• Cardiovasc Ther · Jun 2016

    Multicenter Study

    Hemodynamic Effects, Safety, and Feasibility of Intravenous Esmolol Infusion During Takotsubo Cardiomyopathy With Left Ventricular Outflow Tract Obstruction: Results From A Multicenter Registry.

    • Francesco Santoro, Riccardo Ieva, Armando Ferraretti, Mario Fanelli, Francesco Musaico, Nicola Tarantino, Martino Luigi Di LD Cardiology Department, University of Foggia, Foggia, Italy., Gennaro Luisa De LD "San Paolo" Hospital, Bari, Italy., Pasquale Caldarola, Biase Matteo Di MD Cardiology Department, University of Foggia, Foggia, Italy., and Natale Daniele Brunetti.
    • Cardiology Department, University of Foggia, Foggia, Italy.
    • Cardiovasc Ther. 2016 Jun 1; 34 (3): 161-6.

    BackgroundLeft ventricular outflow tract obstruction (LVOTO) may complicate an episode of Takotsubo cardiomyopathy (TTC), potentially leading to cardiogenic shock. Beta-blockers are considered the most suitable treatment for such complication.Aim Of The StudyThe objective of this study was to evaluate the hemodynamic effects, safety, and feasibility of a selective beta-blocker (β1) with a short half-life, esmolol, in subjects with a TTC episode.MethodsNinety-six consecutive patients with TTC were enrolled in a multicenter registry. The hemodynamic and echocardiographic effects of esmolol (0.15-0.3 mg/kg/min) were analyzed in nine consecutive patients with LVOTO. Clinical course of patients, hemodynamics, days of hospitalization, LV function, and adverse events at follow-up were recorded.ResultsLeft ventricular outflow tract obstruction was present in 10 (10.4%) of 96 patients. Patients with LVOTO were older and had higher values of troponin-I at admission. LV ejection fraction at admission (36.1 ± 8.4%) significantly improved at discharge (51.4 ± 6.9%, P = 0.001). Among patients treated with esmolol infusion, LVOT pressure gradient before treatment was 47.6 ± 16.6 mmHg and after 18.2 ± 2.3 mmHg (P = 0.0091). Systolic blood pressure decreased from 123.8 ± 29.1 to 112.6 ± 12.7 mmHg (P = 0.1537). Mean hospital stay was 9 ± 2 days. No adverse events were observed during hospitalization and at follow-up.ConclusionsEsmolol infusion was temporally associated with reduction in intraventricular gradient and systemic blood pressure in patients with TTC and LVOTO. Further controlled studies are warranted to confirm these preliminary findings.© 2016 John Wiley & Sons Ltd.

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