Use of beta-blockers and in-hospital mortality in patients with Takotsubo cardiomyopathy - a systematic review and meta-analysis

Abstract Introduction Takotsubo cardiomyopathy (TC) is a stress-induced catecholamine acute myocardial dysfunction in the absence of significant coronary disease. The pathophysiology of TC remains understood and the use of beta-blockers (BBs) appears promising. However, the impact of BBs in acute-phase management remains uncertain. Purpose We aimed to conduct a systematic review and meta-analysis evaluating the early use of BBs in TC and its effects in-hospital mortality. Methods PubMed, Embase and Cochrane were searched for studies that evaluated the use of BBs in TC patients and its short-terms effects. Statistical analysis was performed using RevMan 5.1.7. The results are expressed using Hazard ratio (HRs) and 95% confidence intervals (CI) were extracted using a random-effects model. Heterogeneity was assessed with I². Results We included 5 cohort studies, with a total of 5,428 patients. The vast majority were women (81%) with a mean age of 70.1±12.6 years. More than half of patients (52.0%) had previous hypertension. ST-elevation in the first electrocardiogram was observed in 37.3% of the patients. Early administration of beta-blockers was not associated with a statistically significant reduction in in-hospital mortality (HR 0.78, 95% CI 0.59-1.02, p=0.07), and this finding was consistent across different beta-blocker types, doses, and routes of administration. Conclusion In patients with Takotsubo cardiomyopathy, early beta-blocker therapy did not significantly influence in-hospital mortality. Future randomized studies are essential to clarify the role of beta-blockers in this setting.Early administration of beta-blockers