Spontaneous Takotsubo Syndrome and Its Recurrences: Pathogenetic Role of Intraventricular Mechanical Factors　― Reply ―

resembles of apical phenotype, we believe that it should not be included in the original condition of TTS.Thus, although we think that the suggestion made by Yalta et al. is not relevant to the matter at hand, we agree that we should be cautious in the diagnosis of TTS in patients with pre-existing myocardial conditions.In addition, other important messages from our study include the lower prevalence of typical ECG changes at the initial presentation of TTS in recurrent cases, and the reproducibility of the ballooning patterns between initial and recurrent TTS.Finally, we would like to once again emphasize the importance of evaluating the presence or absence of a clear emotional or physical trigger at initial episodes TTS in all patients, because the absence of a definable trigger is an independent and important predictor of TTS recurrence.