Authors’ reply

We would like to thank Finsterer and Stöllberger for the interesting comment on our article.1 We fully agree that the main limitation of the study is the small number of men included in the analysis, but this is due to rare occurrence of takotsubo syndrome (TTS) in men in general population. The percentage of men among patients with TTS is only about 10% worldwide.2 As we mentioned, this may be the reason for underestimating the incidence of complications.

Coronary angiography was performed in all patients except for 2, and in all of them significant coronary artery disease was excluded. However, according to the current International Takotsubo Diagnostic Criteria, even severe coronary artery disease does not exclude the diagnosis of TTS.3 The majority of experts consider the Mayo Clinic criteria no longer valid.

As shown in Table 2 in our article,1 chest pain was present in 84.3% of women and 81% of men, whereas dyspnea, in 49.3% and 38.1%, respectively. The difference was not significant. Data on leg edema or palpitations were not collected.

Please note that physical stress triggered TTS in 30 women (14.2%) and 7 men (35%). Because of the small number of men, the difference between TTS classes (I, IIa, IIb, III) in men and women could not be reliably assessed.4

We performed cardiac MRI only in the case of clinical doubt. In each such case, we diagnosed TTS only when other conditions were excluded.

Although 6 women and no men died, the difference in mortality was not significant: 2.9% and 0%, respectively.

As far as the QTc interval is concerned, no difference between women and men was reported on days 1, 3, and 5.

To sum up, we agree that there is a need for further multicenter studies to ensure the homogeneity of the groups. However, in our opinion, our analysis based on a population from 2 large Polish cardiology centers is a good starting point for further research.