{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:43:42Z","timestamp":1789778622948,"version":"4.0.1"},"reference-count":26,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"unspecified","delay-in-days":122,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,10,17]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Takotsubo cardiomyopathy (TC) is a stress-induced catecholamine acute myocardial dysfunction in the absence of significant coronary disease. The pathophysiology of TC remains poorly understood, and the use of beta-blockers (\u03b2-Blockers) appears promising. However, the impact of \u03b2-blockers in acute-phase management remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to conduct a systematic review and meta-analysis evaluating the early use of \u03b2-Blocker in TC and its effects on in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase and Cochrane were searched for studies that evaluated the use of BBs in TC patients and its short-term effects. Statistical analysis was performed using RevMan V,5.4.1. The results are expressed using HRs and 95% confidence intervals (CI) were extracted using a random-effects model. Heterogeneity was assessed with I\u00b2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included five cohort studies, with a total of 5428 patients. The vast majority were women (81%) with a mean age of 70.1\u00b112.6 years. More than half of the patients (52.0%) had previous hypertension. ST-elevation in the first ECG was observed in 37.3% of the patients. Early administration of \u03b2-blockers was not associated with a statistically significant reduction in in-hospital mortality (HR 0.78, 95%\u2009CI 0.59 to 1.02, p=0.07), and this finding was consistent across different \u03b2-blocker types, doses and routes of administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early \u03b2-Blocker therapy did not significantly influence in-hospital mortality in patients with TC. Future randomised studies are essential to clarify beta-blockers\u2019 role in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251055617.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003762","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:40:28Z","timestamp":1761907228000},"page":"e003762","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Use of beta-blockers and in-hospital mortality in patients with Takotsubo cardiomyopathy: systematic review and meta-analysis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4298-8649","authenticated-orcid":false,"given":"Caroline","family":"de Oliveira Fischer Bacca","sequence":"first","affiliation":[{"name":"Medical Sciences Research Center, University Center for the Development of Alto Vale, Brazil, UNIDAVI, Rio do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0229-6805","authenticated-orcid":false,"given":"Beatriz","family":"Stephan","sequence":"additional","affiliation":[{"name":"Albert Einstein Instituto Israelito de Ensino e Pesquisa, S\u00e3o Paulo, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6394-5371","authenticated-orcid":false,"given":"Victor Alejandro","family":"Gomez","sequence":"additional","affiliation":[{"name":"Hospital Auxilio Mutuo San Pablo, Bayam\u00f3n, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0170-7211","authenticated-orcid":false,"given":"Marcelo Vier","family":"Gambetta","sequence":"additional","affiliation":[{"name":"Medical Sciences Research Center, University Center for the Development of Alto Vale, Brazil, UNIDAVI, Rio do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6869-9580","authenticated-orcid":false,"given":"Giovanna","family":"Cardoso de Moraes","sequence":"additional","affiliation":[{"name":"Albert Einstein Instituto Israelito de Ensino e Pesquisa, S\u00e3o Paulo, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-8050","authenticated-orcid":false,"given":"Giulia Lisanti","family":"Soares","sequence":"additional","affiliation":[{"name":"Albert Einstein Israelite Hospital, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9911-3405","authenticated-orcid":false,"given":"Marina","family":"Machado","sequence":"additional","affiliation":[{"name":"Faculdades Integradas Pit\u00e1goras de Montes Claros, Montes Claros, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8434-552X","authenticated-orcid":false,"given":"Vinh Quang Tri","family":"Ho","sequence":"additional","affiliation":[{"name":"University of Debrecen Faculty of Medicine, Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4682-8095","authenticated-orcid":false,"given":"Luciana","family":"Gioli-Pereira","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care, Albert Einstein Israelite Hospital, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"2026010701113240000_12.2.e003762.1","unstructured":"Sato HTH , Uchida T , Dote K , et al . Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K , Haze K , Hori M , eds. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagakuhyoronsha Publishing, 1990: 56\u201364."},{"key":"2026010701113240000_12.2.e003762.