Transient left ventricular apical ballooning syndrome: a 4-year experience.
BACKGROUND
Transient left ventricular apical ballooning syndrome, primarily described in Japanese patients, has been recently recognized outside Japan also. Aim of this study is to elucidate incidence and clinical features of left ventricular apical ballooning syndrome in a tertiary-care hospital in northeastern Italy.


RESULTS
From January 2002 to August 2006, 29 patients admitted for suspected acute coronary syndrome (25 women, mean age 64+/-12 years) fulfilled the Mayo Clinic Criteria of left ventricular apical ballooning syndrome. Twenty patients (69%) had an episode of emotional or physiologic stress preceding left ventricular apical ballooning syndrome. Fourteen patients (48%) had at least one risk factor for coronary artery disease. Chest pain was present at admission in 24 patients (83%). Twenty-five patients (86%) had ST-T segment abnormalities at ECG on admission. Four patients were treated with fibrinolytic therapy and one with glycoprotein IIb/IIIa inhibitors. At coronary angiography, 23 patients (79%) had no coronary lesions, 2 (7%) had small vessel occlusion and 4 (14%) had nonsignificant coronary stenosis. ECG changes and echocardiographic wall motion abnormalities completely regressed in all patients within 10 weeks. Neither death nor major complications occurred during in-hospital stay and after discharge. Two patients (7%) experienced a recurrence during follow-up.


CONCLUSIONS
Left ventricular apical ballooning syndrome is a novel syndrome with a nonnegligible incidence, a clinical presentation mimicking acute myocardial infarction and a favorable outcome. The present data confirm a higher prevalence in women and the frequent association with emotional stress. The differential diagnosis with acute myocardial infarction at presentation is still puzzling, and only ECG findings in conjunction with echocardiography and coronary angiography are so far diagnostics.
Spedicato
Leonardo
L
Department of Cardiopulmonary Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy. spedicato.leonardo@aoud.sanita.fvg.it
Zanuttini
Davide
D
Nucifora
Gaetano
G
Sciacca
Claudia
C
Badano
Luigi P
LP
Minen
Giorgio
G
Morocutti
Giorgio
G
Bernardi
Guglielmo
G
Fioretti
Paolo M
PM
D000368:Aged; D006328:Cardiac Catheterization; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000209:etiology