ABC | Volume 114, Nº3, March 2020

Original Article Campos et al. Takotsubo syndrome recurrence Arq Bras Cardiol. 2020; 114(3):477-483 this opportunity, such as the association between female gender and higher recurrence rate, and the non-efficacy of BB in the prevention of a second episode. Other variables, not yet addressed by Singh et al., 5 could be associated with a higher rate of recurrence by this systematic review, such as the shorter time after the first episode, low BMI and LV middle third hypercontractility. In this study, the STROBE 8 was used in order to evaluate and select the studies found, while Singh et al. used the “Quality of Reporting of Observational Longitudinal Research”, 21 and special focus was given to TTS recurrence rate, selecting articles that reported a minimum of 3% of recurrence rate, which may have turned this systematic review into more task-specific. Given the local experience of the authors, a TTS prevalence of 3.2% was observed in patients initially suspected of ST elevation acute myocardial infarction and there were no recurrences in the 1-year ambulatory median follow up. No data about the risk of recurrence when submitted to the same stress factor again were found. Whether a second exposure to the same stressor should be avoided may be a matter of interest for future studies. Among the limitations of this review, as those of the selected studies, are: the fact that some studies were performed in a single population without external validation; the lack of more clinical details of the patients who presented recurrence (most articles do not bring data from the patients that recurred in an individual basis, thus it was not possible to analyze the combining data from individual patients together); in addition to the scarcity of studies related to the topic, although this factor did not prevent this systematic review realization to be carried out. A strong methodology, with a high cut-off point in STROBE and the use of the PRISMA model, provided a solid basis for consistently constructing this systematic review. Conclusion Considering the above, female gender, lower BMI, LV middle third hypercontractility, and shorter time after the first episode were associated to a greater recurrence chance. Patient’s age and electrocardiographic presentation, related to the manifestation of a second TTS episode, deserve to be better investigated by studies with larger populations. Author contributions Conception and design of the research and Acquisition of data: Campos FAD, Ritt LEF; Analysis and interpretation of the data, Statistical analysis, Writing of the manuscript and Critical revision of the manuscript for intellectual content: Campos FAD, Ritt LEF, Costa JPS, Cruz CM, Feitosa Filho GS, Borges QO, Darze ES. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1. 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