{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:47:51Z","timestamp":1790279271961,"version":"4.1.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Takotsubo cardiomyopathy is an acute cardiac emergency presenting with severe left ventricular dysfunction. Physical exercise training or cognitive behavioral therapy may enhance myocardial recovery after takotsubo cardiomyopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      In a prospective multicenter clinical trial conducted between February 2020 and August 2023, patients with acute takotsubo cardiomyopathy were randomized 1:1:1 to physical exercise training, cognitive behavioral therapy, or standard care for 12 weeks after index presentation. The primary end point was resting phosphocreatine\/gamma-ATP ratio assessed by\n                      <jats:sup>31<\/jats:sup>\n                      P-magnetic resonance spectroscopy. Secondary end points were the rate of oxygen consumption at peak exercise on cardiopulmonary exercise testing, 6-minute walk distance, left ventricular global longitudinal strain, and the Minnesota Living With Heart Failure Questionnaire. Twelve-week changes in outcome were compared between allocated trial interventions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Seventy-six participants were recruited: the median age was 66 years, and 91% were women. Compared with standard care, the primary end point of myocardial phosphocreatine\/gamma-ATP ratio was improved by physical exercise training (0.4 [95% CI, 0.1\u20130.8];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.016) and cognitive behavioral therapy (0.3 [0.01\u20130.7];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.043). Both physical exercise training and cognitive behavioral therapy improved rate of oxygen consumption at peak exercise (4.7 [1.4\u20138.0] and 4.0 [1.5\u20136.4] mL\/min per kg;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001 and 0.004, respectively) and 6-minute walk distance (92.6 [24.7\u2013160.6] and 73.3 [7.9\u2013138.8] m;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004 and 0.029, respectively) compared with standard care. There were no differences in global longitudinal strain or symptom burden.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients with acute takotsubo cardiomyopathy, a 12-week intervention with exercise training or cognitive behavioral therapy improved left ventricular myocardial energetics and exercise performance without demonstrable effects on symptoms of heart failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04425785.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.125.013229","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:00:38Z","timestamp":1764756038000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Physical Exercise or Cognitive Behavioral Therapy for Takotsubo Cardiomyopathy: A Randomized Controlled Trial"],"prefix":"10.1161","volume":"19","clinical-trial-number":[{"clinical-trial-number":"nct04425785","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9723-5142","authenticated-orcid":true,"given":"David T.","family":"Gamble","sequence":"first","affiliation":[{"name":"Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre (D.T.G., H.K., L.C., A.R., J.S., D.H., P.K.M., D.D.), School of Medicine and Dentistry, University of Aberdeen, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7984-6452","authenticated-orcid":true,"given":"James","family":"Ross","sequence":"additional","affiliation":[{"name":"Aberdeen Biomedical Imaging Centre (J.R.), School of Medicine and Dentistry, University of Aberdeen, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0412-2227","authenticated-orcid":true,"given":"Hilal","family":"Khan","sequence":"additional","affiliation":[{"name":"Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre (D.T.G., H.K., L.C., A.R., J.S., D.H., P.K.M., D.D.), School of Medicine and Dentistry, University of Aberdeen, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3670-0741","authenticated-orcid":true,"given":"Lesley","family":"Cheyne","sequence":"additional","affiliation":[{"name":"Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre (D.T.G., H.K., L.C., A.R., J.S., D.H., P.K.M., D.D.), School of Medicine and Dentistry, University of Aberdeen, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7821-4365","authenticated-orcid":true,"given":"Amelia","family":"Rudd","sequence":"additional","affiliation":[{"name":"Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre (D.T.G., H.K., L.C., A.R., J.S., D.H., P.K.M., D.D.), School of Medicine and Dentistry, University of Aberdeen, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janaki","family":"Srivanasan","sequence":"additional","affiliation":[{"name":"Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre (D.T.G., H.K., L.C., A.R., J.S., D.H., P.K.M., D.D.), School of Medicine and Dentistry, University of Aberdeen, United 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