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Purpose: To evaluate the echocardiographic prognostic implications in patients (pts.) with tako-tsubo cardiomyopathy (TTC).Methods: 110 consecutive pts (66.7 ± 11.5 years; 91% females) enrolled in the Tako-Tsubo Italian Network (TIN) underwent transthoracic echocardiography within 6 hours from hospital admission and at discharge. Left ventricular ejection fraction (LVEF), wall motion score index (WMSI), mitral inflow, E/e', mitral regurgitation (MR), left ventricular outflow tract (LVOT) obstruction ≥ 25 mmHg, right ventricular (RV) involvement were systematically assessed. The hard events, including acute heart failure, cardiogenic shock, ventricular tachycardia/fibrillation (VT/VF) and death during hospitalization were reported.Results: The apical form was detected in 100 pts. (91%), LVOT obstruction in 18 pts. (16.3%), ≥ moderate MR in 16 pts. (14.5%) and RV involvement in 15 pts (13.6%). LVEF (from 37.65±6.11% to 54.47±8.01%; p<0.001), WMSI (from 1.75±0.26 to 1.24±0.22, p<0.001), LVESV (from 54.2±14 ml to 37.8±9.9 ml, p<0.001) and E/e' (from 10.6±3.9 to 8.9±2.4, p<0.001) significantly improved from admission to discharge. Acute heart failure (20 pts, 18.2 %), cardiogenic shock (12 pts, 10.9%), VT/VF (5pts, 4.5%), and cardiac death (5 pts, 4.5%) were reported during hospital stay. At univariate analysis WMSI [p=0.005, CI 11,23 (2.04-61.80)], ≥ moderate MR [p=0.029, CI 3.36 (1.13-9.96)] and E/e' [p=0.003, CI 1,17 (1.05-1.31)] at admission were associated with hard events. At multivariate analysis the only independent predictor of hard events was E/e'[p=0.003, CI 1,17 (1.05-1.30)].Conclusions: Echocardiography is an important tool to identify the patients with TTC at higher risk of major cardiac complications. Early diastolic dysfunction is associated with short term adverse outcome.