Takotsubo syndrome (TS) is an underdiagnosed and remains an underestimated cardiac condition 123 . Although recently data from several large registries have advanced our knowledge of disease characteristics 456 , studies on management and specific therapies are largely missing. Around 10 % of patients develop cardiogenic shock, which has some inherent differences [7] compared to cardiogenic shock from other conditions such as acute myocardial infarction [8] or decompensated chronic heart failure. We recently published the first series of patients with TS and cardiogenic shock, who had been treated with an Impella percutaneous left ventricular assist device [9] . Our study has evoked a commentary from Japan [10] , which addresses recovery of left ventricular (LV) function, monitoring and device selection. We thank the authors for important comments, and respond to their questions on behalf of all co-authors.