Tako-tsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma?

A new cardiac syndrome exhibiting transient left ventricular (LV) apical ballooning has been widely described in Japan. Conversely, there are few series outside Japan. 2 This syndrome usually affects elderly women, frequently preceded by emotional/physical stress. 2 These patients present with chest pain, ECG abnormalities, and minimal enzymatic release, mimicking an anterior wall acute coronary syndrome (ACS). LV contractility recovers in several days. Today, the aetiology remains unknown. Systematically, coronary artery disease (CAD) has been ruled out because of the wide akinetic area and absence of significant coronary artery stenosis on angiography. Recently we have published that tako-tsubo patients have a well developed left anterior descending (LAD) coronary artery, suggesting that the akinetic area could be supplied by LAD alone. To test the hypothesis that a ruptured coronary plaque could be the underlying aetiology of this syndrome we prospectively performed intravascular ultrasound (IVUS) examination in five consecutive tako-tsubo patients.