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J Am Coll Cardiol, 2001; 38:11-18
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY

Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction

Kazufumi Tsuchihashi, MD, PhDa, Kenji Ueshima, MD, PhD{dagger}, Tatsuro Uchida, MD, PhD{ddagger}, Nobuhiro Oh-mura, MD, PhD§, Kazuo Kimura, MD, PhD||, Mafumi Owa, MD, PhD, Minoru Yoshiyama, MD, PhD#, Shunichi Miyazaki, MD, PhD**, Kazuo Haze, MD, PhD{dagger}{dagger}, Hisao Ogawa, MD, PhD{ddagger}{ddagger}, Takashi Honda, MD, PhD§§, Mamoru Hase, MDa, Ryu-ichi Kai, MD, PhD§, Isao Morii, MD, PhD** for the Angina Pectoris-Myocardial Infarction Investigations in Japan

a Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
{dagger} Second Department of Internal Medicine and Cardiology, Memorial Heart Center, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
{ddagger} Division of Cardiovascular Medicine, Sendai Cardiovascular Center, Sendai, Japan
§ Department of Cardiovascular Medicine, Omiya Medical Center, Jichi Medical School, Omiya, Saitama, Japan
|| Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
First Department of Internal Medicine, Shinsyu University School of Medicine, Matsumoto, Nagano, Japan
# Division of Cardiology, Osaka City University School of Medicine, Osaka, Japan
** Division of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan
{dagger}{dagger} Department of Cardiology, Osaka City General Hospital, Osaka, Japan
{ddagger}{ddagger} Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
§§ Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan

Manuscript received November 15, 2000; revised manuscript received March 8, 2001, accepted March 26, 2001.

Reprint requests and correspondence: Dr. Kazufumi Tsuchihashi, Second Department of Internal Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo 060-0061, Japan
tsuchiha{at}sapmed.ac.jp

OBJECTIVES

To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study.

BACKGROUND

Only several case presentations have been reported with regard to this syndrome.

METHODS

We analyzed 88 patients (12 men and 76 women), aged 67 ± 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies.

RESULTS

Thirty-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 ± 11% to 64 ± 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 ± 14 months, two patients showed recurrence, and one died suddenly.

CONCLUSIONS

A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  AP-MI = Angina Pectoris-Myocardial Infarction investigations
  CAG = coronary angiogram or coronary angiographic
  CK = creatine kinase
  ECG = electrocardiogram or electrocardiographic
  LV = left ventricle or left ventricular
  LVG = left ventriculography or left ventriculographic




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Transient left ventricular apical ballooning without coronary artery stenosis: a form of stunning-like phenomenon? Reply
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Reply
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