Transient left ventricular apical ballooning syndrome: A 4-year experience

Leonardo Spedicato, Davide Zanuttini, Gaetano Nucifora, Claudia Sciacca, Luigi P. Badano, Giorgio Minen, Giorgio Morocutti, Guglielmo Bernardi, Paolo M. Fioretti

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background Transient left ventricular apical ballooning syndrome, primarily described in Japanese patients, has been recently recognized outside Japan also. Aim of this study is to elucidate incidence and clinical features of left ventricular apical ballooning syndrome in a tertiary-care hospital in northeastern Italy. Methods and results From January 2002 to August 2006, 29 patients admitted for suspected acute coronary syndrome (25 women, mean age 64 ± 12 years) fulfilled the Mayo Clinic Criteria of left ventricular apical ballooning syndrome. Twenty patients (69%) had an episode of emotional or physiologic stress preceding left ventricular apical ballooning syndrome. Fourteen patients (48%) had at least one risk factor for coronary artery disease. Chest pain was present at admission in 24 patients (83%). Twenty-five patients (86%) had ST-T segment abnormalities at ECG on admission. Four patients were treated with fibrinolytic therapy and one with glycoprotein Ilb/IIIa inhibitors. At coronary angiography, 23 patients (79%) had no coronary lesions, 2 (7%) had small vessel occlusion and 4 (14%) had nonsignificant coronary stenosis. ECG changes and echocardiographic wall motion abnormalities completely regressed in all patients within 10 weeks. Neither death nor major complications occurred during in-hospital stay and after discharge. Two patients (7%) experienced a recurrence during follow-up. Conclusion Left ventricular apical ballooning syndrome is a novel syndrome with a nonnegligible incidence, a clinical presentation mimicking acute myocardial infarction and a favorable outcome. The present data confirm a higher prevalence in women and the frequent association with emotional stress. The differential diagnosis with acute myocardial infarction at presentation is still puzzling, and only ECG findings in conjunction with echocardiography and coronary angiography are so far diagnostics.

LanguageEnglish
Pages916-921
Number of pages6
JournalJournal of Cardiovascular Medicine
Volume9
Issue number9
DOIs
Publication statusPublished - 1 Jan 2008

Keywords

  • Acute myocardial infarction
  • Coronary angiography
  • Echocardiography
  • Left ventricular apical ballooning syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Spedicato, L., Zanuttini, D., Nucifora, G., Sciacca, C., Badano, L. P., Minen, G., ... Fioretti, P. M. (2008). Transient left ventricular apical ballooning syndrome: A 4-year experience. Journal of Cardiovascular Medicine, 9(9), 916-921. https://doi.org/10.2459/JCM.0b013e3283027f8e
Spedicato, Leonardo ; Zanuttini, Davide ; Nucifora, Gaetano ; Sciacca, Claudia ; Badano, Luigi P. ; Minen, Giorgio ; Morocutti, Giorgio ; Bernardi, Guglielmo ; Fioretti, Paolo M. / Transient left ventricular apical ballooning syndrome : A 4-year experience. In: Journal of Cardiovascular Medicine. 2008 ; Vol. 9, No. 9. pp. 916-921.
@article{219c60e9c2a142d8b1505ae9e1619e79,
title = "Transient left ventricular apical ballooning syndrome: A 4-year experience",
abstract = "Background Transient left ventricular apical ballooning syndrome, primarily described in Japanese patients, has been recently recognized outside Japan also. Aim of this study is to elucidate incidence and clinical features of left ventricular apical ballooning syndrome in a tertiary-care hospital in northeastern Italy. Methods and results From January 2002 to August 2006, 29 patients admitted for suspected acute coronary syndrome (25 women, mean age 64 ± 12 years) fulfilled the Mayo Clinic Criteria of left ventricular apical ballooning syndrome. Twenty patients (69{\%}) had an episode of emotional or physiologic stress preceding left ventricular apical ballooning syndrome. Fourteen patients (48{\%}) had at least one risk factor for coronary artery disease. Chest pain was present at admission in 24 patients (83{\%}). Twenty-five patients (86{\%}) had ST-T segment abnormalities at ECG on admission. Four patients were treated with fibrinolytic therapy and one with glycoprotein Ilb/IIIa inhibitors. At coronary angiography, 23 patients (79{\%}) had no coronary lesions, 2 (7{\%}) had small vessel occlusion and 4 (14{\%}) had nonsignificant coronary stenosis. ECG changes and echocardiographic wall motion abnormalities completely regressed in all patients within 10 weeks. Neither death nor major complications occurred during in-hospital stay and after discharge. Two patients (7{\%}) experienced a recurrence during follow-up. Conclusion Left ventricular apical ballooning syndrome is a novel syndrome with a nonnegligible incidence, a clinical presentation mimicking acute myocardial infarction and a favorable outcome. The present data confirm a higher prevalence in women and the frequent association with emotional stress. The differential diagnosis with acute myocardial infarction at presentation is still puzzling, and only ECG findings in conjunction with echocardiography and coronary angiography are so far diagnostics.",
keywords = "Acute myocardial infarction, Coronary angiography, Echocardiography, Left ventricular apical ballooning syndrome",
author = "Leonardo Spedicato and Davide Zanuttini and Gaetano Nucifora and Claudia Sciacca and Badano, {Luigi P.} and Giorgio Minen and Giorgio Morocutti and Guglielmo Bernardi and Fioretti, {Paolo M.}",
year = "2008",
month = "1",
day = "1",
doi = "10.2459/JCM.0b013e3283027f8e",
language = "English",
volume = "9",
pages = "916--921",
journal = "Journal of Cardiovascular Medicine",
issn = "1558-2027",
number = "9",

}

Spedicato, L, Zanuttini, D, Nucifora, G, Sciacca, C, Badano, LP, Minen, G, Morocutti, G, Bernardi, G & Fioretti, PM 2008, 'Transient left ventricular apical ballooning syndrome: A 4-year experience', Journal of Cardiovascular Medicine, vol. 9, no. 9, pp. 916-921. https://doi.org/10.2459/JCM.0b013e3283027f8e

Transient left ventricular apical ballooning syndrome : A 4-year experience. / Spedicato, Leonardo; Zanuttini, Davide; Nucifora, Gaetano; Sciacca, Claudia; Badano, Luigi P.; Minen, Giorgio; Morocutti, Giorgio; Bernardi, Guglielmo; Fioretti, Paolo M.

