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. 2024 Mar 12;110(7):476-481.
doi: 10.1136/heartjnl-2023-322980.

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

Francesco Santoro  1 , Scott Sharkey  2 , Rodolfo Citro  3 , Tetsuji Miura  4 , Luca Arcari  5   6 , Jose Angel Urbano-Moral  7 , Thomas Stiermaier  8 , Ivan Javier Nuñez-Gil  9 , Angelo Silverio  10 , Nicola Di Nunno  11 , Ilaria Ragnatela  11 , Rosa Cetera  11 , Junichi Nishida  4 , Ingo Eitel  8 , Natale Daniele Brunetti  12
Affiliations

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

Francesco Santoro et al. Heart. .

Abstract

Introduction: Takotsubo 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.

Methods: We 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.

Results: We 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).

Conclusions: Our study did not find sufficient statistical evidence regarding combination therapy with BB and ACEi/ARBs in reduction of TTS recurrence.

Keywords: cardiomyopathies; meta-analysis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Graphic representation of network meta-analysis and results of direct comparisons of beta-blocker and/or ACEi/ARB regimens for the end point Takotsubo syndrome recurrence. None of the OR reached statistical significance. ACEi, ACE inhibitors; ARBs, angiotensin receptor blockers; pts, patients.
Figure 3
Figure 3
Forest plot OR for prevention of Takotsubo syndrome prevention with drug therapy. ACEi/ARBs, ACE inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers.
See this image and copyright information in PMC

References

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