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RESEARCH ARTICLE
Early evolution of psychological functioning after Takotsubo syndrome: A prospective cohort study
Badiha Herranz1,2 ,
Inés Magán1,2 ,
Borja Ibáñez3,4 ,
María Rosario Ortas5 ,
María Asunción Esteve-Pastor6 ,
Manuel Martínez-Sellés7,8 ,
Antonia Sambola9 ,
Tamara García Camarero10 ,
Iván J. Núñez-Gil11,12,13 ,
Bárbara Izquierdo Coronel14 ,
Nicolás Rosillo15 ,
Guillermo Moreno15,16 ,
Rosa Jurado1,2 ,
Cristina Martín-Arriscado Arroba17 ,
Héctor Bueno3,15,18*
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1 Facultad HM de Ciencias de la Salud de la Universidad Camilo José Cela, Villanueva de la Cañada, Madrid , Spain
2 Instituto de Investigación Sanitaria HM Hospitales, Madrid , Spain
3 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid , Spain
4 Cardiology Department, Hospital Fundación Jimenez Díaz, Madrid , Spain
5 Cardiology Department, Hospital Universitario Miguel Servet Zaragoza, Zaragoza , Spain
6 Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Murcia , Spain
7 Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid , Spain
8 School of Biomedical Sciences and Health, Universidad Europea de Madrid. School of Medicine, Universidad Complutense, Madrid , Spain
9 Cardiology Department, Hospital Vall d´Hebron, Barcelona , Spain
10 Cardiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander , Spain
11 Fundación para la Investigación Biomédica del Hospital Clínico San Carlos, Madrid , Spain
12 Cardiology Department, Hospital Universitario de Torrejón, Madrid , Spain
13 Faculty of Medicine, Health and Sports, Universidad Europea de Madrid. Villaviciosa de Odón, Madrid , Spain
14 Hospital Universitario de Getafe, Getafe, Madrid, Spain, Universidad Europea de Madrid. Facultad de Ciencias Biomédicas, Salud y Deporte. Departamento de Medicina. Madrid , Spain
15 Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid , Spain
16 Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid , Spain
17 Clinical Research Unit, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid , Spain
18 Cardiology Department, Hospital Universitario 12 de Octubre, Madrid , Spain
HPR, 026280153 https://doi.org/10.36922/HPR026280153
Received: 8 July 2026 | Revised: 14 August 2026 | Accepted: 20 August 2026 | Published online: 3 September 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract
Background: Although ventricular function usually recovers rapidly after Takotsubo syndrome (TTS), little is known about the early evolution of psychological functioning.
Objectives: In this study, we examined longitudinal changes across multiple psychological domains during the first month in patients with TTS, patients with acute myocardial infarction (AMI), and healthy controls (HC).
Methods: Eighty-five participants (37 TTS, 23 AMI, and 25 HC) completed psychological assessments during the acute phase and 30 days later. The assessment included symptoms of anxiety and depression, anger, coping strategies, emotion regulation, resilience and worry. Longitudinal changes were evaluated using linear mixed-effects models including fixed effects for group, time, and the group × time interaction, with a random intercept for participants.
Results: A significant group × time interaction was observed for anger-in control, with patients with AMI showing a greater increase over time than HC; this interaction remained significant after false discovery rate (FDR) correction for multiple testing. An interaction was also observed for cognitive coping in the primary analysis, but it did not remain significant after FDR correction and was therefore considered exploratory.
Conclusion: Most psychological outcomes did not show statistically significant longitudinal changes during the first month after TTS. These findings highlight the importance of incorporating psychological assessment into routine follow-up after TTS.
Graphical abstract
Keywords
Takotsubo syndrome
Longitudinal study
Emotion regulation
Resilience
Acute myocardial infarction
Funding
This project was funded by Instituto de Salud Carlos III (AES Program, Grant PI 17/01799), VII Convocatoria de Ayudas a la Investigación de la Universidad Camilo José Cela (2020-22), and a predoctoral fellowship awarded to Badiha Herranz (Beca de excelencia Banco Santander-UCJC para la promoción de la Investigación a alumnos de doctorado [2022–2025]).
Conflict of interest
Dr. Héctor Bueno receives research funding from the European Union (EU4H-2022-JA-03; JAGHI2.0-101323676-GAP-101323676), Instituto de Salud Carlos III, Spain (FORTALECE program, PI21/01572), Sociedad Española de Cardiología, Alnylam, AstraZeneca, Bayer, BMS-Janssen, Boehringer Ingelheim, and has received consulting/speaking fees from AstraZeneca. Nicolás Rosillo is funded by the European Union (EU4H-2022-JA-03) and reports funding for conferences from AstraZeneca Spain. Badiha Herranz, Inés Magán, Borja Ibáñez, María Rosario Ortas, María Asunción Esteve, Antonia Sambola, Tamara García, Rosa Jurado, Iván Núñez-Gil, Guillermo Moreno, Manuel Martínez -Sellés, Bárbara Izquierdo Coronel, and Cristina Martín-Arriscado Arroba declare no competing interest.
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