Efficacy of beta-blocker therapy in Takotsubo cardiomyopathy: A systematic review and meta-analysis

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2025-06-06 DOI:10.1016/j.ijcard.2025.133483

Ricardo A. Rodriguez Mejia , Arminder Singh , Amol Bahekar , Ashish Gupta

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引用次数: 0

Abstract

Background

Takotsubo cardiomyopathy (TTC) is a stress-induced condition with limited evidence-based treatment options. Beta-blockers are commonly used, yet their efficacy remains uncertain. This meta-analysis evaluates the impact of beta-blocker therapy on mortality and recurrence in TTC patients.

Methods

We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Semantic Scholar, alongside trial registries and grey literature, for studies from inception to March 2025. Included studies examined adult TTC patients treated with beta-blockers versus controls, reporting all-cause mortality and recurrence. Odds ratios (ORs) with 95 % confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with I² statistics, and publication bias was evaluated via funnel plots. Subgroup analyses stratified studies by design (retrospective, prospective, mixed) to assess methodological heterogeneity. A meta-regression explored ejection fraction (EF) as a moderator of mortality outcomes.

Results

Nineteen studies (n = 11,167 patients, predominantly female, mean age 59–74 years) were included. Beta-blocker therapy significantly reduced all-cause mortality by 28 % (OR 0.72, 95 % CI: 0.62–0.84, p < 0.001; I² = 30 %) with consistent effects across study designs (between-subgroup heterogeneity p = 0.86). Subgroup analyses showed a non-significant 21 % reduction in 1-year mortality (OR 0.79, 95 % CI: 0.54–1.16, p = 0.23; I² = 52 %) and a significant 29 % reduction in 2–5-year mortality (OR 0.71, 95 % CI: 0.61–0.82, p < 0.001; I² = 7 %). Recurrence decreased by 29 % overall (OR 0.71, 95 % CI: 0.52–0.97, p = 0.03; I² = 57 %), with significant protective effects in mixed (OR 0.595) and retrospective (OR 0.485) studies but not prospective studies (OR 0.842), demonstrating significant between-subgroup heterogeneity (p = 0.01). Meta-regression showed no significant moderation of mortality by EF (p = 0.64), suggesting consistent benefits across cardiac function levels.

Conclusions

Beta-blockers significantly reduce long-term mortality and recurrence in TTC. While mortality benefits are consistent across study designs, recurrence outcomes show methodological sensitivity, with stronger evidence from mixed and retrospective studies. Benefits are more pronounced with sustained therapy, with no variation by EF. These findings support beta-blocker use in long-term TTC management, though randomized trials are needed to confirm causality and optimize protocols.

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受体阻滞剂治疗Takotsubo心肌病的疗效：一项系统综述和荟萃分析。

背景：Takotsubo心肌病（TTC）是一种应激性疾病，循证治疗选择有限。-受体阻滞剂常用，但其疗效仍不确定。本荟萃分析评估β受体阻滞剂治疗对TTC患者死亡率和复发率的影响。方法：我们系统地检索PubMed、EMBASE、Cochrane Library、Web of Science、谷歌Scholar和Semantic Scholar，以及试验注册库和灰色文献，从研究开始到2025年3月。纳入的研究检查了接受β受体阻滞剂治疗的成人TTC患者与对照组，报告了全因死亡率和复发率。比值比（or）为95 %的置信区间（ci）采用随机效应模型进行汇总。采用I2统计量评估异质性，通过漏斗图评估发表偏倚。亚组分析按设计分层研究（回顾性、前瞻性、混合）评估方法学异质性。荟萃回归探讨了射血分数（EF）作为死亡率结果的调节因子。结果：纳入19项研究（n = 11,167例患者，主要为女性，平均年龄59-74 岁）。β受体阻滞剂治疗可显著降低全因死亡率，降低幅度为28% % (OR 0.72, 95 % CI: 0.62-0.84, p 2 = 30 %)，且各研究设计的效果一致（亚组间异质性p = 0.86）。亚组分析显示，1年死亡率降低21% % (OR 0.79, 95 % CI: 0.54-1.16, p = 0.23；I2 = 52 %)和29 %减少2-5-year死亡率(或0.71,95 % CI: 0.61 - -0.82, p 2 = 7 %)。复发率总体降低29 % (OR 0.71, 95 % CI: 0.52-0.97, p = 0.03；I2 = 57 %)，在混合研究（OR 0.595）和回顾性研究（OR 0.485）中有显著的保护作用，但在前瞻性研究中没有（OR 0.842），显示了显著的亚组间异质性（p = 0.01）。meta回归显示EF对死亡率没有显著的调节作用（p = 0.64），表明在心功能水平上有一致的益处。结论：β受体阻滞剂可显著降低TTC的长期死亡率和复发率。虽然死亡率的益处在不同的研究设计中是一致的，但复发结果显示出方法学上的敏感性，混合研究和回顾性研究提供了更有力的证据。持续治疗的益处更明显，EF没有变化。这些发现支持β受体阻滞剂用于长期TTC治疗，尽管需要随机试验来确认因果关系并优化方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.