Concurrence of angiographic coronary artery disease in patients with apical ballooning syndrome (tako-tsubo cardiomyopathy).

OBJECTIVE

To determine the coexistence of coronary artery disease (CAD) in an unselected cohort of patients with apical ballooning syndrome (ABS).

BACKGROUND

ABS is a clinical condition of unknown etiology with symptoms that mimic an acute coronary syndrome and is characterized by the presence of transient left ventricular dysfunction primarily affecting the apex of the heart.

METHODS

We conducted a retrospective case series in a single tertiary care hospital. Patients were identified by searching for several inclusive discharge diagnoses in all hospitalized patients. Suspected cases were analyzed using prespecified diagnostic criteria. Demographic, clinical, and imaging data were collected. Coronary lesions were assessed by quantitative angiography.

RESULTS

Thirty-one cases of ABS were identified. The majority of the cases were female, and ischemia was documented in all patients by electrocardiographic or cardiac biomarker criteria. Nineteen patients (61.3%) had angiographic evidence of CAD, with multivessel involvement in seven (23%). Nine patients (29%) had luminal stenosis severity greater than 50% in at least one epicardial vessel.

CONCLUSIONS

In an unselected cohort of patients with ABS, coronary atherosclerosis is commonly present. Whether CAD simply coexists or is related to the pathophysiology of ABS is unclear.