Key result
Current evidence for stress cardiomyopathy therapies is limited and largely lacks randomized data, though some evidence supports beta-blockers for LVOT obstruction and ACE inhibitors for secondary prevention.
Current treatment of stress cardiomyopathy relies on limited evidence, highlighting the need for randomized controlled trials to establish optimal pharmacological and nonpharmacological therapies.
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Evidence too limited for routine recommendations in stress cardiomyopathy; leaves open optimal therapies pending randomized trials.
Several therapeutic options are available for the treatment of the acute phase of stress cardiomyopathy, pharmacological (β-blockers, diuretics, anticoagulants, antiarrhythmics, noncatecholamine inotropics [levosimendan]), and nonpharmacological (intra-aortic balloon pumping, extracorporeal membrane oxygenation), according to the wide possible clinical presentation and course of the disease. However, there is a gap in evidence, and very few data come from randomized and adequately powered studies. Some evidence supports the use of β-blockers, in particular with a short half-life, in the case of left ventricular outflow tract obstruction, and angiotensin-converting enzyme inhibitors in secondary prevention. Future perspectives include the study of genetic basis of stress cardiomyopathy, role of miRNA and neurovegetative modulation. Randomized studies, however, are surely warranted.
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Brunetti et al. (2016) conducted a review in Stress (takotsubo) Cardiomyopathy. Pharmacological and nonpharmacological therapies was evaluated. Current evidence for stress cardiomyopathy therapies is limited and largely lacks randomized data, though some evidence supports beta-blockers for LVOT obstruction and ACE inhibitors for secondary prevention.
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