Study population

This retrospective, observational single-centre study was conducted at a tertiary care centre. From November 2007 to January 2021, patients with clinical suspicion of TTS referred for CMR were identified. TTS was defined based on the International Takotsubo Diagnostic Criteria including CMR results and standard clinical work-up [18]. According to these recommendations, the main diagnostic criterion was the presence of (transient) left ventricular RWMA extending beyond a single coronary vascular distribution and presenting as apical ballooning or midventricular, basal, or focal wall motion abnormalities. Also, concomitant coronary artery disease was not a general contradiction for takotsubo syndrome. Patients with positive LGE who had typical RWMA and fulfilled diagnostic criteria for TTS were also included (e.g., RWMA beyond myocardial scarring) [18]. Patients with other CMR diagnosis were excluded (e.g., infectious myocarditis). Clinical characteristics were received from in-house medical records. The study complies with the principles of the Helsinki Declaration and was approved by the local institutional review board that waived informed consent due to retrospective study design (number: 303/16).