Abstract 3463: Incidence, Clinical Findings and Outcome of White Women with Left Ventricular Apical Ballooning Syndrome
Background: Left ventricular apical ballooning syndrome (LVABS) is a clinical condition, that may mimic ST-elevation acute myocardial infarction. Objective: To assess the incidence, clinical findings and outcome of white women with LVABS.
Methods and Results: Out of 305 consecutive women with chest pain and anterior ST-elevation acute myocardial infarction, 36 (12%) patients meet the diagnostic criteria (Mayo Clinic) for LVABS and were compared with the remaining 269 women with angiographic evidence of epicardial coronary artery disease (ECAD). Patients with LVABS showed a lower incidence of diabetes (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 (90.5±19.6 vs 82±18.8; p=0.018) than women with ECAD. Urgent angiography showed no significant ECAD in patients with LVABS, and an average of 1.6±0.7 diseased coronary arteries (>50% stenosis) in the remaining 269 women (p=0.0001). Peak CK-MB value was smaller in patients with LVABS (21.5±25.7 mU/mL) as compared with women with ECAD (307.2±301.7 mU/mL; p=0.0001). The only independent predictor of LVABS among women with anterior AMI was a peak CK-mb value lower than 50 U/L (p=0.0001). Left ventricular systolic function at admission was similar between women with LVABS and those with ECAD (2D-echo ejection fraction, EF: 35.6%±8.4% vs 35.5%±8.0%; p=0.944), while it was significantly different at discharge (EF: 50.1%±9.6% vs 45.2%±13.5%; p=0.021). Moreover, at six-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, rehospitalization; 92% vs 69%; p=0.001) than women with ECAD.
Conclusion: A substantial minority of women with anterior acute myocardial infarction have a LVABS. Despite the favourable outcome, LVABS should be considered in the differential diagnosis in women with chest pain and ST-segment elevation in the precordial leads. Peak CK-mb value is a strong predictor of a LVABS in women with an anterior AMI.