akotsubo syndrome (TTS) is a disorder known to be triggered by several stresses. [1][2][3][4][5] The stresses that have been associated with TTS can be primarily divided into 2 categories: physical stress or mental stress. Natural disasters can be a type of mental stress and are known to trigger the onset of TTS. 6-8 The Great East Japan earthquake (GEJ-E) disaster and massive tsunami, which occurred at 14:46 hours on March 11, 2011, was a magnitude 9.0 earthquake with an epicenter off the coast of Sanriku. The maximum seismic intensity of the earthquake was 7 in Kurihara, Miyagi Prefecture, and the tsunami reached up to ≥9.3 m in Soma, Miyagi Prefecture. A total of 19,630 people died, 2,569 were recorded as missing, 6,230 were injured, and 115,8976 homes were damaged on March 1, 2018. The earthquake has been reported as having a large impact on the development and treatment of various cardiovascular diseases. 9-17 At first, the GEJ-E disaster was also thought to have increased the number of cases of TTS, but a short-term report from Miyagi Prefecture in 2013 indicated that there was no obvious increase. 18 Even nearly 10 years after the disaster, people are still living in temporary housing, and there are concerns that the effects of the disaster may have led to chronic stress. A previous study reported that the incidence of acute heart failure was increased for a long time after the GEJ-E disaster. 19 However, no studies have compared the incidence of TTS in coastal and inland areas and the long-term course of TTS after the GEJ-E disaster.This study aimed to investigate (1) the incidence and Editorial p ????