CORRESPONDENCE: LETTERS TO THE EDITOR
Stress Cardiomyopathy
Scott W. Sharkey, MD, FACC*,
John R. Lesser, MD, FACC,
Martin S. Maron, MD and
Barry J. Maron, MD, FACC
* Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 60, Minneapolis, Minnesota 55407 (Email: scott.sharkey{at}allina.com).
We were interested to see the report of Hurst et al. (1) describing 4 women with stress (tako-tsubo) cardiomyopathy and systolic "midventricular ballooning." As noted by the investigators, this left ventricular (LV) contraction pattern differs from that of many other patients with stress cardiomyopathy because the distal portion of the chamber at the LV apex demonstrates a normal contraction pattern (apical sparing). Indeed, in our initial report of women with stress cardiomyopathy we also reported normal contraction of the apical LV segment in 9 of 22 patients (41%) based on cardiac magnetic resonance imaging (MRI) (2). In addition, Abdulla et al. (3) also recently reported apical sparing in 14 of 35 patients (40%) with stress cardiomyopathy. Therefore, this particular reversible pattern of abnormal LV contraction is very common in stress cardiomyopathy, and it may well have been an overestimation on the part of Hurst et al. (1) to regard this form of the condition as a novel variant.
Conversely, such patients clearly represent a subset within this disease spectrum, although of uncertain mechanism and clinical significance at this time. This diversity of phenotypic expression would, however, underscore the superiority of the term "stress cardiomyopathy" to describe this diverse entity rather than the ultimately confusing "midventricular ballooning" or "apical ballooning syndrome" (4–6). At this relatively early juncture in the evolving description of stress cardiomyopathy, application of clear and consistent nomenclature seems essential.
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References
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1. Hurst RT, Askew JW, Reuss CS, et al. Transient midventricular ballooning syndrome: a new variant J Am Coll Cardiol 2006;48:579-583.[Abstract/Free Full Text]2. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States Circulation 2005;111:472-479. 3. Abdulla I, Kay S, Mussap C, et al. Apical sparing in tako-tsubo cardiomyopathy Intern Med J 2006;36:414-418.[CrossRef][Web of Science][Medline] 4. Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction Ann Intern Med 2004;141:858-865.[Abstract/Free Full Text] 5. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarctionAngina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol 2001;38:11-18.[Abstract/Free Full Text] 6. Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU Chest 2005;128:296-302.
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