Long-term outcome and sex distribution across ages of left ventricular apical ballooning syndrome.

OBJECTIVE: Apical ballooning syndrome is a rare clinical entity that predominantly involves elderly women and is considered to be benign. We report our experience regarding this syndrome in terms of sex distribution and long-term outcome.

METHODS: Between 1999 and 2006, we identified 28 consecutive patients affected by the apical ballooning syndrome. Inclusion criteria were an onset of mimicking acute myocardial infarction, transient akinesia/dyskinesia of the mid-apical left ventricular segments and no significant obstructive coronary artery disease. Patients with a recent brain disease, pheocromocytoma, hypertrophic cardiomyopathy and suspected myocarditis were excluded. Sex distribution was assessed across different ages according to quartiles: less than 61 years of age (group 1), 61-71 years (group 2), 72-77 years (group 3) and more than 77 years (group 4). In-hospital and follow-up events were observed.

RESULTS: The apical ballooning syndrome represented 1.69% of ST-segment elevation acute coronary syndromes. There were more women than men in groups 2 (85.7 vs. 14.3%), 3 (85.7 vs. 14.3%) and 4 (100 vs. 0%), but there were fewer women than men in group 1 (42.9 vs. 57.1%), with an overall supremacy of women (78.6 vs. 21.4%) (P=0.02). In-hospital events were one (3.6%) cardiac death and five (17.9%) nonfatal events. At the median follow-up of 24 months, one patient was lost and two (7.7%) died of cardiac causes, thus, the total cardiac mortality was 10.7% (3/28 patients); no recurrence occurred and left ventricular ejection fraction increased from 40.4 to 58.6% (P<0.01).

CONCLUSION: In our population, left ventricular apical ballooning syndrome included several typical features. However, a peculiar sex tendency across various age groups was observed and, although older women predominated, men seemed to be more affected than women at a younger age. The long-term prognosis seems to be favourable.