β受体阻滞剂和Takotsubo综合征的长期死亡率：多中心GEIST登记的结果。

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2025-05-01 DOI:10.1016/j.jchf.2024.11.015

Sergio Raposeiras-Roubin MD, PhD , Francesco Santoro MD, PhD , Luca Arcari MD , Ravi Vazirani MD , Giuseppina Novo MD , Aitor Uribarri MD , Mariano Enrica MD , Javier Lopez-Pais MD , Federico Guerra MD , Fernando Alfonso MD, PhD , Toni Pätz MD , Clara Fernandez-Cordon MD , Roberta Montisci MD , Miguel Corbi-Pascual MD , Maria Francesca Marchetti MD , Manuel Almendro MD , Luca Cacciotti MD , Oscar Vedia MD , Ibrahim El-Battrawy MD , Emilia Blanco-Ponce MD , Ivan J. Nuñez-Gil MD, PhD

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引用次数: 0

摘要

背景：β受体阻滞剂被认为是Takotsubo综合征（TTS）患者的合理治疗方法，尽管缺乏关于其预后影响的一致证据，但仍被广泛使用。目的：本研究旨在评估β受体阻滞剂治疗对长期死亡率和TTS复发的影响。方法：作者分析了国际多中心GEIST（德国、意大利、西班牙Takotsubo登记处）登记的2853例确诊为TTS的出院患者。他们进行了倾向评分匹配分析，根据出院时是否接受受体阻滞剂药物治疗，将697名患者分成两组进行配对。采用Cox回归分析出院时β受体阻滞剂对预测死亡率和随访期间TTS复发的预后价值。结果：在平均2.6年的随访中，485例（17.0%）死亡，97例（3.4%）复发。出院时接受β受体阻滞剂治疗的患者（n = 2125）（74.5%）死亡率较低（6.0 vs 8.1 / 100患者/年）。倾向评分匹配后，作者发现-受体阻滞剂组随访期间死亡率较低(HR: 0.71；95% ci: 0.55-0.90)。死亡率的差异尤其以第一年的死亡率为代价。亚组间无差异。此外，在随访期间，受体阻滞剂治疗与较低的TTS复发率无关（HR: 0.74, 95% CI: 0.61-1.89）。在放电时使用-受体阻滞剂与左心室射血分数恢复之间也没有关联。结论：受体阻滞剂治疗TTS患者与较低的随访死亡率相关，但与较低的TTS复发率无关。(德语、意大利语、西班牙语Takotsubo Registry [GEIST]；NCT04361994)。

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Beta-Blockers and Long-Term Mortality in Takotsubo Syndrome

Background

Beta-blockers are considered a reasonable therapy for patients with Takotsubo syndrome (TTS), commonly used despite the absence of consistent evidence about its prognosis impact.

Objectives

This study aimed to assess the impact of beta-blocker therapy on long-term mortality and TTS recurrence.

Methods

The authors analyzed 2,853 patients discharged with a confirmed TTS diagnosis, enrolled in the international multicenter GEIST (The GErman Italian Spanish Takotsubo Registry). They performed a propensity score matching analysis to draw up 2 groups of 697 patients paired according to whether or not they received medical therapy with beta-blockers at hospital discharge. The prognostic value of beta-blockers at discharge to predict mortality and TTS recurrence during follow-up was analyzed using Cox regression.

Results

During a mean follow-up of 2.6 years, 485 patients (17.0%) died and 97 (3.4%) have had TTS recurrence. Patients treated with beta-blockers at discharge (n = 2,125) (74.5%) had a lower mortality rate (6.0 vs 8.1 per 100 patients/year). After propensity score matching, the authors found that mortality during follow-up was lower in the beta-blocker group (HR: 0.71; 95% CI: 0.55-0.90). Differences in mortality were especially at the expense of mortality in the first year. No differences were found by subgroups. Moreover, beta-blocker therapy was not associated with lower TTS recurrence during the follow-up (HR: 0.74; 95% CI: 0.61-1.89). No association between the use of beta-blockers at discharge and left ventricle ejection fraction recovery has also been observed.

Conclusions

Beta-blocker therapy in patients with TTS is associated with lower follow-up mortality, but not with lower TTS recurrence. (The GErman Italian Spanish Takotsubo Registry [GEIST]; NCT04361994)

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.