Issues in Cardiovascular NursingClinical characteristics, ballooning pattern, and long-term prognosis of transient left ventricular ballooning syndrome
Introduction
Transient left ventricular ballooning syndrome (TLVBS), also known as Takotsubo cardiomyopathy or stress cardiomyopathy, is characterized by an acute onset of left ventricular (LV) dysfunction, accompanied by chest symptoms, electrocardiogram changes, and elevated cardiac markers in the absence of angiographically significant coronary artery stenoses.1, 2, 3, 4 Clinical recovery in this syndrome was reported as excellent in most cases, when appropriate treatment was performed during the acute phase.5, 6, 7, 8 However, there are few data regarding the long-term prognosis of TLVBS. Moreover, it remains unknown whether or not the preceding stress types or the ballooning patterns affect the long-term prognosis. In this study, we report on the long-term prognosis of TLVBS, and investigate the predictors of long-term prognosis.
Section snippets
Study patients
From January 1997 to October 2007, 6241 consecutive patients with a diagnosis of an acute coronary syndrome, including ST-elevation and non-ST-elevation myocardial infarction, underwent cardiac catheterization at a tertiary-care center (a hospital with 1951 sickbeds, with approximately 6500 staff members, including over 1200 doctors and 2000 nurses). Of 6241 patients, 87 (1.4%) were diagnosed with TLVBS. The criteria for inclusion involved: 1) transient akinesia/dyskinesia beyond a single major
Clinical characteristics of nonsurvivors
The clinical characteristics of nonsurvivors are summarized in Table I. The median follow-up was 42 months (interquartile range, 19 to 72 months). The overall long-term mortality was 23% (20 patients). Noncardiac mortality comprised 21% (18 patients), and cardiac mortality comprised 2% (2 patients). In terms of long-term mortality, 8 patients died of malignancy, 4 of stroke, 3 of pneumonia, and 3 of sepsis. Two patients were thought to have died from sudden cardiac attacks. The overall
Discussion
The clinical outcomes of patients with TLVBS are be generally favorable.10, 11, 12, 13 However, a limited amount of literature exists regarding the long-term prognosis of TLVBS.14, 15, 16
To the best of our knowledge, ours is one of the largest studies investigating the prognosis of TLVBS in detail in the most long-term period.17, 18 In our study, the overall long-term mortality was substantial, but cardiac mortality was low. Underlying noncardiac diseases were the only independent predictors of
Conclusions
In this study, we investigated the long-term prognosis of TLVBS. The in-hospital mortality as well as long-term cardiac mortality of TLVBS seemed to be low. The most common causes of deaths were associated with underlying noncardiac diseases, and not with TLVBS itself.
References (27)
- et al.
Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan
J Am Coll Cardiol
(2001) - et al.
Assessment of clinical features in transient left ventricular apical ballooning
J Am Coll Cardiol
(2003) - et al.
Tako-Tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction
Am Heart J
(2002) - et al.
Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review
Int J Cardiol
(2008) - et al.
Takotsubo cardiomyopathy
Heart Lung
(2008) - et al.
Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction
Am Heart J
(2008) - et al.
Review: transient left ventricular apical ballooning, broken heart syndrome, ampulla cardiomyopathy, atypical apical ballooning, or Tako-Tsubo cardiomyopathy
Cardiovasc Revasc Med
(2007) - et al.
Stress induced cardiomyopathy: a review
Eur J Intern Med
(2007) - et al.
Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU
Chest
(2005) - et al.
The clinical features of transient left ventricular nonapical ballooning syndrome: comparison with apical ballooning syndrome
Am Heart J
(2007)