The clinical features of transient left ventricular nonapical ballooning syndrome: comparison with apical ballooning syndrome.
BACKGROUND
Recently, several cases of atypical left ventricular (LV) ballooning syndrome without involvement of the LV apex have been reported. However, there has been no assessment of the clinical features of this novel presentation or comparison with the typical transient LV apical ballooning syndrome.


METHODS
We evaluated 47 patients diagnosed with transient LV ballooning syndrome. The diagnostic criteria were (1) transient akinesia/dyskinesia beyond a single major coronary artery vascular distribution, (2) absence of significant coronary artery disease on coronary angiograms, and (3) new electrocardiographic changes.


RESULTS
Thirty-one patients showed classic LV apical ballooning, and 16 showed atypical LV ballooning without involvement of the LV apex (nonapical ballooning). Clinical presentations and inhospital courses of illness were mostly similar among patients with nonapical ballooning (group NA) and patients with apical ballooning (group A). However, on admission, there were fewer patients with cardiogenic shock or pulmonary edema in group NA than in group A (19% vs 48%, P = .048). Group NA patients were relatively younger than group A patients (median ages 58 vs 70 years, P = .02), and fewer patients had coronary risk factors in group NA than in group A (38% vs 77%, P = .01). On electrocardiogram, T-wave inversion was noted less frequently in the NA group than in the A group (69% vs 97%, P = .01).


CONCLUSIONS
Transient LV nonapical ballooning syndrome and classic LV apical ballooning syndrome may be different manifestations of a single syndrome. They appear to have differences in the severity of heart failure, in patient characteristics, and in electrocardiographic change.
Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Joo-Yong
JY
Hahn
Hyeon-Cheol
HC
Gwon
Seung Woo
SW
Park
Seung-Hyuk
SH
Choi
Jin Ho
JH
Choi
Jin Oh
JO
Choi
Sang Chul
SC
Lee
Young Keun
YK
On
June-Soo
JS
Kim
Duk Kyung
DK
Kim
Eun Suk
ES
Jeon
Sang Hoon
SH
Lee
Kyung-Pyo
KP
Hong
Jeong Euy
JE
Park
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left