Original ArticleClinical Characteristics and Outcome of Apical Ballooning Syndrome in Auckland, New Zealand
Introduction
Apical ballooning syndrome (ABS) (also known as Tako-tsubo cardiomyopathy or stress-induced transient left ventricular dysfunction) is an increasingly recognised subset of the broader group of acute coronary syndromes (ACS) characterised by acute but rapidly reversible left ventricular (LV) dysfunction in the absence of obstructive coronary disease. Prevalence of ABS is reported to be 1–2.5% in patients presenting with acute coronary syndrome (ACS) and 12% of women presenting with anterior ST-elevation myocardial infarction (STEMI) [1], [2]. The condition tends to occur in postmenopausal women after a stressful event. The aetiology of ABS is currently poorly understood and likely to be complex but the association with stress and catecholamine surge has lead many investigators to suspect that this is primarily a neurohormonal phenomenon mediated via coronary vasomotion or directly affecting the LV myocardium [3], [4]. Although initially described in Japan, it has subsequently been reported in many countries around the world [5], [6], [7], [8].
This study describes the clinical presentation and outcome of patients with ABS in a large New Zealand cohort. We also explored whether any characteristics at admission (e.g. the presence of a precipitating stressor or ST elevation) identified a heterogeneous subgroups of patients with a more complicated in-hospital course.
Section snippets
Method
The study population was prospectively identified from the three major public hospitals in the Auckland region (Middlemore Hospital, Auckland City Hospital and North Shore Hospital) between March 2004 and July 2010. The cohort comprised 100 consecutive patients who fulfilled the diagnostic criteria of ABS proposed by the Mayo Clinic group [9]: (1) transient hypokinesis, akinesis, or dyskinesis in the left ventricular mid segments with or without apical involvement; regional wall motion
Results
One hundred consecutive patients with ABS (95 females, 5 males) were included in the study. The clinical characteristics of all patients are presented in Table 1. The mean age at presentation was 65 ± 11 years (median 66) and 95% were women. Seventy-five patients were European. Thirty-five patients had hypertension and 17 patients were on β-blockers before admission.
Discussion
To our knowledge, this cohort is the largest series of ABS patients published to date in Australasia and one of the largest internationally. Ninety-five percent of the cohort were women over 60 years of age, similar to that reported for Japanese [5], [11], [12], North American [13], [14], [15], [16], and European cohorts [17]. The distribution of patients by ethnicity was representative of the Auckland population without a predominance of a particular ethnic group.
Presentation was preceded by a
Conclusion
This prospective study represents the largest ABS cohort published to date in Australasia and also one of the largest internationally. Our clinical and echocardiographic findings support previously published series. Recurrence is infrequent and the long-term prognosis is good. Although the pathogenesis remains unclear, the similar age and gender distribution range of myocardial damage, LV recovery and prognosis, in those with and without ST elevation at admission, and with and without
Competing Interests
None.
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