Citro R, et al. - In 326 patients (mean age 69.5 ± 10.7 years, 28 male) who presented with Takotsubo syndrome (TTS) and severely reduced left ventricular ejection fraction (LVEF ≤ 35%), researchers assessed the long-term outcomes. According to LVEF, two groups of patients were defined (≤ 35%, n = 131; > 35%, n = 195). They performed long-term follow-up (median 26.5 months) to assess composite major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, heart failure, and TTS recurrence) and rehospitalization. Based on the findings, LVEF ≤ 35% at presentation was identified as an important parameter to recognize TTS patients at higher risk, both in the acute phase and in long-term follow-up. Independent predictors of MACE included LVEF ≤ 35% at admission and age. In the acute phase, patients with LVEF ≤ 35% vs patients with LVEF > 35% experienced cardiogenic shock, acute heart failure, and intra-aortic balloon pump support more frequently. These patients had higher rates of composite MACE and rehospitalization for cardiac causes at long-term follow-up.