Left ventricular apical ballooning syndrome: prevalence, clinical characteristics and pathogenetic mechanisms in a European population.
BACKGROUND
Left ventricular apical ballooning syndrome (LVABS) is a cardiac syndrome mimicking acute myocardial infarction, whose prevalence in western populations and pathogenesis are not yet well defined. The aim of the study was to assess its prevalence, clinical characteristics and pathophysiological mechanisms in a European population of myocardial infarction patients.


METHODS
Of a series of 1457 patients with acute myocardial infarction 18 fulfilled the diagnostic criteria for LVABS. To evaluate the pathogenetic mechanisms we studied coronary blood flow with TIMI flow grade and corrected TIMI frame count (CTFC) in all patients and performed provocative testing with ergonovine and dobutamine echocardiography in 14.


RESULTS
All patients were women aged 72+/-9 years. A triggering event was identifiable in 39% of cases. LV ejection fraction in the acute phase was 46+/-5%. No deaths or major complications occurred during hospitalization. Response to ergonovine was negative in all 14 patients and dobutamine induced a dynamic LV obstruction in 4/14 (28%). Mean CTFC was abnormally prolonged in all 3 major coronary arteries and 16/18 patients (89%) had an abnormal CTFC in >/=1 coronary vessel. No cardiac deaths occurred during follow-up and 1 patient only had a recurrence.


CONCLUSIONS
The prevalence of LVABS is 1.2% among all patients with acute myocardial infarction, but rises to 4.9% in women. Short- and long-term prognosis is good. Abnormal CTFC suggests the presence of a coronary microvascular dysfunction, while dynamic LV obstruction can contribute to the development of LVABS in a minority of patients.
Department of Cardiology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. marprevi@hotmail.com
Mario
M
Previtali
Alessandra
A
Repetto
Stefania
S
Panigada
Rita
R
Camporotondo
Luigi
L
Tavazzi
D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D004280:Dobutamine; D004452:Echocardiography; D004874:Ergonovine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology; D010120:Oxytocics; D015995:Prevalence; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000208:ethnology* / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology; D044465:White People / Q000706:statistics & numerical data*
D002316:Cardiotonic Agents; D010120:Oxytocics; D004280:Dobutamine; D004874:Ergonovine