LAUSR

The article by Citro et al.1 published in the European Journal of Heart Failure describes the outcome of Takotsubo syndrome (TTS) patients presenting with severely reduced left ventricular ejection fraction (LVEF≤ 35%) on admission. Recent data have shown that LVEF≤ 35% is a key parameter for identifying high-risk patients susceptible to an impaired clinical outcome. Despite advances in explaining the pathomechanism of TTS, including catecholamine excess hypotheses, low oestrogen levels, endothelial dysfunction and myocardial oedema, the main underlying mechanism remains elusive.2,3 Different registries (e.g. InterTAK registry and GEIST registry) and single-centre studies have shown that TTS is associated with different complications, including arrhythmias, thromboembolic events and cardiogenic shock,4–6 which are more frequent in patients with a declined left ventricular ejection fraction. Based on these data, an old consensus dictating a favourable prognosis for patients with TTS has been critically altered to an impaired outcome with a mortality rate similar to acute coronary syndrome.4,7 We were wondering if authors may provide us with information on thromboembolic events in their patients, and if any differences were found in LVEF≤ 35% as compared to LVEF> 35%. Additionally, prognostic models might be recommended to consider predictors of declined outcome.8