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

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 LVobstruction
can contribute to the development of LVABS in a minority of patients.