• Iván Javier Núñez-Gil, Antonio Fernández-Ortiz, Leopoldo Pérez-Isla, María Luaces, Juan Carlos García-Rubira, David Vivas, Juan J Gonzalez, Joaquín Alonso, José Luis Zamorano, and Carlos Macaya.
• Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain, Europe. ibnsky@yahoo.es
• Coron. Artery Dis. 2008 Nov 1;19(7):449-53.

ObjectivesApical ballooning shares features with acute coronary syndromes. Recently, atypical forms have been reported without apical involvement. Usually, the prognostic reports have compared them with ST-segment elevation infarction. Left ventricular transient dyskinesias (LVTD), however, frequently occur without ST-segment elevation and when present, these patients always have open arteries. Our aim was to assess the baseline features, clinical presentation, natural history and compare long-term prognosis in an LVTD-cohort with a first non-ST-segment elevation acute coronary syndrome (NSTEMI) group.MethodsWe performed a prospective observational study including consecutive patients in two groups: (i) LVTD group: 62 patients with this syndrome between 2003 and 2007. Inclusion criteria were LV segmental transient motion abnormalities; ECG new alterations and elevated troponin; absence of recent significant head trauma or obstructive coronary artery lesions. (ii)Control Group169 patients admitted for a first NSTEMI in 2004.ResultsMedian follow-up was 35 months. Mean age was 65 years. LVTD group included 83.9% females. NSTEMI group was predominantly males. Eleven in-hospital deaths happened in NSTEMI cohort and none in LVTD. Four patients in the LVTD group required readmission and two patients died. In the NSTEMI group, heart failure, unstable angina, myocardial infarction (P<0.001) and death (P=0.11) were more frequent. Cox regression showed that diabetes mellitus, significant onset mitral regurgitation and NSTEMI versus LVTD were found as event-independent predictors.ConclusionLVTD diagnosis represents a decreased risk of events when compared with classic non-ST-segment acute coronary syndrome, pointing out a different pathophysiologic mechanism.

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