Abstract 3932: Influence of Beta-Blocker Pre-Treatment on the Clinical Course of Patients With Tako- Tsubo Cardiomyopathy
Background: Tako-tsubo cardiomyopathy (TTC) is often preceded by emotional or physical stress. Since sympathetic activation may contribute to the pathogenesis of TTC, beta-blocker (BB) therapy has been recommended. No trial data, however, are available so far. This study assessed if BB pre-treatment has an influence on the manifestation and clinical course of TTC.
Methods: Over a 9-year period, TTC was diagnosed in 70 pts (63 f, 7 m, age 71±12). Of these, 5 pts (7%) had discontinued long term BB therapy 3–14 days before manifestation of TTC which was triggered by physical stress. For the purpose of this study, pts with continuous BB therapy on the day of TTC onset were compared to TTC pts without BB pre-treatment. If there were no contraindications, pts received a BB during the acute event and at hospital discharge.
Results: Because of hypertension and atrial fibrillation, 12/70 pts (17%) were taking a BB at TTC onset (metoprolol n=9; atenolol, propranolol, sotalol n=1 each). Age, sex, symptoms and triggering events were not different among pts with and without BB pre-treatment. ECG changes (ST-segment elevation, T-wave inversion, pathological Q wave, QTc interval, atrial fibrillation, ventricular tachycardia, time to ECG normalization) were similar in both groups. Cardiac markers CK and CK-MB were not different, but troponin I was significantly less in BB pre-treatment (3.34±2.24 vs 7.09±5.9 ng/ml, p=0.02). Ejection fraction, left ventricular (LV) end-diastolic pressure, ballooning pattern and time to normalization of LV function were comparable. Complications during the acute clinical course occurred with similar frequency (7/12 vs 29/58, p=ns), however, major complications (cardiogenic shock, acute mitral regurgitation, LV thrombus, stroke, death) were not seen in pts with BB pre-treatment. All 68 surviving pts received a BB at hospital discharge. During a median follow-up of 49 months, 5/68 patients (7%) had a recurrence.
Conclusion: BB therapy is not able to prevent the occurrence of TTC. However, myocardial damage appears to be less, and serious complications such as cardiogenic shock, LV thrombus or death were not observed with BB pre-treatment. Discontinuation of chronic BB therapy in combination with physical stress may trigger the onset of TTC.