Background
Pharmacological therapy with β-blocker medication in patients with Takotsubo syndrome still represents a debated issue and data are controversial. In several studies β-blockers did not demonstrate any benefit on mortality reduction and, furthermore, at long-term follow-up no benefit was shown with β-blockers therapy in terms of lower recurrence rates or better survival.
Aim of the study
Aim of the study is to compare the outcomes regarding mortality, functional status and speckle tracking in TS patients who received β-blocker vs TS patients without β-blocker medication.
Methods
In this prospective register, the study population consisted of 43 patients with TTS, which were hospitalized and treated in department of internal medicine I in Ingolstadt hospital during the years 2013-2019. After enrollment, all patients were followed-up prospectively for major adverse cardiac events, functional status and mortality. A follow-up control including speckle tracking echocardiography was carried out in all patients.
Results
Among the overall 43 Takotsubo patients, 27 patients received β-blocker s (63%) whereas 16 (37%) did not. Most individuals were females (90.7%) while mean age was 72.2 years. Patient median follow-up time was found equal to 38.1 months.
In the univariate analysis for β-blocker s and non β-blocker s cohorts, TTS patients who received β- blockers did not have improved survival, functional status, or echocardiographic speckle tracking findings in comparison to TTS patients without β-blockers. The relationship between β-blockers and dyspnea (p=0.617, table 1), GLS (p=0.630, table 2) and death (p=0.605, table 3) did not differ significant in the two cohorts. This study could not show a benefit of β-blockers treatment regarding prognosis or LV recovery. The role of β-blockers in TTS syndrome and the possible clinical benefit in TTS patients has been widely investigated in the last years and remains an unresolved issue. Most of the previous studies or meta-analyses failed to show an improvement in mortality or MACEs in TTS patients.
Conclusion
In this observational, non-randomized, prospective study was found that TTS patients who received β- blockers did not have improved survival, functional status, or echocardiographic speckle tracking findings in comparison to TTS patients without β-blockers.
Prospective and multicenter randomized studies are surely necessary to investigate the real efficacy of drug therapy in TTS.
Table 1 Relationship between dyspnea and β-blockers. Chi-square test was used for the comparison.
|
|
Β- Blocker, n(%) |
|
|
Dyspnea, n (%) |
No |
Yes |
p |
|
No |
5 (31.3) |
8 (29.6) |
0.617
|
|
Class 1 |
3 (18.8) |
3 (11.1) |
|
Class 2 |
4 (25.0) |
8 (29.6) |
|
Class 3 |
3 (18.8) |
8 (29.6) |
|
Class 4 |
1 (6.3) |
0 (0.0) |
Table 2 Relationship between echocardiographic parameters and β-blockers. Mann- Whitney U test was used for the comparison.
|
|
Β-blocker |
|
|
Parameters |
No |
Yes |
p |
|
1. GLS %, median (IQR) |
14.7 (12.8, 16.9) |
14.4 (10.8, 17.6) |
0.630 |
|
2. EF %, median (IQR) |
55.0 (50.6, 60.0) |
56.0 (50.7, 60.0) |
0.732 |
|
3. GLS/EF Ratio, median (IQR) |
0.28 (0.2, 0.3) |
0.3 (0.2, 0.3) |
0.671 |
|
4. Apex to mid, median (IQR) |
1.1 (0.9, 1.3) |
0.9 (0.6, 1.4) |
0.281 |
|
5. LA Volume (ml/qm), median (IQR) |
34.0 (25.4, 39.9) |
37.1 (30.0, 46.3) |
0.202 |
|
6. TR, median (IQR) |
2.4 (2.1, 2.8) |
2.4 (2.0, 2.8) |
0.934 |
Table 3 Relationship between death occurrence and β-blockers. Chi-square test was used for the comparison.
|
|
Beta-Blocker, n (%) |
|
|
Death, n (%) |
No |
Yes |
p |
|
No |
14 (87.5) |
2(12.5) |
0.605
|
|
Yes |
22(81.5) |
4(18.5) |