{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:41:06Z","timestamp":1785177666455,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T00:00:00Z","timestamp":1728777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100011949","name":"Abbott Vascular","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011949","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005035","name":"Biotronik","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005035","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016303","name":"Medtronic Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016303","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018918","name":"MicroPort","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018918","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014833","name":"Society for Music Theory","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014833","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010447","name":"Deutsches Zentrum f\u00fcr Herz-Kreislaufforschung","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100010447","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100016400","name":"Biss Davies Charitable Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016400","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006520","name":"Edwards Lifesciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008497","name":"Boston Scientific Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The clinical relevance of cardiac troponin (cTn) elevation in takotsubo syndrome (TTS) remains uncertain. The present study sought to investigate the role of cardiac troponin (cTn) elevations in mortality prediction of patients with Takotsubo syndrome (TTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients enrolled in the International Takotsubo (InterTAK) Registry from January 2011 to February 2020 with available data on peak cTn levels were included in the analysis. Peak cTn levels during the index hospitalization were used to define clinically relevant myocardial injury. The threshold at which clinically relevant myocardial injury drives mortality at 1\u2009year was identified using restricted cubic spline analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 2\u2032938 patients, 222 (7.6%) patients died during 1\u2010year follow\u2010up. A more than 28.8\u2010fold increase of cTn above the upper reference limit was identified as threshold for clinically relevant myocardial injury. The presence of clinically relevant myocardial injury was significantly associated with an increased risk of mortality at 5\u2009years (adjusted HR 1.58, 95% CI 1.18\u20132.12, <jats:italic>p<\/jats:italic>\u2009=.002). Clinically relevant myocardial injury was related to an increased 5\u2010year mortality risk in patients with apical TTS (adjusted HR 1.57, 95% CI 1.21\u20132.03, <jats:italic>p<\/jats:italic>\u2009=.001), in presence of physical stressors (adjusted HR 1.60, 95% CI 1.22\u20132.11, <jats:italic>p<\/jats:italic>\u2009=.001), and in absence of emotional stressors (adjusted HR 1.49, 95% CI, 1.17\u20131.89, <jats:italic>p<\/jats:italic>\u2009=.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study for the first time determined a troponin threshold for the identification of TTS patients at excess risk of mortality. These findings advance risk stratification in TTS and assist in identifying patients in need for close monitoring and follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.14317","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T03:59:57Z","timestamp":1728878397000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Cardiac troponin elevation and mortality in takotsubo syndrome: New insights from the international takotsubo registry"],"prefix":"10.1111","volume":"54","author":[{"given":"Barbara E.","family":"St\u00e4hli","sequence":"first","affiliation":[{"name":"University Heart Center, Department of Cardiology University Hospital Zurich, and University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Schindler","sequence":"additional","affiliation":[{"name":"University Heart Center, Department of Cardiology University Hospital Zurich, and University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9361-8817","authenticated-orcid":false,"given":"Victor","family":"Schweiger","sequence":"additional","affiliation":[{"name":"University Heart Center, Department of Cardiology University Hospital Zurich, and University of Zurich  Zurich Switzerland"},{"name":"Department of Cardiology, Deutsches Herzzentrum der Charit\u00e9 Angiology and Intensive Care Medicine  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria L.","family":"Cammann","sequence":"additional","affiliation":[{"name":"University Heart Center, Department of Cardiology University Hospital Zurich, and University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad A.","family":"Szawan","sequence":"additional","affiliation":[{"name":"University Heart Center, Department of 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