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Response to: Correspondence on 'Outcomes of catecholamine and/or mechanical support in Takotsubo syndrome' by John E Madias
  1. Satoshi Terasaki1,
  2. Koshiro Kanaoka2,
  3. Yoshihiko Saito1
  1. 1Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
  2. 2Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  1. Correspondence to Professor Yoshihiko Saito, Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan; yssaito{at}

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The Authors' reply: In response to the valuable comments of John E Madias,1 we are pleased to share the results of the additional analysis on our recent study titled ‘Outcomes of catecholamine and/or mechanical support in Takotsubo syndrome’.2 We hope that the journal readership finds the additional information helpful.

Although the exact pathophysiological mechanisms of Takotsubo syndrome (TTS) are not completely understood, considerable evidence suggests that sympathetic stimulation is crucial to its pathogenesis. It has previously been postulated that the prevalence of diabetes mellitus (DM) in patients with TTS is lower than that in the general population.3–5 The implication of this is that DM exerts a ‘protective effect’ against the development of TTS, a phenomenon …

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  • Contributors ST and YS drafted the initial manuscript with contributions from all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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