Isolated Left Ventricular Basal Ballooning Phenotype of Transient Cardiomyopathy in Young Women

This report describes a variant of transient regional left ventricular dysfunction in which isolated basal left ventricular akinesia with normal mid-ventricular (papillary-level) wall motion and apical hypercontractility were noted in young women (mean age 31 years). This finding was demonstrated in 3 consecutive patients; the first patient was experiencing emotional life-altering events, and the second presented with an acute flare of multiple sclerosis. The third patient presented <24 hours after methamphetamine use. Coronary angiography demonstrated normal epicardial coronary arteries in all patients. Wall motion abnormalities resolved within 2 to 6 weeks. In conclusion, the entity described in this report is reminiscent of apical ballooning (“Tako-Tsubo”), mid-ventricular ballooning, and apical sparing syndromes; however, isolated basal left ventricular involvement has not been previously described and is a newer variant in the spectrum of transient cardiomyopathies. The pathophysiology of this entity has not been elucidated. A unifying feature between the transient cardiomyopathic syndromes most likely is in the concentration, distribution, and activity of cardiac adrenergic receptors.