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In Reply: Dr Gnecchi-Ruscone raises the question of whether the previously reported predominance of Takotsubo cardiomyopathy in women is preserved in a setting of a large catastrophic event such as an earthquake. Among the 25 patients we described with Takotsubo cardiomyopathy following the Niigata-Chuetsu earthquakes in 2004, 24 (96%) were women. The mean age was 71.0 years (range, 49-83 years). Of the 2 patients with Takotsubo cardiomyopathy during the 20 control weeks, one was a woman and one was a man.

Onset of Takotsubo cardiomyopathy is usually preceded by acute personal events, such as a psychological or physical stress, and most of the patients are postmenopausal women (82%-100%; mean age, 62-75 years).^1-3 Given our findings, it appears that Takotsubo cardiomyopathy occurs more often in women regardless of the initial stressor.

Financial Disclosures: None reported.

Hiroshi Watanabe, MD, PhD
hiroshi7@med.niigata-u.ac.jp
Division of Clinical Pharmacology
Vanderbilt University School of Medicine
Nashville, Tenn

Makoto Kodama, MD, PhD; Yoshifusa Aizawa, MD, PhD
Division of Cardiology

Naohito Tanabe, MD, PhD
Division of Health Promotion
Niigata University Graduate School of Medical and Dental Sciences
Niigata, Japan

1. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539-548. FREE FULL TEXT 2. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation. 2005;111:472-479. FREE FULL TEXT 3. Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141:858-865. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294:2169-2170.