CORRESPONDENCE: LETTERS TO THE EDITOR
Reply
R. Todd Hurst, MD*,
Christina S. Reuss, MD,
A. Jamil Tajik, MD and
J. Wells Askew, MD
* Mayo Clinic Arizona, Cardiovascular Diseases, 13400 East Shea Boulevard, Desk 3A, Scottsdale, Arizona 85260 (Email: hurst.todd{at}mayo.edu).
We appreciate the interest of Dr. Sharkey and colleagues in our report on transient midventricular ballooning of the left ventricle (1). Even after careful review of the study by Sharkey et al. (2), we are unable to find any evidence to substantiate their statement that "we also reported normal contraction of the apical LV [left ventricular] segment in 7 of 17 patients (41%) based on cardiac MRI [magnetic resonance imaging]." To the contrary, in their study the investigators state "All [our emphasis] exhibited a large wall-motion abnormality that involved akinesia or hypokinesia of the distal one-half to two-thirds of the LV chamber, which created a distinctive ‘apical ballooning appearance’." Accordingly, we are unable to explain the discrepancy. The report by Abdulla et al. (3) was published after our study was submitted, making it impossible to have previously acknowledged.
Although the assertion that "this particular reversible pattern of abnormal LV contraction is very common in stress cardiomyopathy" may prove to be true, we did not comment on the prevalence of transient midventricular ballooning in our study. In fact, it would be anticipated that recognition of this midventricular variant would increase through a heightened awareness of transient ballooning syndrome, and this has proven correct as demonstrated in the report by Abdulla et al. (3), the recent MRI image from Steen et al. (4), and a case report by Shimizu et al. (5). We believe the "novel" aspect of the cases was recognizing the implications in determining the etiology underlying transient ballooning syndrome rather than the rarity of the occurrence.
The naming of this syndrome may be one of personal preference; however, we would suggest that "transient ballooning syndrome" as a descriptive nomenclature seems most appropriate. "Stress cardiomyopathy" implies a cause-and-effect relationship that, at present, has not been fully elucidated. Stress is ubiquitous, yet an associated transient cardiomyopathy is not!
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References
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- 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]
- 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.
- Abdulla I, Kay S, Mussap C, et al. Apical sparing in tako-tsubo cardiomyopathy Intern Med J 2006;36:414-418.[CrossRef][ISI][Medline]
- Steen H, Merten C, Katus H, Giannitsis E. A rare form of midventricular tako-tsubo after emotional stress followed up with magnetic resonance imaging Circulation 2006;114:e248.[Abstract/Free Full Text]
- Shimizu M, Kato Y, Masai H, Shima T, Miwa Y. Recurrent episodes of takotsubo-like transient left ventricular ballooning occurring in different regions: a case report J Cardiol 2006;48:101-107.[Medline]
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