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Santoro F, Sharkey S, Citro R, Miura T, Arcari L, Urbano-Moral JA, Stiermaier T, Nuñez-Gil IJ, Silverio A, Di Nunno N, Ragnatela I, Cetera R, Nishida J, Eitel I, Brunetti ND. Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis. Heart 2024; 110:476-481. [PMID: 37666647 PMCID: PMC10958301 DOI: 10.1136/heartjnl-2023-322980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is an acute heart failure syndrome, featured by transient left ventricular systolic dysfunction. Recurrences of TTS are not infrequent and there is no standard preventive therapy. The aim of this study was to evaluate in a network meta-analysis if beta-blockers (BB) and ACE inhibitors/angiotensin receptor blockers (ACEi/ARBs), in combination or not, can effectively prevent TTS recurrences. METHODS We performed a systematic network meta-analysis, using MEDLINE/EMBASE and the Cochrane Central Register of Controlled Trials for clinical studies published between January 2010 and September 2022. We considered all those studies including patients receiving medical therapy with BB, ACEi/ARBs. The primary outcome was TTS recurrence. RESULTS We identified 6 clinical studies encompassing a total of 3407 patients with TTS. At 40±10 months follow-up, TTS recurrence was reported in 160 (4.7%) out of 3407 patients. Mean age was 69.8±2 years and 394 patients (11.5%) out of 3407 were male. There were no differences in terms of TTS recurrence when comparing ACEi/ARBs versus control (OR 0.83; 95% CI 0.47 to 1.47, p=0.52); BB versus control (OR 1.01; 95% CI 0.63 to 1.61, p=0.96) and ACEi/ARBs versus BB (OR 0.88; 95% CI 0.51 to 1.53, p=0.65).Combination of BB and ACEi/ARBs was also not effective in reducing the risk of recurrence versus control (OR 0.91; 95% CI 0.58 to 1.43, p=0.68) vs ACEi/ARBs (OR 0.79; 95% CI 0.46 to 1.34, p=0.38)) and vs BB (OR 0.77; 95% CI 0.49 to 1.21, p=0.26). CONCLUSIONS Our study did not find sufficient statistical evidence regarding combination therapy with BB and ACEi/ARBs in reduction of TTS recurrence.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Scott Sharkey
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Rodolfo Citro
- Cardiovascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Tetsuji Miura
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Jose Angel Urbano-Moral
- Inherited Cardiac Conditions & Myocardial Disease Unit, Cardiology Department, University Hospital Jaen, Jaen, Spain
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Ivan Javier Nuñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Nicola Di Nunno
- Department of Medical & Surgical Sciences, Università degli Studi di Foggia, Foggia, Italy
| | - Ilaria Ragnatela
- Department of Medical & Surgical Sciences, Università degli Studi di Foggia, Foggia, Italy
| | - Rosa Cetera
- Department of Medical & Surgical Sciences, Università degli Studi di Foggia, Foggia, Italy
| | - Junichi Nishida
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Lübeck, Germany
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Madias JE. Further Evidence for a Global Myocardial Involvement and an Incomplete Recovery in Takotsubo Syndrome. Am J Cardiol 2024; 211:381. [PMID: 38042264 DOI: 10.1016/j.amjcard.2023.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Affiliation(s)
- John E Madias
- The Icahn School of Medicine at Mount Sinai, New York, New York; The Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York
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Yalta K, Yilmaztepe M, Zorkun C. Left Ventricular Dysfunction in the Setting of Takotsubo Cardiomyopathy: A Review of Clinical Patterns and Practical Implications. Card Fail Rev 2018; 4:14-20. [PMID: 29892470 PMCID: PMC5971666 DOI: 10.15420/cfr.2018:24:2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/14/2018] [Indexed: 12/21/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is primarily regarded as a form of acute and transient myocardial disease with a variety of characteristic wall-motion abnormalities. Importantly, a significant portion of TTC cases generally present with variable degrees of acute left ventricular (LV) dysfunction with or without clinical HF. On the other hand, LV dysfunction in the setting of TTC has been universally and exclusively considered as a synonym for systolic dysfunction, potentially overlooking other forms of myocardial pathologies, including transient diastolic dysfunction, in this setting. More interestingly, recent observations suggest that TTC, despite its macroscopic recovery, may not always manifest as a fully reversible phenomenon, suggesting persistence of microscopic changes at the cellular level to some degree. In clinical practice, these residual changes might largely account for the evolution of certain pathologies, including persistent diastolic dysfunction and subclinical LV dysfunction with variable symptomatology (particularly those arising during high levels of myocardial workload, including exercise, etc.) among TTC survivors. Within this context, the present review aims to highlight various clinical patterns and implications of LV dysfunction in the setting of TTC, and to provide basic information regarding morphological and mechanistic characteristics of wall-motion abnormalities in this setting.
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Affiliation(s)
- Kenan Yalta
- Trakya University, Cardiology Department Edirne, Turkey
| | | | - Cafer Zorkun
- Trakya University, Cardiology Department Edirne, Turkey
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