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J Am Coll Cardiol, 2003; 41:737-742, doi:10.1016/S0735-1097(02)02925-X
© 2003 by the American College of Cardiology Foundation
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CLINICAL STUDY: ACUTE APICAL BALLOONING

Assessment of clinical features in transient left ventricular apical ballooning

Yoshiteru Abe, MD*, Makoto Kondo, MD*,*, Ryota Matsuoka, MD*, Makoto Araki, MD*, Kiyoshi Dohyama, MD* and Hitoshi Tanio, MD*

* Division of Cardiology, Shimada Municipal Hospital, Shimada, Shizuoka, Japan

Manuscript received January 20, 2002; revised manuscript received September 9, 2002, accepted September 20, 2002.

* Reprint requests and correspondence: Dr. Makoto Kondo, Division of Cardiology, Shimada Municipal Hospital, 1200-5 Noda, Shimada City, Shizuoka, 427-8502 Japan.
kondo-m{at}gb3.so-net.ne.jp

OBJECTIVES: We sought to assess the clinical features of transient left ventricular (LV) apical ballooning.

BACKGROUND: Although several cases regarding transient LV apical ballooning have been reported, the etiology remains unknown.

METHODS: We investigated 17 patients (14 women, median age 74 years old with a range of 54 to 91 years old) who fulfilled the following criteria: 1) transient LV apical ballooning; 2) ST-T segment change in several leads in electrocardiogram; and 3) no history of old myocardial infarction, valvular heart disease, subarachnoid hemorrhage, or pheochromocytoma.

RESULTS: Emotional and physical stress were observed in 16 patients (94%). Technetium-99m tetrofosmin tomographic imaging revealed decreased uptake at the apex of the left ventricle in 11 patients (85%) that later returned to uniform. No significant stenosis or angiographical slow flow in epicardial coronary arteries was observed (n = 9). Provocative focal vasospasm was induced in only one patient (14%) (n = 7). Moreover, no significant abnormality in the coronary microcirculation was detected by Doppler guidewire (n = 3) or contrast echocardiography (n = 1). No patients showed a rise in viral antibody titers. Biopsy specimens revealed interstitial fibrosis in six patients (100%) and slight cell infiltration in three others (50%) (n = 6).

CONCLUSIONS: These findings suggested that neither abnormalities in the coronary circulation nor acute myocarditis was related to the etiology. Although neurogenic stunned myocardium induced by emotional or physical stress was suggested as the etiology, further investigations are necessary.

Abbreviations and Acronyms
  CAG
  coronary angiogram
  CFR
  coronary flow reserve
  DDT
  deceleration time of the diastolic flow velocity
  DSVR
  diastolic to systolic velocity ratio
  ECG
  electrocardiogram
  ESRF
  early systolic reverse flow
  LV
  left ventricular
  MCE
  myocardial contrast echocardiography
  MI
  myocardial infarction
  TF
  technetium-99m tetrofosmin




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