title: Hemodynamic Effects, Safety, and Feasibility of Intravenous Esmolol Infusion During Takotsubo Cardiomyopathy With Left Ventricular Outflow Tract Obstruction: Results From A Multicenter Registry.
abstract: BACKGROUND
  Left 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.
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  Ninety-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.
  
  
  RESULTS
  Left 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.
  
  
  CONCLUSIONS
  Esmolol 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.
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ieva
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Ferraretti
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Fanelli
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musaico
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Tarantino
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Luigi Di
authors.initials: LD
authors.lastname: Martino
authors.affiliation: "San Paolo" Hospital, Bari, Italy.
authors.forename: Luisa De
authors.initials: LD
authors.lastname: Gennaro
authors.affiliation: "San Paolo" Hospital, Bari, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Caldarola
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Matteo Di
authors.initials: MD
authors.lastname: Biase
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006207:Half-Life; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D008297:Male; D010865:Pilot Projects; D011412:Propanolamines / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D012042:Registries; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D011412:Propanolamines; C036604:esmolol
keywords: Esmolol; Intraventricular gradient; Left ventricular outflow tract obstruction; Stress cardiomyopathy; Systolic anterior motion; Takotsubo cardiomyopathy