Transient left ventricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction

OBJECTIVES To determine the clinical features of a novel heart syndrome wit h transient left ventricular (LV) apical ballooning, but without coronary a rtery stenosis, that mimics acute myocardial infarction, we performed a mul ticenter retrospective enrollment study. BACKGROUND Only several case presentations have been reported with regard t o this syndrome. METHODS We analyzed 88 patients (12 men and 76 women), aged 67 +/- 13 years , who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies. RESULTS Thirty-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had em otional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or ex cessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave f ormation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56 %) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fractio n improved from 41 +/- 11% to 64 +/- 10%. Transient intraventricular pressu re gradient and provocative vasospasm were documented in 13/72 (18%) and 10 /48 (21%) of the patients, respectively. During follow-up for 13 +/- 14 mon ths, two patients showed recurrence, and one died suddenly. CONCLUSIONS A novel cardiomyopathy with transient apical ballooning was rep orted. Emotional or physical stress might play a key role in this cardiomyo pathy, but;he precise etiologic basis still remains unclear. CT Am Cell Car diol 2001;38:11- 8) (C) 2001 by the American College of Cardiology.