Advertisement

Clinical Characteristics and Outcome of Left Ventricular Ballooning Syndrome in a European Population

      We assessed the clinical characteristics and determinants of the prognosis of patients with left ventricular ballooning syndrome (LVBS) in an European population. A total of 128 patients with LVBS (98% women, age 67 ± 11 years) were prospectively followed up for a median of 13 months. A trigger event was identifiable in 58% of the patients. Anterior ST-segment elevation was documented in 38% and negative T waves in 41% of the patients. Apical ballooning was present in 82% and midventricular ballooning in 18%. The initial LV ejection fraction was 41 ± 9%. In-hospital events included the death of 1 patient (0.8%), LV failure in 13 (10%), LV thrombi in 4 (3.1%), sustained ventricular or supraventricular tachyarrhythmias in 6 (4.7%) and asystole in 2 patients (1.6%). The extent of wall motion abnormalities (odds ratio 4.16, p = 0.012), dyspnea at presentation (odds ratio 3.42, p = 0.01), and treatment with nitrates (odds ratio 0.30, p = 0.015) were significant univariate predictors of in-hospital events. The recovery of regional wall motion abnormalities occurred within 1 month of the event in 73% of patients. During follow-up, events occurred in 7 (6%) of 121 patients, including noncardiac death in 1 (0.8%), recurrent LVBS in 2 (1.6%), heart failure in 1 (0.8%), and recurrent chest pain in 3 (2.5%). In conclusion, in a European population, LVBS was characterized by a significant rate of in-hospital events, mainly related to pump failure, and low short-term mortality. The extent of wall motion abnormalities was the best predictor of acute events. Contractile recovery occurred within 1 month in most patients. The long-term prognosis was good, with a recurrence rate of <2%/year.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dote K.
        • Sato H.
        • Tateishi H.
        • Huchida T.
        • Ishihara M.
        Myocardial stunning due to simultaneous multivessel coronary spasm: a review of 5 cases.
        J Cardiol. 1991; 21: 203-214
        • Tsuchihashi K.
        • Ueshima K.
        • Uchida T.
        • Ohmura N.
        • Kimura K.
        • Owa M.
        • Yoshiyama M.
        • Miyazaki S.
        • Haze K.
        • Hogawa H.
        • Honda T.
        • Hase M.
        • Kai R.
        • Morii I.
        For the angina pectoris-myocardial infarction investigations in Japan: Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction.
        J Am Coll Cardiol. 2001; 38: 11-18
        • Kurisu S.
        • Sato H.
        • Kawagoe T.
        • Ishihara M.
        • Shimatani Y.
        • Nishioka K.
        • Kono Y.
        • Umemura T.
        • Nakamura S.
        Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction.
        Am Heart J. 2002; 143: 448-455
        • Desmet W.J.R.
        • Adriaenssens B.F.M.
        • Dens J.A.Y.
        Apical ballooning of the left ventricle: first series in white patients.
        Heart. 2003; 89: 1027-1031
        • Bybee K.T.
        • Prasad A.
        • Barsness G.W.
        • Lerman A.
        • Jaffe A.S.
        • Murphy J.G.
        • Wright R.
        • Rihal C.S.
        Clinical characteristics and thrombolysis in myocardial infarction frame count in women with transient left ventricular apical ballooning syndrome.
        Am J Cardiol. 2004; 94: 343-346
        • Sharkey S.W.
        • Lesser J.R.
        • Zenovich A.G.
        • Maron M.S.
        • Lindberg J.
        • Longe T.F.
        • Maron B.J.
        Acute and reversible cardiomyopathy provoked by stress in women from the United States.
        Circulation. 2005; 111: 472-479
        • Parodi G.
        • Del P.S.
        • Carrabba N.
        • Salvadori C.
        • Mimisha G.
        • Simonetti I.
        • Antoniucci D.
        • Gensini G.F.
        Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome.
        Am J Cardiol. 2007; 99: 182-185
        • Bybee K.
        • Kara T.
        • Prasad A.
        • Lerman A.
        • Barsness G.
        • Wright S.
