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403 TRANSIENT LEFT VENTRICULAR APICAL BALLOONING (TAKOTSUBO DISEASE) AND A UNIQUE PARAMETER FOR CHARACTERIZING LEFT VENTRICULAR SEVERITY.
  1. S. Mendelsohn,
  2. E. Mendelsohn
  1. Mercy Medical Center, Redding, CA; USC Medical School, Los Angeles, CA

Abstract

Background Transient left ventricular apical ballooning (TLVAB) presents with a strikingly abnormal left ventricular pathology: acute, marked apical dilatation and increased basal contractility. Although there are several descriptive case series, to our knowledge the rate of resolution of TLVAB has not been objectively followed (the left ventricular ejection fraction has been noted in some series, but it can misrepresent the degree of injury to the apex as it characterizes overall left ventricular contractility—not the severity of the apical abnormality). We have devised a unique parameter to objectively characterize the degree of injury, and we have followed this parameter in 10 patients.

Methods Ten patients underwent cardiac catheterization and sequential follow-up echocardiograms. All patients presented acutely with cardiac symptoms (predominantly chest pain) and TLVAB pathology. A severity index (SI) was calculated as a ratio of the ballooned segment diameter to the outflow tract diameter in systole. The SI was plotted over time until the patient expired or left ventricular function optimized.

Results Nine patients demonstrated improvement in the SI. In the seven patients undergoing follow-up echocardiography within the first week, the median SI improved from 2.2 (interquartile range [IQR], 2.0-2.5) on admission to 1.5 (IQR, 1.2-1.9). In the seven patients undergoing follow-up echocardiography between weeks 1 and 4, the median SI improved from 2.2 (IQR, 2.2-2.9) on admission to 0.8 (IQR, 0.7-1.1). In summary, we were able to demonstrate that the SI normalized in 7 of the 10 patients by 1 month.

Discussion As compared to the ejection fraction, which can be “pseudo-normalized” by outflow tract hypercontractility, the SI is an intuitive index that correlates well to the visual impression in TLVAB and allows objective, serial follow-up.

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