CardiomyopathyAre Some False-Positive Stress Echocardiograms a Forme Fruste Variety of Apical Ballooning Syndrome?
Section snippets
Methods
As previously described,10, 11 we prospectively identified all consecutive patients with (1) normal left ventricular systolic function at rest (no regional wall motion abnormalities at rest), (2) a markedly abnormal left ventricular response to stress, and (3) normal coronary arteries on an angiogram obtained within 30 days of the stress test from November 2003 to December 2006. A markedly abnormal left ventricular response to stress was defined as the presence of new regional wall motion
Results
During the 38 months of the study, 1,645 consecutive patients underwent stress echocardiography followed by coronary angiography within 30 days. Of these, 141 patients developed new regional wall motion abnormalities with stress and had angiographically normal coronary arteries. Eighty-seven patients were excluded because they had a decrease in left ventricular end-systolic size in response to stress and another 23 were excluded because they had regional wall motion abnormalities at rest.
Discussion
The major findings of this study were that markedly abnormal SEs in patients with normal left ventricular systolic function at rest and normal epicardial coronary arteries occurred predominantly (1) in postmenopausal women, (2) during exercise echocardiography, (3) in the absence of a hypertensive response, and (4) with more frequent involvement of the midventricular and apical segments compared with the basal segments of the left ventricle.
In the present study, only patients who had normal
References (17)
- et al.
Exercise-induced ST segment depression in the diagnosis of multivessel coronary disease: a meta analysis
J Am Coll Cardiol
(1989) - et al.
Transient left ventricular apical ballooning during dobutamine myocardial perfusion imaging
Int J Cardiol
(2008) - et al.
Takotsubo cardiomyopathy induced by treadmill exercise testing: an insight into the pathophysiology of transient left ventricular apical (or midventricular) ballooning in the absence of obstructive coronary artery disease
J Am Coll Cardiol
(2007) - et al.
Tako-Tsubo syndrome after an exercise echocardiography
Int J Cardiol
(2008) - et al.
Reversible late gadolinium enhancement in a case of Takotsubo cardiomyopathy following high-dose dobutamine stress MRI
Int J Cardiol
(2008) - et al.
Prognostic value of exercise echocardiography in 2,632 patients > or = 65 years of age
J Am Coll Cardiol
(2001) - et al.
Use of a scoring model combining clinical, exercise test, and echocardiographic data to predict mortality in patients with known or suspected coronary artery disease
Am J Cardiol
(2004) - et al.
Outcome after normal exercise echocardiography and predictors of subsequent cardiac events: follow-up of 1,325 patients
J Am Coll Cardiol
(1998)
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