Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis

Abstract

IntroductionTakotsubo 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.MethodsWe 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.ResultsWe 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).ConclusionsOur study did not find sufficient statistical evidence regarding combination therapy with BB and ACEi/ARBs in reduction of TTS recurrence.

Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome

“…Our patient was not taking a beta-blocker at the time of TTS recurrence. Some observational data found a protective effect of this therapy, but controversy exist about the efficacy of both beta-blockers and ACE-inhibitors administration (6,15,16). In consideration of the possible TTS onset without clinical suspicion of COVID-19 disease, its incidence in this setting may be underestimated.…”

How to Use Cardiac Magnetic Resonance Imaging in Myocardial Infarction With Nonobstructive Coronary Arteries

“…Uncertainties remain about the treatment of patients with Takotsubo syndrome, where a recent meta-analysis points against treatment with angiotensin-converting enzyme/A2-inhibition and beta-blockers. 30 Currently, it is unclear if patients with suspected MINOCA with normal investigations, including an early CMR, should have the final diagnosis of MINOCA and be treated as a CMR-verified myocardial infarction. Some of these patients will be shown to have plaque disruption if optical coherence tomography is performed and should thus be treated for myocardial infarction.…”