Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy)

Haghi, Dariusch; Fluechter, Stephan; Süselbeck, Tim; Kaden, Jens J.; Borggrefe, Martin; Papavassiliu, Theano

doi:10.1016/j.ijcard.2006.09.019

Cited by 106 publications

(93 citation statements)

References 22 publications

(41 reference statements)

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“…Transmurality of STEMI is much greater than that of ABS. Previous cardiac magnetic resonance imaging studies 14,15 have shown that STEMI is manifested as a milder increase in myocardial biomarkers in ABS. However, the extent of wall motion abnormalities is larger in patients with ABS than in those with STEMI because visually appreciable myocardial contraction ceases with less myocardial damage than transmural damage or ischemia.…”

Section: Discussionmentioning

confidence: 95%

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Park

Prasad

Rihal

et al. 2009

Mayo Clinic Proceedings

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OBJECTIVE:To compare left ventricular (LV) systolic and diastolic function in patients with apical ballooning syndrome (ABS) and those with acute myocardial infarction (AMI) using 2-dimensional Doppler echocardiography and strain rate imaging (SRI). PATIENTS AND METHODS:We prospectively enrolled patients with newly diagnosed AMI and ABS who had akinetic apical walls. Both 2-dimensional Doppler echocardiography and SRI were performed on hospital day 1 or within 24 hours of primary percutaneous coronary intervention. RESULTS:Twenty-four patients with AMI and 13 patients with ABS (mean ± SD age, 63±15 vs 73±12 years; P=.03) were prospectively enrolled in the study from October 3, 2005 through July 12, 2006.The mean ± SD LV end-diastolic volume was larger (58.1±9.1 vs 45.2±10.6 mL/m 2 ; P<.001) and the mean ± SD LV ejection fraction was lower (35%±6% vs 43%±9%; P=.006) in patients with ABS compared with patients with AMI. The early diastolic mitral annular velocity was similar (0.06±0.02 vs 0.06±0.02 m/s; P=.85) in both groups, but the ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was higher in patients with AMI than in patients with ABS (16.3±6.9 vs 12.2±3.2; P=.05). The systolic strain rate was decreased at the apex in both groups (P=.98). Both the early diastolic strain rate of the apex (0.64±0.24 vs 0.48±0.30 s -1 ; P=.04) and the postsystolic shortening index of the apex (61%±15% vs 45%±23%; P=.006) were higher in the patients with ABS than in those with AMI. However, early diastolic SR was higher in the akinetic apical walls of patients with AMI with recovery than those with no recovery (0.64±0.35 vs 0.43±0.25 s -1 ; P=.04) and was similar between akinetic apical walls of patients with AMI with recovery and the akinetic apical walls of ABS.CONCLUSION: Compared with patients with AMI, those with ABS showed the functional paradox of worse initial LV systolic function with larger LV size but better LV diastolic function. The early systolic strain rate and postsystolic shortening were greater in patients with ABS than in those with AMI; hence, these measurements can be helpful in distinguishing ABS from AMI and in detecting myocardial viability.Mayo Clin Proc. 2009;84(6):514-521 ABS = apical ballooning syndrome; AMI = acute myocardial infarction; CAG = coronary angiography; E = early diastolic mitral valve inflow velocity; Ea = early diastolic mitral annulus velocity; E/Ea = ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity; ECG = electrocardiography; LV = left ventricular; LVEF = LV ejection fraction; PCI = percutaneous coronary intervention; SR = strain rate; SRI = SR imaging; STEMI = ST-segment elevation myocardial infarction; WMSI = wall motion score index © 2009 Mayo Foundation for Medical Education and ResearchT he clinical presentation of apical ballooning syndrome (ABS) mimics that of acute myocardial infarction (AMI). Both conditions are characterized by acute onset of chest pain, electrocardiographic (ECG) ...

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Section: Discussionmentioning

confidence: 95%

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Park

Prasad

Rihal

et al. 2009

Mayo Clinic Proceedings

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“…Other suggested names are 'transient ventricular ballooning syndrome,' 'left ventricular apical ballooning,' 'stress-induced cardiomyopathy,' 'ampulla cardiomyopathy,' and 'broken heart syndrome.' Recently a new atypical form of takotsubo has been described (8). This variant consists of a hypokinesia of the base or middle netic, a larger drop in ventricle output can be expected and the atrium will suffer from a heavier afterload.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy or apical ballooning: a case report and a short literature study

Beule¹,

Ardies²,

Booij³

et al. 2011

Journal of the Belgian Society of Radiology

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“…3 a Four-chamber view showing mid-apical oedema in T2-weighted sequences and b no evidence of significant late gadolinium enhancement in T1-weighted inversion recovery post-contrast sequences usually documented in cases of MI or myocarditis [21]. Whilst initially it was believed that lack of LGE was a necessary condition to diagnose TCM and would thus help differentiate it from MI, in the study by Haghi et al [22], 88 % of patients showed a patchy type of LGE. In view of these findings, Rolf et al [23] performed multiple endomyocardial biopsies in sites with and without LGE showing a significantly higher extracellular matrix containing collagen-1 in LGE areas.…”

Section: Cmr Findings In Tcmmentioning

confidence: 99%

TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance

2015

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TakoTsubo cardiomyopathy (TCM) is a unique type of reversible cardiomyopathy that is precipitated by a stressful emotional or physical event. The increasing incidence is due to the greater use of emergency coronary angiography, newer cardiac biomarkers together with more sensitive cardiac imaging techniques. Few case reports have documented how TCM can present with malignant arrhythmias such as torsades de pointes caused by the repolarisation abnormalities or QTc prolongation. Although TCM is usually considered a benign reversible condition, its associated arrhythmic risk is increasingly recognised. TCM often presents as an acute coronary syndrome with unobstructed coronary arteries at angiography. In this patient population, cardiac magnetic resonance (CMR) is a useful tool to establish a differential diagnosis, discriminating TCM from acute myocarditis and myocardial infarction with spontaneous recanalisation. CMR is becoming a promising new diagnostic modality in risk stratifying patients with potential higher arrhythmic risk.

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Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy)

Cited by 106 publications

References 22 publications

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Takotsubo cardiomyopathy or apical ballooning: a case report and a short literature study

TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance

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