title: 24 hour ST segment analysis in transient left ventricular apical ballooning.
abstract: OBJECTIVE
  The etiologic basis of transient left ventricular apical ballooning, a novel cardiac syndrome, is not clear. Among the proposed pathomechanisms is coronary vasospasm. Long-term ST segment analysis may detect vasospastic episodes but has not been reported.
  
  
  METHODS
  30 consecutive patients with transient left ventricular apical ballooning, left ventricular dysfunction and normal or near-normal coronary arteries were investigated. A 24-hour Holter ECG was obtained after emergency admission. ST segment analysis was performed automatically in 2 leads and confirmed by visual inspection. Criteria for an ischemic event were: 1. ST elevation or 2. horizontal or down-sloping ST segments ≥1 min duration and ≥100 µV J+80 point deviation corrected for baseline ST-deviation.
  
  
  RESULTS
  Patients presented with ST segment elevation (n = 19) and/or T wave inversion (n = 20) on admission ECG. Ejection fraction was 50±12%. No transient ST elevations were observed during Holter ECG analysis. In 3 patients, 8 transient episodes of ST depression were recorded. Durations of episodes varied between 75 s and 790 s (mean 229 s). Maximal ST deviation averaged -191±71 µV. Ischemic burden was -1 to -22 mVs (mean -8 mVs). 27 patients showed no ischemic events.
  
  
  CONCLUSIONS
  ST segment analysis of 24 h Holter recordings revealed minor ischemic events in only 10% of patients with transient left ventricular apical ballooning. Overall, ST segment changes were not indicative of recurrent coronary spasm playing a major role in the genesis of transient left ventricular apical ballooning.
authors.affiliation: Medical Department II, University of Luebeck, Luebeck, Germany. frank.bode@uk-sh.de
authors.forename: Frank
authors.initials: F
authors.lastname: Bode
authors.forename: Christof
authors.initials: C
authors.lastname: Burgdorf
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
authors.forename: Volkhard
authors.initials: V
authors.lastname: Kurowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis