Coronary artery disease
Incidence, Clinical Findings, and Outcome of Women With Left Ventricular Apical Ballooning Syndrome

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Left ventricular apical ballooning syndrome (LVABS) is a clinical condition that may mimic ST-elevation acute myocardial infarction (AMI). To assess incidence, clinical findings, and outcome of white women with LVABS, we reviewed 305 consecutive women with chest pain and anterior ST-elevation AMI referred for potential mechanical revascularization; 36 (12%) patients met the diagnostic criteria for LVABS and were compared with the remaining 269 women with angiographic evidence of coronary artery disease (CAD). Patients with LVABS showed a lower incidence of diabetes mellitus (5% vs 21%, p = 0.023), a higher rate of antecedent stressful events (26% vs 3%, p <0.0001), and a higher heart rate at admission (91 ± 20 vs 82 ± 19, p = 0.018) than women with CAD. Urgent angiography showed no significant CAD in patients with LVABS and an average of 1.6 ± 0.7 diseased coronary arteries (>50% stenosis) in the 269 control women (p = 0.0001). Peak creatine kinase-MB value was lower in patients with LVABS (21 ± 26 mU/ml) than in women with CAD (307 ± 302 mU/ml, p = 0.0001). The only independent predictors of LVABS among women with anterior AMI were peak creatine kinase-MB value (p = 0.0001) and the presence of an antecedent stressful event (p = 0.001). LV systolic function at admission was similar between women with LVABS and those with CAD (echocardiographic ejection fraction 35.6 ± 8.4% vs 35.5 ± 8.0%, p = 0.944) but was significantly different at discharge (ejection fraction 50.1 ± 9.6% vs 45.2 ± 13.5%, p = 0.021). Moreover, at 6-month follow-up, women with LVABS showed a better survival rate (97% vs 86%, p = 0.055) and freedom from major cardiac events (death, reinfarction, or rehospitalization 92% vs 69%, p = 0.001) than women with CAD. In conclusion, few women presenting with clinical features of anterior AMI have LVABS. Despite a favorable outcome, LVABS should be considered in the differential diagnosis of women with chest pain and ST-segment elevation in the precordial leads. Peak creatine kinase-MB value and the presence of an antecedent stressful event are strong predictors of LVABS in women with anterior AMI.

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Methods and Results

The present study was conducted from July 2003 to December 2005. Criteria for enrollment included (1) admission to the Florence University department of cardiology (Florence, Italy) for chest pain persisting >30 minutes associated with ST-segment elevation of ≥0.1 mV in ≥2 contiguous electrocardiographic leads; (2) admission within 24 hours of symptom onset; and (3) patient consent to undergo urgent coronary angiography. Patients with CAD underwent appropriate mechanical reperfusion, as

Discussion

LVABS was initially described in Japan; subsequently, it has been recognized in the United States3 and Europe.7, 8 Although reports in the medical literature have been increasing, attention to transient LVABS has increased all over the world. The present report deals with 1 of the largest population of white women with LVABS ever reported. Clinical features of the population were quite similar to those of women presenting with ST-elevation AMI due to CAD. However, the prevalence of diabetes was

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