24 hour ST segment analysis in transient left ventricular apical ballooning.

PloS one

PubMedID: 23505493

Bode F, Burgdorf C, Schunkert H, Kurowski V. 24 hour ST segment analysis in transient left ventricular apical ballooning. PLoS ONE. 2013;8(3):e58349.
OBJECTIVE
The etiologic basis of transient left ventricular apical ballooning, a novel cardiac syndrome, is not clear. Among the proposed pathomechanisms is coronary vasospasm. Long-term ST segment analysis may detect vasospastic episodes but has not been reported.

METHODS
30 consecutive patients with transient left ventricular apical ballooning, left ventricular dysfunction and normal or near-normal coronary arteries were investigated. A 24-hour Holter ECG was obtained after emergency admission. ST segment analysis was performed automatically in 2 leads and confirmed by visual inspection. Criteria for an ischemic event were: 1. ST elevation or 2. horizontal or down-sloping ST segments =1 min duration and =100 µV J+80 point deviation corrected for baseline ST-deviation.

RESULTS
Patients presented with ST segment elevation (n?=?19) and/or T wave inversion (n?=?20) on admission ECG. Ejection fraction was 50±12%. No transient ST elevations were observed during Holter ECG analysis. In 3 patients, 8 transient episodes of ST depression were recorded. Durations of episodes varied between 75 s and 790 s (mean 229 s). Maximal ST deviation averaged -191±71 µV. Ischemic burden was -1 to -22 mVs (mean -8 mVs). 27 patients showed no ischemic events.

CONCLUSIONS
ST segment analysis of 24 h Holter recordings revealed minor ischemic events in only 10% of patients with transient left ventricular apical ballooning. Overall, ST segment changes were not indicative of recurrent coronary spasm playing a major role in the genesis of transient left ventricular apical ballooning.