Response to Association of Prolonged QTc Interval With Takotsubo Cardiomyopathy: A Neurocardiac Syndrome Inside the Mystery of the Insula of Reil

Abstract

"It has often been argued that absolute scepticism is self-contradictory; […] Using the proposition that there are 28.5% patients without any evident trigger, the author of the letter concludes that stress hypotesis could be not valid. This is an error in inference. Second, the following objection to the stress hypotesis is that the plasma catecholamines in the majority of patients with TC show normal or near normal values, as highlighted in our review, and that TC may occur in patients with neuropathies and diabetes. These premises are true and do not, in the least, contradict the fact that the cardiac lesions in patients with TC have a neural etiology due to intracardiac release of catecholamines.This reasoning is fallacious. If we knew that adrenalectomy does not protect the heart and that the decreased cardiac activity on Although infarction confined to the IC in humans is somewhat rare, according to our previous report, at bivariate analysis insular involvement showed significant association with QTc. 9 In addition, regarding the statement that "ventricular arrhythmias should be a frequent complication of ischemic stroke in the median [sic] cerebral artery territory, which supplies the IC", the point is that not all ischemic strokes in the middle cerebral artery (MCA) territory involve the IC. While we are unaware of studies supporting Finsterer's conclusion, a recent study of 1311 patients with ischemic stroke in the MCA territory, disapproves this assertion, since only 112 patients (8.5%) showed IC involvement. 10 As such, MCA stroke is not synonymous with IC involvement.