 20.5 vs 9.0 days ± 5.8, P = .016) and lower left ventricular ejection fraction (34.6% vs 50.3%, P = .001) and less frequently had emotional triggers (29% vs 42%, P = .026). RV impairment was associated with increased incidence of in-hospital (32% vs 18%, P = .005) and out-of-hospital complications (30% vs 15%, P = .001). Event-free survival was lower in patients with RV impairment (log-rank, P < .001). RV impairment (hazard ratio, 1.88 [95% CI: 1.20, 2.92]; P = .005) emerged as an independent predictor of the primary end point. Conclusion In patients with TS, the presence of RV impairment identified a high-risk subgroup with worse clinical course and increased risk of in-hospital and long-term complications. Keywords: MR Imaging, Cardiac, Volume Analysis, Takotsubo Syndrome, Cardiovascular Magnetic Resonance, Right Ventricle, Prognosis ClinicalTrials.gov identifier no. NCT06277297 Supplemental material is available for this article. © RSNA, 2026.