Lack of efficacy of drug therapy in preventing takotsubo cardiomyopathy recurrence: a meta-analysis

Clin Cardiol. 2014 Jul;37(7):434-9. doi: 10.1002/clc.22280. Epub 2014 Apr 3.

Abstract

Background: Efficacy of chronic drug therapy in prevention of stress-induced cardiomyopathy recurrences is not well established. We therefore aimed to evaluate in this meta-analysis whether pharmacological treatment can effectively prevent takotsubo cardiomyopathy (TTC) recurrences, according to available studies.

Hypothesis: There is no evidence for preventing TTC recurrence by drug therapy.

Methods: After a PubMed search, we conducted a meta-analysis of available studies (clinical nonrandomized registries) on efficacy of drug therapy in preventing recurrence of TTC.

Results: A total of 23 (4.5%) TTC recurrences occurred in the 511 patients included in the analysis. Seven studies on the effects of β-blockers on prevention of TTC recurrence were evaluated; the odds ratio (OR) was 0.44 and the 95% confidence interval (CI) was 0.15-1.31. In 5 studies on the effects of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, the OR was 0.42 and the 95% CI was 0.08-2.36; in 3 studies on statins, the OR was 0.74 and the 95% CI was 0.07-7.3; and in 4 studies on aspirin, the OR was 0.33 with a 95% CI of 0.05-2.17 (P value not significant in all cases).

Conclusions: A meta-analysis of the efficacy of different medications through the clinical TTC registries available showed no clinical evidence for a standard drug treatment in the chronic management of TTC. β-Blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and aspirin do not seem to significantly reduce recurrences of TTC. Randomized, adequately powered studies are needed to further assess this issue.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Cardiovascular Agents / therapeutic use*
  • Humans
  • Odds Ratio
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Secondary Prevention / methods*
  • Takotsubo Cardiomyopathy / diagnosis
  • Takotsubo Cardiomyopathy / drug therapy*
  • Time Factors
  • Treatment Outcome

Substances

  • Cardiovascular Agents