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

INTRODUCTION: Takotsubo cardiomyopathy (TC) is a stress-induced catecholamine acute myocardial dysfunction in the absence of significant coronary disease. The pathophysiology of TC remains poorly understood, and the use of beta-blockers (β-Blockers) appears promising. However, the impact of β-blockers in acute-phase management remains uncertain. AIMS: We aimed to conduct a systematic review and meta-analysis evaluating the early use of β-Blocker in TC and its effects on in-hospital mortality. METHODS: PubMed, Embase and Cochrane were searched for studies that evaluated the use of BBs in TC patients and its short-term effects. Statistical analysis was performed using RevMan V,5.4.1. The results are expressed using HRs and 95% confidence intervals (CI) were extracted using a random-effects model. Heterogeneity was assessed with I². RESULTS: We included five cohort studies, with a total of 5428 patients. The vast majority were women (81%) with a mean age of 70.1±12.6 years. More than half of the patients (52.0%) had previous hypertension. ST-elevation in the first ECG was observed in 37.3% of the patients. Early administration of β-blockers was not associated with a statistically significant reduction in in-hospital mortality (HR 0.78, 95% CI 0.59 to 1.02, p=0.07), and this finding was consistent across different β-blocker types, doses and routes of administration. CONCLUSION: Early β-Blocker therapy did not significantly influence in-hospital mortality in patients with TC. Future randomised studies are essential to clarify beta-blockers' role in this setting. PROSPERO REGISTRATION NUMBER: CRD420251055617.