ABC | Volume 114, Nº3, March 2020

Short Editorial Fernandes & Montera Takotsubo Syndrome: A Recurrent Disease? Arq Bras Cardiol. 2020; 114(3):484-485 documented in 30 patients (4%) at a median follow-up of 830 days. Cardiovascular risk factors, such as arterial hypertension were significantly higher in the recurrence group. Interestingly, in 14 patients (46%), TTS was triggered by a new stressor compared with the first TTS event (9 patients experienced an emotional trigger, and 5 patients experienced a physical trigger) and up to 2 TTS recurrences were documented in 6% of cases. 10 There remain many unanswered questions regarding this complex syndrome. Interestingly, in this review the use of betablockers or other heart failure medications was not proved to reduce the chance of recurrence. Kato et al., 11 showed that 59.6% of patients were on regular betablocker therapy on admission related to TTS recurrence, most of which were beta 1-selective compounds in 84.6%, suggesting that beta 1-selective antagonists might not prevent TTS recurrence and an optimal treatment still needs to be determined. 11 1. Sato H. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K., Haze K., Hori M., editors. Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure. Tokyo (Japan): Kagakuhyoronsha Publishing Co; 1990. pp. 56–64. 2. Prasad A., Lerman A., Rihal C. S. Apical ballooning syndrome (tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155(3):408–17. 3. Ghadri JR, Wittstein IS,Prasad A, Sharkey S, Dote K, Akashi YJ, et al. International Expert consensus document on Takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018;39(22):2032–46. 4. Schneider B, Sechtem U. Influence of age and gender in Takotsubo syndrome. Heart Fail Clin. 2016;12(4):521–30. 5. Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo syndrome. Circulation 2017;135(24):2426–41. 6. Dawson DK. Acute stress-induced (takotsubo) cardiomyopathy. Heart. 2018;104(2):96-102. 7. Templin C, Ghadri JR, Diekmann J, Napp LC, BataiosuDR, Jaguszewski M,et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015;373(10):929–38. 8. El-Battrawy I, Santoro F, Stiermaier T, Möller C, Guastafierro F, NovoG, et al. Incidence and Clinical Impact of Recurrent Takotsubo Syndrome: Results From the GEIST Registry.J AmHeart Assoc.2019;8(9):e010753. 9. Campos FAD, Ritt LEF, Costa JPS, Margarida Cruz CM, Feitosa-Filho GS, Oliveira QB et al. Factors Associated with Recurrence in Takotsubo Syndrome: A Systematic Review. Arq Bras Cardiol. 2020; 114(3):477-483. 10. Pelica F, Pasceri V, Patti G, Tanzilli G, Speciale G, Gaudio C, et al. Long-Term Prognosis and Outcome Predictors in Takotsubo Syndrome: A Systematic Review and Meta-Regression Study. JACC Heart Fail. 2019;7(2):143-54. 11. KatoK,DiVeceD,CammannVL,MicekJ,SzawanKA,BacchiB,etal.InterTAK Collaborators. Takotsubo Recurrence: Morphological Types and Triggers and Identification of Risk Factors. J AmColl Cardiol. 2019;73(8):982-4. 12. Rashed A, Shokr M, Subahi A, Siddiqui F, Alkatib A, Afonso L. Reverse Takotsubo Cardiomyopathy in a Patient With Prior Apical Takotsubo Cardiomyopathy: Challenging the Beta Receptor Gradient Theory. Ochsner J. 2019;19(3):256-9. References 485