I read the contribution by Gopalakrishnan et al, published on line ahead of print on September 3, 2015 in the American Journal of Cardiology , about the predictors of short-term and long-term outcomes in 56 consecutive patients with takotsubo syndrome (TTS) presenting to a single urban medical center. Mortality rate was 8.9% in hospital, with additional 17.9% after discharge, and a nonfatal recurrence rate of 1.8% was observed. Of >60 clinical factors analyzed, “QTc interval at presentation was the factor most strongly predictive of overall outcome, after intubation.” The investigators reported that overall mortality of 15 deaths over the entire course of a mean of 4.47 years of observation, used the QTc from the admission electrocardiogram (ECG; the 48-hour ECGs were also considered) for the analysis, found a hazard ratio of QTc (per 50 ms) of 0.39 and 0.43, and p values of 0.019 and 0.051, in the univariate and multivariate analyses, correspondingly. However, the complex relation of QTc and mortality may require the usage of values of the QTc on admission, peak QTc, change in the QTc, and the QTC from the ECG closest to the time of death, from daily ECGs, data which probably were not available in the present retrospective study. The investigators appear to focus on the “intense catecholamine release and hyperadrenergic tone,” and the upsetting of the “balance between sympathetic innervation and parasympathetic compensation,” as mediators for the prolongation of the QTc; however, current progress has emphasized the role of myocardial edema (ME) as the mechanism for the changes of cardiac electrical repolarization, seen in TTS. Indeed, an apicobasal ME gradient has been detected by cardiac magnetic resonance imaging, which correlates with the lengthening of QTc. Another parallel consequence of ME is a transient voltage attenuation of the QRS complexes (attenuation of the QRS complexes) in the ECGs of patients with TTS, recently reported, and the investigators are encouraged to attempt to corroborate or refute this finding, by evaluating their 56 pairs of the ECGs from admission and 48 hours later for ATTQRS. The equipment used by the investigators for the acquisition of digitized ECGs (Philips PageWriter TC70 series, Philips, Amsterdam, The Netherlands) provides automated measurements of peak-to-peak QRS complexes for all 12 ECG leads, which can be used to calculate the possibly present ATTQRS.