Clinical InvestigationsCongestive Heart FailureClinical correlates and prognostic significance of electrocardiographic abnormalities in apical ballooning syndrome (Takotsubo/stress-induced cardiomyopathy)
Section snippets
Patients
To identify potential patients with the ABS, we retrospectively searched the Mayo Clinic cardiac catheterization database from January 1988 to October 2006 for inpatients with acute cardiac illness who underwent both coronary and left ventricular angiography. Our initial search was restricted to all patients with coronary artery diameter stenoses <40% and hypokinesis, akinesis or dyskinesis of the mid and/or apical left ventricular segments with sparing of the basal segments. This search
Baseline characteristics
There was no difference in age, sex, and prevalence of conventional risk factors for atherosclerosis, medications on admission, or the presence of a precipitating stressor between the three groups (Table I). The peak troponin level and ejection fraction at presentation were also similar in the 3 groups (Table II). None of the patients had spontaneous coronary spasm, embolism, thrombus, or plaque rupture on the angiogram performed during the acute presentation.
ECG findings
Of the 105 patients identified with
Discussion
The major findings of this study are that (1) ABS may present with or without ST-segment elevation on the ECG, and (2) the clinical and echocardiographic characteristics as well as the outcomes of those with or without ST elevation are similar.
Our findings suggest that approximately one third of patients with ABS present with ST-segment elevation, one third with significant T-wave inversion and the remainder with nonspecific features on the ECG. These conclusions are derived from one of the
Conclusion
Apical ballooning syndrome is an increasingly diagnosed acute cardiomyopathy that can mimic ACS at presentation. The cardiomyopathy should be considered in the differential diagnosis of both ST-segment and non–ST-segment elevation myocardial infarction. By most estimates, approximately 1% to 2% of all patients presenting with an initial primary diagnosis of myocardial infarction have ABS7, 9 Since there are approximately 732,000 hospital discharges with a primary diagnosis of an acute
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