Scottish Cardiac Society 34th Annual General Meeting Thursday 2 & Friday 3 October 2025

Background: Takotsubo cardiomyopathy is an acute cardiac emergency presenting with severe left ventricular dysfunction. Physical exercise training or cognitive behavioural therapy may enhance myocardial recovery after takotsubo cardiomyopathy. Methods: In a prospective multi-centre clinical trial conducted between February 2020 and August 2023, patients with acute takotsubo cardiomyopathy were randomised 1:1:1 to physical exercise training, cognitive behavioural therapy or standard care for 12 weeks after index presentation. The primary endpoint was resting phosphocreatine/ gamma-adenosine triphosphate ratio (PCr/yATP) assessed by 31P-magnetic resonance spectroscopy. Secondary endpoints were peak oxygen consumption (peak VO2) on cardiopulmonary exercise testing, 6-min walk distance, left ventricular global longitudinal strain and Minnesota Living with Heart Failure questionnaire. Twelve-week changes in outcome were compared between allocated trial interventions. Results: Seventy-six participants were recruited: median age was 66 years and 91% were women. Compared to standard care, the primary endpoint of myocardial PCr/ yATP ratio was improved by physical exercise training (0.4 [95% con fi dence interval 0.1 – 0.8]; p = 0.016) and cognitive behavioural therapy (0.3 [0.01 – 0.7]; p = 0.043). Both physical exercise training and cognitive behavioural therapy improved peak VO2 (4.7 [1.4 – 8.0] and 4.0 [1.5 – 6.4] mL/ min/kg; p = 0.001 and 0.004 respectively) and 6-min walk