The clinical features of transient left ventricular nonapical ballooning syndrome: Comparison with apical ballooning syndrome

Background: Recently, several cases of atypical left ventricular (LV) ballooning syndrome without involvement of the LV apex have been reported. However, there has been no assessment of the clinical features of this novel presentation or comparison with the typical transient LV apical ballooning syndrome. Methods: We evaluated 47 patients diagnosed with transient LV ballooning syndrome. The diagnostic criteria were (1) transient akinesia/dyskinesia beyond a single major coronary artery vascular distribution, (2) absence of significant coronary artery disease on coronary angiograms, and (3) new electrocardiographic changes. Results: Thirty-one patients showed classic LV apical ballooning, and 16 showed atypical LV ballooning without involvement of the LV apex (nonapical ballooning). Clinical presentations and inhospital courses of illness were mostly similar among patients with nonapical ballooning (group NA) and patients with apical ballooning (group A). However, on admission, there were fewer patients with cardiogenic shock or pulmonary edema in group NA than in group A (19% vs 48%, P = .048). Group NA patients were relatively younger than group A patients (median ages 58 vs 70 years, P = .02), and fewer patients had coronary risk factors in group NA than in group A (38% vs 77%, P = .01). On electrocardiogram, T-wave inversion was noted less frequently in the NA group than in the A group (69% vs 97%, P = .01). Conclusions: Transient LV nonapical ballooning syndrome and classic LV apical ballooning syndrome may be different manifestations of a single syndrome. They appear to have differences in the severity of heart failure, in patient characteristics, and in electrocardiographic change.