Mutahar Daud, Zaka Ammar, Bacchi Stephen, Stretton Brandon, Kovoor Joshua G, Gupta Aashray K, Mridha Naim
Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD 4216, Australia.
Department of Cardiology, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD 4215, Australia.
Eur Heart J Open. 2025 Apr 16;5(3):oeaf040. doi: 10.1093/ehjopen/oeaf040. eCollection 2025 May.
Takotsubo cardiomyopathy (TTC) is a form of transient left ventricular systolic dysfunction without evidence of complicated coronary artery disease. Efficacy of medical therapy in secondary prevention of all-cause mortality is not well established. We performed a systematic review and network meta-analysis to compare survival benefit of secondary prevention medical therapy in patients with TTC.
PubMed, Embase, and Cochrane were searched up to 6 January 2024. Eligible studies included multivariable-adjusted or propensity-matched studies of patients receiving medical therapy with beta-blockers, angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARBs), aspirin, and statins after an index presentation with TTC. The primary outcome was all-cause mortality at any time point. Secondary outcome was TTC recurrence. Random-effect hierarchical Bayesian meta-analysis was performed. We identified 13 observational studies. Takotsubo cardiomyopathy mortality was reported in 435 (4.7%) out of 9237 patients, across a median follow-up of 2.18 years. Mean age was 69.7 ± 12.5 years, and 7906 patients (90.7%) were females. Beta-blockers were associated with a statistically significant reduction in mortality compared to control [hazard ratio (HR) 0.65, 95% confidence interval (CI) (0.55-0.77)]. ACE inhibitors/ARBs showed a nonsignificant trend towards mortality reduction [HR 0.76, 95% CI (0.54-1.07)]. Statins [HR 0.96, 95% CI (0.77-1.19)] and aspirin [HR 0.87, 95% CI (0.55-1.38)] showed no significant mortality benefit. Bayesian probability ranks favoured beta-blockers as the most effective treatment for TTC mortality prevention.
This review highlights the modest efficacy of secondary prevention medications in the management of TTC, as ACE or ARBs, beta-blockers, aspirin, and statins failed to demonstrate comparative mortality benefit. Randomized controlled trials are needed to confirm efficacy of pharmacotherapy in this vulnerable patient cohort.
应激性心肌病（TTC）是一种无复杂冠状动脉疾病证据的短暂性左心室收缩功能障碍形式。药物治疗在全因死亡率二级预防中的疗效尚未明确。我们进行了一项系统评价和网状Meta分析，以比较TTC患者二级预防药物治疗的生存获益。
检索了截至2024年1月6日的PubMed、Embase和Cochrane数据库。符合条件的研究包括对首次出现TTC后接受β受体阻滞剂、血管紧张素转换酶抑制剂（ACE）或血管紧张素受体阻滞剂（ARB）、阿司匹林和他汀类药物治疗的患者进行多变量调整或倾向匹配的研究。主要结局是任何时间点的全因死亡率。次要结局是TTC复发。进行了随机效应分层贝叶斯Meta分析。我们纳入了13项观察性研究。在9237例患者中，有435例（4.7%）报告了应激性心肌病死亡，中位随访时间为2.18年。平均年龄为69.7±12.5岁，7906例患者（90.7%）为女性。与对照组相比，β受体阻滞剂与死亡率的统计学显著降低相关[风险比（HR）0.65，95%置信区间（CI）（0.55 - 0.77）]。ACE抑制剂/ARB显示出死亡率降低的非显著趋势[HR 0.76，95% CI（0.54 - 1.07）]。他汀类药物[HR 0.96，95% CI（0.77 - 1.19）]和阿司匹林[HR 0.87，95% CI（0.55 - 1.38）]未显示出显著的死亡率获益。贝叶斯概率排序支持β受体阻滞剂作为预防TTC死亡最有效的治疗方法。
本综述强调了二级预防药物在TTC管理中的适度疗效，因为ACE或ARB、β受体阻滞剂、阿司匹林和他汀类药物均未显示出比较死亡率获益。需要进行随机对照试验来证实药物治疗在这一脆弱患者群体中的疗效。
