Left ventricular apical ballooning syndrome: Prevalence, clinical characteristics and pathogenetic mechanisms in a European population

Mario Previtali, Alessandra Repetto, Stefania Panigada, Rita Camporotondo, Luigi Tavazzi

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Abstract

Background: Left ventricular apical ballooning syndrome (LVABS) is a cardiac syndrome mimicking acute myocardial infarction, whose prevalence in western populations and pathogenesis are not yet well defined. The aim of the study was to assess its prevalence, clinical characteristics and pathophysiological mechanisms in a European population of myocardial infarction patients. Methods: Of a series of 1457 patients with acute myocardial infarction 18 fulfilled the diagnostic criteria for LVABS. To evaluate the pathogenetic mechanisms we studied coronary blood flow with TIMI flow grade and corrected TIMI frame count (CTFC) in all patients and performed provocative testing with ergonovine and dobutamine echocardiography in 14. Results: All patients were women aged 72 ± 9 years. A triggering event was identifiable in 39% of cases. LV ejection fraction in the acute phase was 46 ± 5%. No deaths or major complications occurred during hospitalization. Response to ergonovine was negative in all 14 patients and dobutamine induced a dynamic LV obstruction in 4/14 (28%). Mean CTFC was abnormally prolonged in all 3 major coronary arteries and 16/18 patients (89%) had an abnormal CTFC in ≥ 1 coronary vessel. No cardiac deaths occurred during follow-up and 1 patient only had a recurrence. Conclusions: The prevalence of LVABS is 1.2% among all patients with acute myocardial infarction, but rises to 4.9% in women. Short- and long-term prognosis is good. Abnormal CTFC suggests the presence of a coronary microvascular dysfunction, while dynamic LV obstruction can contribute to the development of LVABS in a minority of patients.

Original languageEnglish
Pages (from-to)91-96
Number of pages6
JournalInternational Journal of Cardiology
Volume134
Issue number1
DOIs
Publication statusPublished - May 1 2009

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Takotsubo Cardiomyopathy
Population
Myocardial Infarction
Ergonovine
Dobutamine
Coronary Vessels
Echocardiography
Hospitalization
Recurrence

Keywords

  • Apical ballooning syndrome
  • Dobutamine echocardiography
  • Ergonovine echocardiography
  • Tako-tsubo cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Left ventricular apical ballooning syndrome: Prevalence, clinical characteristics and pathogenetic mechanisms in a European population",
abstract = "Background: Left ventricular apical ballooning syndrome (LVABS) is a cardiac syndrome mimicking acute myocardial infarction, whose prevalence in western populations and pathogenesis are not yet well defined. The aim of the study was to assess its prevalence, clinical characteristics and pathophysiological mechanisms in a European population of myocardial infarction patients. Methods: Of a series of 1457 patients with acute myocardial infarction 18 fulfilled the diagnostic criteria for LVABS. To evaluate the pathogenetic mechanisms we studied coronary blood flow with TIMI flow grade and corrected TIMI frame count (CTFC) in all patients and performed provocative testing with ergonovine and dobutamine echocardiography in 14. Results: All patients were women aged 72 ± 9 years. A triggering event was identifiable in 39{\%} of cases. LV ejection fraction in the acute phase was 46 ± 5{\%}. No deaths or major complications occurred during hospitalization. Response to ergonovine was negative in all 14 patients and dobutamine induced a dynamic LV obstruction in 4/14 (28{\%}). Mean CTFC was abnormally prolonged in all 3 major coronary arteries and 16/18 patients (89{\%}) had an abnormal CTFC in ≥ 1 coronary vessel. No cardiac deaths occurred during follow-up and 1 patient only had a recurrence. Conclusions: The prevalence of LVABS is 1.2{\%} among all patients with acute myocardial infarction, but rises to 4.9{\%} in women. Short- and long-term prognosis is good. Abnormal CTFC suggests the presence of a coronary microvascular dysfunction, while dynamic LV obstruction can contribute to the development of LVABS in a minority of patients.",
keywords = "Apical ballooning syndrome, Dobutamine echocardiography, Ergonovine echocardiography, Tako-tsubo cardiomyopathy",
author = "Mario Previtali and Alessandra Repetto and Stefania Panigada and Rita Camporotondo and Luigi Tavazzi",
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T1 - Left ventricular apical ballooning syndrome

T2 - Prevalence, clinical characteristics and pathogenetic mechanisms in a European population

AU - Previtali, Mario

AU - Repetto, Alessandra

AU - Panigada, Stefania

AU - Camporotondo, Rita

AU - Tavazzi, Luigi

PY - 2009/5/1

Y1 - 2009/5/1

N2 - Background: Left ventricular apical ballooning syndrome (LVABS) is a cardiac syndrome mimicking acute myocardial infarction, whose prevalence in western populations and pathogenesis are not yet well defined. The aim of the study was to assess its prevalence, clinical characteristics and pathophysiological mechanisms in a European population of myocardial infarction patients. Methods: Of a series of 1457 patients with acute myocardial infarction 18 fulfilled the diagnostic criteria for LVABS. To evaluate the pathogenetic mechanisms we studied coronary blood flow with TIMI flow grade and corrected TIMI frame count (CTFC) in all patients and performed provocative testing with ergonovine and dobutamine echocardiography in 14. Results: All patients were women aged 72 ± 9 years. A triggering event was identifiable in 39% of cases. LV ejection fraction in the acute phase was 46 ± 5%. No deaths or major complications occurred during hospitalization. Response to ergonovine was negative in all 14 patients and dobutamine induced a dynamic LV obstruction in 4/14 (28%). Mean CTFC was abnormally prolonged in all 3 major coronary arteries and 16/18 patients (89%) had an abnormal CTFC in ≥ 1 coronary vessel. No cardiac deaths occurred during follow-up and 1 patient only had a recurrence. Conclusions: The prevalence of LVABS is 1.2% among all patients with acute myocardial infarction, but rises to 4.9% in women. Short- and long-term prognosis is good. Abnormal CTFC suggests the presence of a coronary microvascular dysfunction, while dynamic LV obstruction can contribute to the development of LVABS in a minority of patients.

AB - Background: Left ventricular apical ballooning syndrome (LVABS) is a cardiac syndrome mimicking acute myocardial infarction, whose prevalence in western populations and pathogenesis are not yet well defined. The aim of the study was to assess its prevalence, clinical characteristics and pathophysiological mechanisms in a European population of myocardial infarction patients. Methods: Of a series of 1457 patients with acute myocardial infarction 18 fulfilled the diagnostic criteria for LVABS. To evaluate the pathogenetic mechanisms we studied coronary blood flow with TIMI flow grade and corrected TIMI frame count (CTFC) in all patients and performed provocative testing with ergonovine and dobutamine echocardiography in 14. Results: All patients were women aged 72 ± 9 years. A triggering event was identifiable in 39% of cases. LV ejection fraction in the acute phase was 46 ± 5%. No deaths or major complications occurred during hospitalization. Response to ergonovine was negative in all 14 patients and dobutamine induced a dynamic LV obstruction in 4/14 (28%). Mean CTFC was abnormally prolonged in all 3 major coronary arteries and 16/18 patients (89%) had an abnormal CTFC in ≥ 1 coronary vessel. No cardiac deaths occurred during follow-up and 1 patient only had a recurrence. Conclusions: The prevalence of LVABS is 1.2% among all patients with acute myocardial infarction, but rises to 4.9% in women. Short- and long-term prognosis is good. Abnormal CTFC suggests the presence of a coronary microvascular dysfunction, while dynamic LV obstruction can contribute to the development of LVABS in a minority of patients.

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