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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, …
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.