Variant form of the acute apical ballooning syndrome (takotsubo cardiomyopathy): observations on a novel entity

Takotsubo cardiomyopathy (TTC) consists of an acute onset of transient akinesia of the apical and mid portions of the left ventricle, without significant coronary artery stenosis. TTC is often accompanied by chest pain, dynamic reversible ST-T segment abnormalities, and increased cardiac enzymes disproportionate to the extent of akinesia.1 Until now, it was believed that wall motion abnormalities (WMA) in this syndrome invariably affect the left ventricular (LV) apex. However, we present a syndrome mimicking classic TTC without involvement of the LV apex. We retrospectively evaluated consecutive patients admitted with an acute coronary syndrome between January 2004 and December 2004. Patients who met the following criteria were selected: firstly, reversible akinesia/dyskinesia beyond a single major coronary artery vascular distribution on left ventriculography sparing the LV apex; secondly, no coronary artery diameter stenosis > 50% on angiography; thirdly, increased cardiac enzymes; and lastly, available results of a gadolinium enhanced cardiovascular magnetic resonance (CMR) scan. Laboratory tests, serial ECGs, and echocardiography were performed according to standard protocol for management of acute coronary syndromes at our …