title: Long-term outcome and sex distribution across ages of left ventricular apical ballooning syndrome.
abstract: OBJECTIVE
  Apical ballooning syndrome is a rare clinical entity that predominantly involves elderly women and is considered to be benign. We report our experience regarding this syndrome in terms of sex distribution and long-term outcome.
  
  
  METHODS
  Between 1999 and 2006, we identified 28 consecutive patients affected by the apical ballooning syndrome. Inclusion criteria were an onset of mimicking acute myocardial infarction, transient akinesia/dyskinesia of the mid-apical left ventricular segments and no significant obstructive coronary artery disease. Patients with a recent brain disease, pheocromocytoma, hypertrophic cardiomyopathy and suspected myocarditis were excluded. Sex distribution was assessed across different ages according to quartiles: less than 61 years of age (group 1), 61-71 years (group 2), 72-77 years (group 3) and more than 77 years (group 4). In-hospital and follow-up events were observed.
  
  
  RESULTS
  The apical ballooning syndrome represented 1.69% of ST-segment elevation acute coronary syndromes. There were more women than men in groups 2 (85.7 vs. 14.3%), 3 (85.7 vs. 14.3%) and 4 (100 vs. 0%), but there were fewer women than men in group 1 (42.9 vs. 57.1%), with an overall supremacy of women (78.6 vs. 21.4%) (P=0.02). In-hospital events were one (3.6%) cardiac death and five (17.9%) nonfatal events. At the median follow-up of 24 months, one patient was lost and two (7.7%) died of cardiac causes, thus, the total cardiac mortality was 10.7% (3/28 patients); no recurrence occurred and left ventricular ejection fraction increased from 40.4 to 58.6% (P<0.01).
  
  
  CONCLUSIONS
  In our population, left ventricular apical ballooning syndrome included several typical features. However, a peculiar sex tendency across various age groups was observed and, although older women predominated, men seemed to be more affected than women at a younger age. The long-term prognosis seems to be favourable.
authors.affiliation: Cardiovascular Department, Umberto I Hospital, Mestre, Venice, Italy. paolo.buja@excite.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Buja
authors.forename: Guerrino
authors.initials: G
authors.lastname: Zuin
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Pede
authors.forename: Michela
authors.initials: M
authors.lastname: Madalosso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grassi
authors.forename: Massimo
authors.initials: M
authors.lastname: Celestre
authors.forename: Paolo
authors.initials: P
authors.lastname: Millosevich
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
mesh_terms: D017677:Age Distribution; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017678:Sex Distribution; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000628:therapy