LETTER TO THE EDITOR
Transient left ventricular apical ballooning without coronary artery stenosis: a form of stunning-like phenomenon?
Junya Ako, MD*,
Koichi Kozaki, MD, PhD,
Masao Yoshizumi, MD, PhD and
Yasuyoshi Ouchi, MD, PhD
* Department of Geriatric Medicine, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan 113-8655
junya-tky{at}umin.ac.jp
We read with great interest the study published by Tsuchihashi et al. (1) in the July issue of the Journal. The study presented detailed findings with regard to the unusual phenomenon that mimic acute coronary syndrome.
Left ventricular (LV) contraction abnormalities without coronary stenosis have been previously reported in physically or emotionally stressed patients (2–4). Epicardial coronary spasm has not been confirmed in these patients even while ST-segment is elevated in the electrocardiogram (ECG). Kawai et al. (3) stated this could be a form of cardiomyopathy, termed "ampulla cardiomyopathy". However, Tsuchihashi et al. (1) suggested that the histological change was similar to that of catecholamine-induced myocardial damage and that microvascular spasm was involved.
We have been interested in this form of reversible LV dysfunction, and recently reported the involvement of impaired coronary microcirculation in transient LV contraction abnormalities (5). Coronary arteriography revealed no significant stenosis in the epicardial arteries. Relative coronary flow reserve measured by intracoronary Doppler guide wire was significantly reduced, which suggested severely decreased coronary microcirculation in these patients. Contrast myocardial echocardiography revealed that the impaired ventricular perfusion was reversible. According to our findings about coronary microcirculation, the histological changes seen in these patients might be a result of a stunning-like phenomenon due to microvascular abnormalities.
Finally, the investigators carefully used the term "transient left ventricular apical ballooning" in the title of their study (1). The exact mechanism of this reversible contraction abnormality still remains unclear. A term defining the pathogenesis of this syndrome will be necessary in the near future.
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References
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- Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris–Myocardial Infarction Investigations in Japan. J Am Coll Cardiol. 2001;38:11–18[Abstract/Free Full Text]
- Sharkey SW, Shear W, Hodges M, Herzog CA. Reversible myocardial contraction abnormalities in patients with an acute noncardiac illness. Chest. 1998;114:98–105[Abstract/Free Full Text]
- Kawai S, Suzuki H, Yamaguchi H, et al. Ampulla cardiomyopathy ("Takotusbo" cardiomyopathy)—reversible left ventricular dysfunction: with ST-segment elevation. Jpn Circ J. 2000;64:156–159[CrossRef][Medline]
- Pavin D, Le Breton H, Daubert C. Human stress cardiomyopathy mimicking acute myocardial syndrome. Heart. 1997;78:509–511[Abstract/Free Full Text]
- Ako J, Takenaka K, Uno K, et al. Reversible left ventricular systolic dysfunction—reversibility of coronary microvascular abnormality. Jpn Heart J. 2001;42:355–363[CrossRef][Medline]
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