title: Assessment of clinical features in transient left ventricular apical ballooning.
abstract: OBJECTIVE
  We sought to assess the clinical features of transient left ventricular (LV) apical ballooning.
  
  
  BACKGROUND
  Although several cases regarding transient LV apical ballooning have been reported, the etiology remains unknown.
  
  
  METHODS
  We investigated 17 patients (14 women, median age 74 years old with a range of 54 to 91 years old) who fulfilled the following criteria: 1) transient LV apical ballooning; 2) ST-T segment change in several leads in electrocardiogram; and 3) no history of old myocardial infarction, valvular heart disease, subarachnoid hemorrhage, or pheochromocytoma.
  
  
  RESULTS
  Emotional and physical stress were observed in 16 patients (94%). Technetium-99m tetrofosmin tomographic imaging revealed decreased uptake at the apex of the left ventricle in 11 patients (85%) that later returned to uniform. No significant stenosis or angiographical slow flow in epicardial coronary arteries was observed (n = 9). Provocative focal vasospasm was induced in only one patient (14%) (n = 7). Moreover, no significant abnormality in the coronary microcirculation was detected by Doppler guidewire (n = 3) or contrast echocardiography (n = 1). No patients showed a rise in viral antibody titers. Biopsy specimens revealed interstitial fibrosis in six patients (100%) and slight cell infiltration in three others (50%) (n = 6).
  
  
  CONCLUSIONS
  These findings suggested that neither abnormalities in the coronary circulation nor acute myocarditis was related to the etiology. Although neurogenic stunned myocardium induced by emotional or physical stress was suggested as the etiology, further investigations are necessary.
authors.affiliation: Division of Cardiology, Shimada Municipal Hospital, Shimada, Shizuoka, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Abe
authors.forename: Makoto
authors.initials: M
authors.lastname: Kondo
authors.forename: Ryota
authors.initials: R
authors.lastname: Matsuoka
authors.forename: Makoto
authors.initials: M
authors.lastname: Araki
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Dohyama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tanio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D017682:Myocardial Stunning / Q000175:diagnosis / Q000503:physiopathology; D010507:Periodicity; D011379:Prognosis; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology