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Correspondence on 'Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome’ by Silverio et al
  1. Amanda Chang,
  2. Arooj Khan,
  3. Kan Liu
  1. Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Kan Liu, Medicine, The University of Iowa, Iowa City, IA 52242, USA; Kan-Liu{at}

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To the Editor

We have read the article by Silverio et al 1 regarding beta-blockers reducing all-cause mortality in patients with Takotsubo syndrome (TTS). The beneficial effect of beta-blockers particularly applies to TTS patients with hypertension or cardiogenic shock. While this exciting finding validates an important risk reduction strategy in TTS survivors at long-term follow-up, Silverio et al’s1 results also bring up a seemingly paradoxical therapeutic dilemma in TTS patients with cardiogenic shock.

Dynamic left ventricular outflow tract (LVOT) obstruction and worsening mitral regurgitation (MR) play important roles in TTS-associated cardiogenic shock.2 3 Preceding myocardial structural abnormalities (hypertensive heart disease and basal septal hypertrophy, …

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  • Contributors AC, AK and KL all worked on writing and editing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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