        • Rihal C.
        Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction.
        Ann Intern Med. 2004; 141: 858-865
        • Kurowski V.
        • Kaiser A.
        • von Hof K.
        • Killermann D.P.
        • Mayer B.
        • Hartmann F.
        • Shunkert H.
        • Radke P.W.
        Apical and midventricular transient left ventricular dysfunction syndrome (Tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.
        Chest. 2007; 132: 809-816
        • Hurst R.T.
        • Askew J.W.
        • Reuss C.S.
        • Lee R.W.
        • Sweeney J.P.
        • Fortuin F.D.
        • Oh J.K.
        • Tajik A.J.
        Transient midventicular ballooning syndrome: a new variant.
        J Am Coll Cardiol. 2006; 48: 579-583
        • Elesber A.A.
        • Prasad A.
        • Lennon R.J.
        • Wright R.S.
        • Lerman A.
        • Rihal C.
        Four-year recurrence rate and prognosis of the apical ballooning syndrome.
        J Am Coll Cardiol. 2007; 50: 448-452
        • Regnante R.A.
        • Zuzek R.W.
        • Weinsier S.B.
        • Latif S.R.
        • Linsky R.A.
        • Ahmed H.N.
        • Sadiq I.
        Clinical characteristics and four-year outcomes of patients in the Rhode Island takotsubo cardiomyopathy registry.
        Am J Cardiol. 2009; 103: 1015-1019
        • Vidi V.
        • Rajesh V.
        • Singh P.P.
        • Mukherjee J.T.
        • Lago R.M.
        • Vanesy D.M.
        • Waxman S.
        • Pyne C.T.
        • Piemonte T.C.
        • Gossman D.R.
        • Nesto R.W.
        Clinical characteristics of Tako-tsubo cardiomyopathy.
        Am J Cardiol. 2009; 104: 578-582
        • Sharkey S.W.
        • Windenburg D.C.
        • Lesser J.R.
        • Maron M.S.
        • Hauser R.H.
        • Lesser J.N.
        • Haas T.S.
        • Hodges J.S.
        • Maron B.J.
        Natural history and expanded clinical profile of stress (Tako-tsubo) cardiomyopathy.
        J Am Coll Cardiol. 2010; 55: 333-341
        • Prasad A.
        Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction.
        Circulation. 2007; 115: e56-e59
        • Schiller N.B.
        • Shah P.M.
        • Crawford M.
        • DeMaria A.
        • Devereux R.
        • Feigenbaum H.
        • Gutgesell H.
        • Reichek N.
        • Sahn D.
        • Schnittiger I.
        • American Society of Echocardiography Committee on Standards, subcommittee on quantification of two-dimensional echocardiogram
        Recommendations for quantification of the left ventricle by two-dimensional echocardiography.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Parodi G.
        • Del Pace S.
        • Salvadori G.
        • Carrabba N.
        • Olivotto I.
        • Gensini G.F.
        • Tuscany Registry of Takotsubo Cardiomyopathy
        Left ventricular apical ballooning syndrome as a novel cause of acute mitral regurgitation.
        J Am Coll Cardiol. 2007; 50: 647-649
        • Gianni M.
        • Dentali F.
        • Grandi A.M.
        • Sumner G.
        • Hiralal R.
        • Lonn E.
        Apical ballooning syndrome or Tako-tsubo cardiomyopathy: a systematic review.
        Eur Heart J. 2006; 27: 1523-1529
        • Mori H.
        • Ishikawa S.
        • Kojima S.
        • Hayashi J.
        • Watanabe Y.
        • Hoffmann J.I.
        • Okino H.
        Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli.
        Cardiovasc Res. 1993; 27: 192-198
        • Wittstein I.S.
        • Thiemann D.R.
        • Lima J.A.C.
        • Baughman K.L.
        • Schulman S.P.
        • Gerstenblith G.
        • Wu K.C.
        • Rade J.J.
        • Bivalacqua Jr, T.
        • Champion H.C.
        Neurohumoral features of myocardial stunning due to sudden emotional stress.
        N Engl J Med. 2005; 352: 539-548