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β-blockers and outcomes of Takotsubo syndrome: need more clinical data
  1. Toshiaki Isogai1,
  2. Ken Kato2
  1. 1 Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2 Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
  1. Correspondence to Dr Toshiaki Isogai, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA; toisogai-circ{at}

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Takotsubo syndrome (TTS) has gained more awareness and attention in clinical practice in the last decade. Prior studies revealed important insights into the patient characteristics and outcomes of TTS.1 2 One of the most notable facts is that the prognosis of TTS is not as benign as initially expected and is comparable to acute coronary syndrome.1 2 Therefore, it is no surprise that physicians and researchers investigate a potential treatment option to improve the prognosis of TTS. Although the pathophysiology of TTS remains to be fully elucidated, catecholamines appear to play a critical role, as evidenced by the fact that TTS is frequently triggered by acute emotional or physical stress along with excess plasma catecholamine levels.2 3 As a result, β-blockers (BBs) have been empirically considered a reasonable therapy for TTS in the absence of randomised clinical trials.

In the current issue of Heart, Silverio et al examined the association between BBs and long-term survival using 825 patients in the Takotsubo Italian Network registry.4 The authors demonstrated that BB prescription at discharge was significantly associated with lower all-cause mortality after TTS (6.8% vs 13.6%; adjusted hazard ratio (aHR)=0.563, 95% confidence interval (CI)=0.356 to 0.889, p=0.014) during a median follow-up of 24 months, particularly with lower non-cardiac mortality (4.9% vs 10.7%; aHR=0.525, 95% CI=0.309 to 0.893, p=0.018) rather than cardiac mortality (1.8% vs 3.0%; aHR=0.699, 95% CI=0.284 to 1.722, p=0.436). Also, the effect modification was observed in patients with hypertension and those who developed cardiogenic shock during the acute phase (p for interaction <0.05). Meanwhile, there was no significant association between BB prescription and TTS recurrence. The authors are to be congratulated on their contribution to current literature on the topic. Nonetheless, several discussions need to be raised about the results and …

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  • Contributors TI wrote the draft. TI and KK edited it critically for important intellectual content. Both authors approved the final 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; externally peer reviewed.

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