Left ventricular apical ballooning syndrome: Prevalence, clinical characteristics and pathogenetic mechanisms in a European population Mario Previtali ⁎ , Alessandra Repetto, Stefania Panigada, Rita Camporotondo, Luigi Tavazzi Department of Cardiology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy Received 16 May 2007; received in revised form 27 December 2007; accepted 20 January 2008 Available online 27 May 2008 Abstract 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. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Apical ballooning syndrome; Tako-tsubo cardiomyopathy; Dobutamine echocardiography; Ergonovine echocardiography 1. Introduction Left ventricular apical ballooning syndrome (LVABS) is an acute cardiac syndrome characterized by reversible balloon-like apical wall motion abnormalities associated with chest pain, ST-T segment changes similar to acute myocardial infarction and myocardial enzyme increase in the absence of significant coronary artery disease [1–3]. LVABS was first described in Japan as Tako-tsubo cardiomyopathy [1–6] and more recently has also been reported in western populations [7–11]. The aetiology of the syndrome is as yet unclear and many pathophysiological mechanisms including stress-induced increase in sympathetic activity, coronary artery spasm, coronary microvascular dysfunction, dynamic intraventricular obstruction and acute myocarditis, have been hypothesized. The purpose of this study was to assess the prevalence of LVABS in a population of 1457 patients with acute myocardial infarction consecutively studied over a 4-year period and to investigate its pathophysiological mechanisms by provocative testing with ergonovine and dobutamine and evaluation of coronary microvascular function. International Journal of Cardiology 134 (2009) 91 – 96 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Department of Cardiology, IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100 Pavia (PV), Italy. Tel.: +39 382503934; fax: +39 382503161. E-mail address: marprevi@hotmail.com (M. Previtali). 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.01.037