24 hour ST segment analysis in transient left ventricular apical ballooning
Frank Bode1, Christof Burgdorf, Heribert Schunkert
1Medical Department II, University of Luebeck, Luebeck, Germany. frank.bode@uk-sh.de
Plos One
|March 19, 2013
Summary
Long-term ST segment analysis in patients with transient left ventricular apical ballooning revealed minimal ischemic events, suggesting coronary vasospasm is unlikely to be a primary cause of this cardiac syndrome.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Clinical Medicine
Background:
- Transient left ventricular apical ballooning (TLVAB) is a novel cardiac syndrome with an unclear etiology.
- Coronary vasospasm is a proposed pathomechanism for TLVAB.
- Long-term ST segment analysis has not been previously reported for detecting vasospastic episodes in TLVAB.
Purpose of the Study:
- To investigate the role of coronary vasospasm in TLVAB using long-term ST segment analysis.
- To determine the frequency and characteristics of ischemic events in TLVAB patients.
Main Methods:
- 30 patients with TLVAB and normal coronary arteries underwent 24-hour Holter ECG monitoring.
- Automated and visual ST segment analysis was performed to identify ischemic events.
- Criteria for ischemic events included ST elevation or significant ST depression (≥1 min duration, ≥100 µV deviation).
Main Results:
- Admission ECGs showed ST elevation (19 patients) and/or T wave inversion (20 patients).
- No transient ST elevations were detected during Holter monitoring.
- Minor ST depression episodes (≤1 min duration) were recorded in only 3 patients (10%), indicating limited ischemic burden.
Conclusions:
- 24-hour Holter ECG ST segment analysis revealed minor ischemic events in only 10% of TLVAB patients.
- ST segment changes were not indicative of recurrent coronary spasm playing a significant role in TLVAB.
- The findings suggest coronary vasospasm is unlikely to be the primary driver of TLVAB.
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