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406761"},{"key":"2026010701113240000_12.2.e003762.3","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.028511","article-title":"Trigger-Associated Clinical Implications and Outcomes in Takotsubo Syndrome: Results From the Multicenter GEIST Registry","volume":"12","author":"P\u00e4tz","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"2026010701113240000_12.2.e003762.4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jjcc.2025.01.009","article-title":"Clinical characteristics and outcomes in takotsubo syndrome -Review of insights from the InterTAK Registry","volume":"85","author":"Kato","year":"2025","journal-title":"J Cardiol"},{"key":"2026010701113240000_12.2.e003762.5","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.123.030623","article-title":"Age-Related Differences in Takotsubo Syndrome: Results From the Multicenter GEIST Registry","volume":"13","author":"El-Battrawy","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"2026010701113240000_12.2.e003762.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01316-X"},{"key":"2026010701113240000_12.2.e003762.7","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-318028"},{"key":"2026010701113240000_12.2.e003762.8","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.036800","article-title":"Cardiogenic Shock Complicating Takotsubo Syndrome: Sex-Related Differences","volume":"13","author":"Tomasino","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"2026010701113240000_12.2.e003762.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2011.03730.x"},{"key":"2026010701113240000_12.2.e003762.10","first-page":"632","article-title":"Age related differences and outcome of patients with Takotsubo syndrome","volume":"14","author":"Huseynov","year":"2017","journal-title":"J Geriatr Cardiol"},{"key":"2026010701113240000_12.2.e003762.11","doi-asserted-by":"crossref","first-page":"3216","DOI":"10.1002\/ehf2.14461","article-title":"Microvascular function and inflammatory activation in Takotsubo cardiomyopathy","volume":"10","author":"Solberg","year":"2023","journal-title":"ESC Heart Fail"},{"key":"2026010701113240000_12.2.e003762.12","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.ahj.2007.10.042","article-title":"Clinical implications of midventricular obstruction and intravenous propranolol use in transient left ventricular apical ballooning (Tako-tsubo cardiomyopathy)","volume":"155","author":"Yoshioka","year":"2008","journal-title":"Am Heart J"},{"key":"2026010701113240000_12.2.e003762.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026010701113240000_12.2.e003762.14","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308712"},{"key":"2026010701113240000_12.2.e003762.15","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1002\/ehf2.14713","article-title":"Effects of pharmacological interventions on mortality in patients with Takotsubo syndrome: a report from the SWEDEHEART registry","volume":"11","author":"Petursson","year":"2024","journal-title":"ESC Heart Fail"},{"key":"2026010701113240000_12.2.e003762.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.04.139"},{"key":"2026010701113240000_12.2.e003762.17","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.amjcard.2015.08.024","article-title":"Predictors of short- and long-term outcomes of Takotsubo cardiomyopathy","volume":"116","author":"Gopalakrishnan","year":"2015","journal-title":"Am J Cardiol"},{"key":"2026010701113240000_12.2.e003762.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.05.015"},{"key":"2026010701113240000_12.2.e003762.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"2026010701113240000_12.2.e003762.20","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.hfc.2016.06.010","article-title":"The International Takotsubo Registry: Rationale, Design, Objectives, and First Results","volume":"12","author":"Ghadri","year":"2016","journal-title":"Heart Fail Clin"},{"key":"2026010701113240000_12.2.e003762.21","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2019.0086"},{"key":"2026010701113240000_12.2.e003762.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.12.239"},{"key":"2026010701113240000_12.2.e003762.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2022.11.010"},{"key":"2026010701113240000_12.2.e003762.24","first-page":"815","article-title":"Beta-Blockers and Long-Term Mortality in Takotsubo Syndrome","volume":"13","author":"Raposeiras-Roubin","year":"2025","journal-title":"JACC: Heart Failure"},{"key":"2026010701113240000_12.2.e003762.25","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2021-320543"},{"key":"2026010701113240000_12.2.e003762.26","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.amjcard.2023.07.024","article-title":"Effect of \u03b2-Blocker Use on Long-Term Mortality in Takotsubo Cardiomyopathy: A Systematic Review and Meta-Analysis","volume":"204","author":"Ahsan","year":"2023","journal-title":"Am J Cardiol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003762","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:11:41Z","timestamp":1767777101000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003762"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,10,31]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/openhrt-2025-003762"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003762","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}