Left anterior descending artery length and coronary atherosclerosis in apical ballooning syndrome (Takotsubo/stress induced cardiomyopathy)

Abstract

A proposed etiology of apical ballooning syndrome (ABS) is a spontaneously aborted anterior myocardial infarction (MI) in patients with a long "wrap around" left anterior descending artery (LAD) rather than it being a unique cardiomyopathy. The aim of this study was to evaluate whether patients with ABS have a higher frequency of "wrap around" LAD. A retrospective analysis of the coronary anatomy and presence of coronary artery disease (CAD) by angiography was performed among 97 ABS patients, and compared to a matched control group with anterior ST-elevation MI. LAD length was graded: type 1--does not supply the left ventricular (LV) apex, type 2--the LAD and right coronary both supply the apex, type 3--supplies the entire apex, and type 4--supplies the apex and >25% of the inferior wall (wrap around). ABS patients had lower ejection fractions at presentation (41% ± 14% vs 47% ± 13%, p=0.001). There was no difference in the frequency of the 4 types of LAD between ABS (7%, 11%, 55%, 27%) and controls (3%, 13%, 51%, 33%), p=0.45. In ABS, there was no difference in the mean LV ejection fraction (32.7%, 38.8%, 42.9%, 41.1%, respectively, p=0.39), or wall motion score index at presentation in the 4 LAD groups. The prevalence of angiographic CAD in ABS was 84%. ABS patients do not have a higher frequency of "wrap around" LAD. This fact, together with a greater magnitude of LV dysfunction at presentation, supports that cardiomyopathy is not due to spontaneously aborted anterior MI.