[Transient left ventricular apical ballooning or tako-tsubo syndrome: 14 cases]

Tako-tsubo syndrome is a new diagnostic entity, still little known. Also called transient left ventricular apical ballooning, stress cardiomyopathy, and neurogenic myocardial stunning, it mimics myocardial infarction, combining chest pain with electrocardiographic changes and a moderate rise in the serum markers of necrosis. Angiography of the coronary artery is normal while that of the left ventricle shows ballooning and basal hyperkinesis. This disorder appears to concern 1 to 2% of patients admitted for suspected myocardial infarction. The aim of our study was to describe the characteristics of this syndrome on the basis of our clinical experience and to analyze the current physiopathological explanations.

Between September 2004 and May 2007, 14 patients in our department were diagnosed with tako-tsubo syndrome. The criteria on which this diagnosis was based were electrocardiographic changes, anomalies of left ventricular kinetics, and absence of stenosis greater than 50% in the coronary arteries.

Nearly all cases occurred in women (13/14), whose mean age was 70.4+/-4.3 years. Eleven patients reported chest pain at admission and 4 had signs of heart failure. The ECG was pathological in all cases. Serum markers routinely showed elevated troponin Ic, with a peak at 2.9+/-1.5 ng/mL. Most patients had coronary angiography, which showed the absence of significant coronary artery disease together with the abnormal left ventricular contractility typical of this diagnosis. An emotional or physical trigger was identified in 11 cases. The clinical course was simple, with neither severe complications nor recurrence; contractile kinetics returned to normal in the month following the onset of symptoms.

Tako-tsubo syndrome has a favorable prognosis in the intermediate and long term, although severe complications may occur. The etiology of this syndrome is unknown, but it must be considered as a differential diagnosis of acute coronary syndrome in elderly women with normal coronary angiography.