Acute and Chronic Heart Failure Therapies in Patients With Takotsubo Cardiomyopathy.
In a further meta-analysis by Singh et al10 the recurrence rate of Takotsubo cardiomyopathy was approximately 5% at 6 years with an annual rate of 1.5%. Recurrent chest pain was
encountered in 14% of cases whilst 11% of patients reported dysponea without evidence of recurrent Takotsubo cardiomyopathy.
Discharge medications during initial admission included β-blockers in 66.8% and angiotensin converting enzyme inhibitors/angiotensin receptor blockers in 67.4% of patients. Recurrence rate was independent of the use of β- blockers, but was less with the use of angiotensin converting enzyme inhibitors/ angiotensin receptor blockers.
The benefit of post-acute coronary syndrome drugs such as statins, aspirin, and clopidogrel, are of unknown benefit. Due to the lack of atherosclerotic plaques in coronary angiography, dual antiplatelet therapy with aspirin and P2Y12 receptor blocker for a period of 12 months may not be required.
However, in a study of 14 patients with Takotsubo cardiomyopathy atherosclerotic plaques were demonstrated on intracoronary ultrasonography with erosive plaques constituting 50% of all cases. In
this situation, the use of dual antiplatelet therapy together with a statin is justified.
The acute treatment of patients with Takotsubo cardiomyopathy generally consists of heart failure medications. The evidence regarding the use of these drugs both acutely and chronically is conflicting.
In general the use of aspirin should be considered in patients who have evidence of coronary disease angiographically. Larger randomized and adequately powered studies are
needed to establish whether there is any benefit from acute and long term use of heart failure therapies.
Heart Res Open J. 2016; SE(1): S1-S3. doi: 10.17140/HROJ-SE-1-101