In: Journal of Cardiovascular Medicine, Vol. 9, No. 9, 01.01.2008, p. 916-921.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Transient left ventricular apical ballooning syndrome

T2 - Journal of Cardiovascular Medicine

AU - Spedicato, Leonardo

AU - Zanuttini, Davide

AU - Nucifora, Gaetano

AU - Sciacca, Claudia

AU - Badano, Luigi P.

AU - Minen, Giorgio

AU - Morocutti, Giorgio

AU - Bernardi, Guglielmo

AU - Fioretti, Paolo M.

PY - 2008/1/1

Y1 - 2008/1/1

N2 - Background Transient left ventricular apical ballooning syndrome, primarily described in Japanese patients, has been recently recognized outside Japan also. Aim of this study is to elucidate incidence and clinical features of left ventricular apical ballooning syndrome in a tertiary-care hospital in northeastern Italy. Methods and results From January 2002 to August 2006, 29 patients admitted for suspected acute coronary syndrome (25 women, mean age 64 ± 12 years) fulfilled the Mayo Clinic Criteria of left ventricular apical ballooning syndrome. Twenty patients (69%) had an episode of emotional or physiologic stress preceding left ventricular apical ballooning syndrome. Fourteen patients (48%) had at least one risk factor for coronary artery disease. Chest pain was present at admission in 24 patients (83%). Twenty-five patients (86%) had ST-T segment abnormalities at ECG on admission. Four patients were treated with fibrinolytic therapy and one with glycoprotein Ilb/IIIa inhibitors. At coronary angiography, 23 patients (79%) had no coronary lesions, 2 (7%) had small vessel occlusion and 4 (14%) had nonsignificant coronary stenosis. ECG changes and echocardiographic wall motion abnormalities completely regressed in all patients within 10 weeks. Neither death nor major complications occurred during in-hospital stay and after discharge. Two patients (7%) experienced a recurrence during follow-up. Conclusion Left ventricular apical ballooning syndrome is a novel syndrome with a nonnegligible incidence, a clinical presentation mimicking acute myocardial infarction and a favorable outcome. The present data confirm a higher prevalence in women and the frequent association with emotional stress. The differential diagnosis with acute myocardial infarction at presentation is still puzzling, and only ECG findings in conjunction with echocardiography and coronary angiography are so far diagnostics.

AB - Background Transient left ventricular apical ballooning syndrome, primarily described in Japanese patients, has been recently recognized outside Japan also. Aim of this study is to elucidate incidence and clinical features of left ventricular apical ballooning syndrome in a tertiary-care hospital in northeastern Italy. Methods and results From January 2002 to August 2006, 29 patients admitted for suspected acute coronary syndrome (25 women, mean age 64 ± 12 years) fulfilled the Mayo Clinic Criteria of left ventricular apical ballooning syndrome. Twenty patients (69%) had an episode of emotional or physiologic stress preceding left ventricular apical ballooning syndrome. Fourteen patients (48%) had at least one risk factor for coronary artery disease. Chest pain was present at admission in 24 patients (83%). Twenty-five patients (86%) had ST-T segment abnormalities at ECG on admission. Four patients were treated with fibrinolytic therapy and one with glycoprotein Ilb/IIIa inhibitors. At coronary angiography, 23 patients (79%) had no coronary lesions, 2 (7%) had small vessel occlusion and 4 (14%) had nonsignificant coronary stenosis. ECG changes and echocardiographic wall motion abnormalities completely regressed in all patients within 10 weeks. Neither death nor major complications occurred during in-hospital stay and after discharge. Two patients (7%) experienced a recurrence during follow-up. Conclusion Left ventricular apical ballooning syndrome is a novel syndrome with a nonnegligible incidence, a clinical presentation mimicking acute myocardial infarction and a favorable outcome. The present data confirm a higher prevalence in women and the frequent association with emotional stress. The differential diagnosis with acute myocardial infarction at presentation is still puzzling, and only ECG findings in conjunction with echocardiography and coronary angiography are so far diagnostics.

KW - Acute myocardial infarction

KW - Coronary angiography

KW - Echocardiography

KW - Left ventricular apical ballooning syndrome

UR - http://www.scopus.com/inward/record.url?scp=55249127126&partnerID=8YFLogxK

U2 - 10.2459/JCM.0b013e3283027f8e

DO - 10.2459/JCM.0b013e3283027f8e

M3 - Article

VL - 9

SP - 916

EP - 921

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

IS - 9

ER -

Spedicato L, Zanuttini D, Nucifora G, Sciacca C, Badano LP, Minen G et al. Transient left ventricular apical ballooning syndrome: A 4-year experience. Journal of Cardiovascular Medicine. 2008 Jan 1;9(9):916-921. https://doi.org/10.2459/JCM.0b013e3283027f8e