Cargando…

Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome

Introduction: Treatment with betablockers is controversial in Takotsubo syndrome (TTS); however, many physicians intuitively initiate or continue betablocker therapy in these patients. The effect of preadmission betablocker use on adverse cardiovascular events has not been studied in the literature....

Descripción completa

Detalles Bibliográficos
Autores principales: Topf, Albert, Mirna, Moritz, Dienhart, Christiane, Jirak, Peter, Bacher, Nina, Boxhammer, Elke, Gharibeh, Sarah X., Motloch, Lukas J., Hoppe, Uta C., Lichtenauer, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962389/
https://www.ncbi.nlm.nih.gov/pubmed/35203673
http://dx.doi.org/10.3390/biomedicines10020464
_version_ 1784677791275417600
author Topf, Albert
Mirna, Moritz
Dienhart, Christiane
Jirak, Peter
Bacher, Nina
Boxhammer, Elke
Gharibeh, Sarah X.
Motloch, Lukas J.
Hoppe, Uta C.
Lichtenauer, Michael
author_facet Topf, Albert
Mirna, Moritz
Dienhart, Christiane
Jirak, Peter
Bacher, Nina
Boxhammer, Elke
Gharibeh, Sarah X.
Motloch, Lukas J.
Hoppe, Uta C.
Lichtenauer, Michael
author_sort Topf, Albert
collection PubMed
description Introduction: Treatment with betablockers is controversial in Takotsubo syndrome (TTS); however, many physicians intuitively initiate or continue betablocker therapy in these patients. The effect of preadmission betablocker use on adverse cardiovascular events has not been studied in the literature. Methods: To investigate this issue, we evaluated clinical complications, defined by the endpoint of occurrence of hemodynamically relevant arrythmia, cardiac decompensation, and all-cause adverse cardiac events, during hospitalization, in 56 patients hospitalized for TTS between April 2017 and July 2021. We compared the risk of adverse cardiovascular events between patients with preadmission betablocker therapy and those without preadmission betablocker therapy. Pretreatment betablocker therapy was defined as daily betablocker intake for more than a week including day of admission. Results: TTS patients taking preadmission betablockers had a significantly increased risk of all-cause complications relative to patients without betablockers in preadmission medication ((52.0% vs. 19.4%, p = 0.010; OR 4.5 (95% Cl 1.38–14.80)). Furthermore, TTS patients already taking betablockers on admission showed a statistically significant increased risk of cardiac decompensation when compared to patients without pretreatment with betablockers (p = 0.013). There were no significant differences in patient characteristics in patients who were taking beta blockers as an adjunct therapy prior to admission for TTS relative to those who were not. There is however an increase in comorbidities, hypertension, and atrial fibrillation, in past medical history in patients taking a preadmission betablocker. The difference is related to therapeutic applications for beta blockers and was not significant based on endpoints of our study. Conclusions: Preadmission betablocker treatment was associated with a 4.5 times higher risk of adverse cardiac events. This increased risk of all-cause complications and of cardiac decompensation within the acute phase of TTS is presumably due to the negative inotropic effects of betablockers and upregulation of β-adrenergic receptors in patients with chronic betablocker therapy.
format Online
Article
Text
id pubmed-8962389
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-89623892022-03-30 Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome Topf, Albert Mirna, Moritz Dienhart, Christiane Jirak, Peter Bacher, Nina Boxhammer, Elke Gharibeh, Sarah X. Motloch, Lukas J. Hoppe, Uta C. Lichtenauer, Michael Biomedicines Article Introduction: Treatment with betablockers is controversial in Takotsubo syndrome (TTS); however, many physicians intuitively initiate or continue betablocker therapy in these patients. The effect of preadmission betablocker use on adverse cardiovascular events has not been studied in the literature. Methods: To investigate this issue, we evaluated clinical complications, defined by the endpoint of occurrence of hemodynamically relevant arrythmia, cardiac decompensation, and all-cause adverse cardiac events, during hospitalization, in 56 patients hospitalized for TTS between April 2017 and July 2021. We compared the risk of adverse cardiovascular events between patients with preadmission betablocker therapy and those without preadmission betablocker therapy. Pretreatment betablocker therapy was defined as daily betablocker intake for more than a week including day of admission. Results: TTS patients taking preadmission betablockers had a significantly increased risk of all-cause complications relative to patients without betablockers in preadmission medication ((52.0% vs. 19.4%, p = 0.010; OR 4.5 (95% Cl 1.38–14.80)). Furthermore, TTS patients already taking betablockers on admission showed a statistically significant increased risk of cardiac decompensation when compared to patients without pretreatment with betablockers (p = 0.013). There were no significant differences in patient characteristics in patients who were taking beta blockers as an adjunct therapy prior to admission for TTS relative to those who were not. There is however an increase in comorbidities, hypertension, and atrial fibrillation, in past medical history in patients taking a preadmission betablocker. The difference is related to therapeutic applications for beta blockers and was not significant based on endpoints of our study. Conclusions: Preadmission betablocker treatment was associated with a 4.5 times higher risk of adverse cardiac events. This increased risk of all-cause complications and of cardiac decompensation within the acute phase of TTS is presumably due to the negative inotropic effects of betablockers and upregulation of β-adrenergic receptors in patients with chronic betablocker therapy. MDPI 2022-02-16 /pmc/articles/PMC8962389/ /pubmed/35203673 http://dx.doi.org/10.3390/biomedicines10020464 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Topf, Albert
Mirna, Moritz
Dienhart, Christiane
Jirak, Peter
Bacher, Nina
Boxhammer, Elke
Gharibeh, Sarah X.
Motloch, Lukas J.
Hoppe, Uta C.
Lichtenauer, Michael
Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome
title Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome
title_full Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome
title_fullStr Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome
title_full_unstemmed Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome
title_short Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome
title_sort pretreatment with betablockers, a potential predictor of adverse cardiovascular events in takotsubo syndrome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962389/
https://www.ncbi.nlm.nih.gov/pubmed/35203673
http://dx.doi.org/10.3390/biomedicines10020464
work_keys_str_mv AT topfalbert pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT mirnamoritz pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT dienhartchristiane pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT jirakpeter pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT bachernina pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT boxhammerelke pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT gharibehsarahx pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT motlochlukasj pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT hoppeutac pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome
AT lichtenauermichael pretreatmentwithbetablockersapotentialpredictorofadversecardiovasculareventsintakotsubosyndrome