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Vol. 72. Issue 8.
Pages 694-695 (August 2019)
Vol. 72. Issue 8.
Pages 694-695 (August 2019)
Letter to the Editor
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Factors Impacting Prognosis Among Patients with Tako-tsubo Syndrome. Response
Factores que afectan al pronóstico de pacientes con síndrome de tako-tsubo. Respuesta
Alberto Pérez-Castellanosa,
Corresponding author

Corresponding author:
, Manuel Martínez-Sellésb,c,d, Bernardo García de la Villaa, Iván J. Núñez-Gile
a Servicio de Cardiología, Hospital de Manacor, Manacor, Balearic Islands, Spain
b Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Universidad Complutense, Madrid, Spain
d Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
e Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
Related content
Rev Esp Cardiol. 2019;72:69410.1016/j.rec.2019.01.018
Nauman Khalid, Sarah Aftab Ahmad, Affan Umer, Lovely Chhabra
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To the Editor,

We appreciate the interest and comments of Khalid et al. regarding our article.1 The results of the successive registries and experimental studies add evidence to support that estrogens play an important role in the modulation of catecholaminergic discharge on the heart, thus affecting the development and outcome of tako-tsubo syndrome (TTS). It is interesting to think that this could lead in the future to design strategies for targeted treatment in patients with TTS. However, other sex-related factors probably influence this different prognosis. For instance, the number of previous pregnancies has recently been shown to be associated with a better prognosis in women with heart failure.2 Also, important sex-related differences have been described in patients with acute myocardial infarction.3 Irrespective of these considerations, we agree that, with respect to the prognosis of patients with TTS, the underlying trigger is also an important factor. In fact, in a previous work by our group,4 we reported that the clinical course during hospitalization (length of stay and complications) and follow-up (recurrences) was worse in secondary than in primary TTS. This is why we proposed to extend this simple nomenclature. Primary TTS has no identifiable trigger, or is triggered by major psychological stress, while secondary TTS is triggered by physical factors (such as respiratory exacerbation, surgery, and trauma).5


The authors wish to acknowledge the inestimable and generous contribution of Irene Martín and all the RETAKO investigators.

A. Pérez-Castellanos, M. Martínez-Sellés, H. Mejía-Rentería, et al.
Tako-tsubo Syndrome in Men: Rare, but With Poor Prognosis.
Rev Esp Cardiol., 71 (2018), pp. 703-708
M. Martínez-Sellés, P. Díez-Villanueva, J. Álvarez Garcia, et al.
Influence of sex and pregnancy on survival in patients admitted with heart failure: Data from a prospective multicenter registry.
Clin Cardiol., 41 (2018), pp. 924-930
M.J. Valero-Masa, J. Velásquez-Rodríguez, F. Diez-Delhoyo, et al.
Sex differences in acute myocardial infarction: Is it only the age?.
Int J Cardiol., 231 (2017), pp. 36-41
I.J. Núñez-Gil, M. Almendro-Delia, M. Andrés, et al.
Secondary forms of Takotsubo cardiomyopathy: A whole different prognosis.
Eur Heart J Acute Cardiovasc Care., 5 (2016), pp. 308-316
A. Dias, I.J. Núñez-Gil, F. Santoro, et al.
Takotsubo syndrome: State-of-the-art review by an expert panel - Part 1.
Cardiovasc Revasc Med., (2018),
Copyright © 2019. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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