Apical ballooning syndrome or aborted acute myocardial infarction? Insights from cardiovascular magnetic resonance imaging

  • Imran S. Syed
  • Abhiram Prasad
  • Jae K. Oh
  • Matthew W. Martinez
  • DaLi Feng
  • Arashk Motiei
  • James D. Glockner
  • Jerome F. Breen
  • Paul R. Julsrud
Original Paper

DOI: 10.1007/s10554-008-9320-6

Cite this article as:
Syed, I.S., Prasad, A., Oh, J.K. et al. Int J Cardiovasc Imaging (2008) 24: 875. doi:10.1007/s10554-008-9320-6

Abstract

Introduction Apical Ballooning Syndrome (ABS) is a novel acute cardiac syndrome that mimics acute myocardial infarction (AMI). This study evaluates the diagnostic utility of cardiac magnetic resonance imaging (CMR) in patients with suspected ABS. Methods and Materials Contrast-enhanced CMR was performed in 13 consecutive patients with suspected ABS on the basis of their initial clinical presentation and cardiac catheterization results. Results Ten patients (all female, mean age 71 ± 8 years) had an eventual diagnosis of ABS. CMR demonstrated left ventricle regional wall motion abnormalities (RWMA) involving the apex and mid-ventricle. Six also had right ventricular apical akinesis. There was no myocardial delayed enhancement (MDE) in these patients. The remaining three patients had initial features suggestive of ABS but were eventually determined to have AMI. Left ventriculography showed typical apical ballooning that was not explained by coronary angiography results. Two had MDE and persistent RWMA consistent with anterior AMI. One had RWMA on CMR consistent with a single vascular territory, and subsequent intravascular ultrasound showed obstructive plaque in the left anterior descending (LAD) artery. The final diagnosis in these patients was AMI with clot lysis prior to coronary angiography. Conclusion While ABS mimics AMI, AMI with spontaneous clot lysis may also mimic ABS, and at least in some patients, be mistaken for ABS. ABS is characterized by the absence of MDE and complete myocardial viability on CMR. The diagnosis of ABS can be excluded if CMR demonstrates MDE consistent with myocardial necrosis in a pattern and distribution consistent with AMI.

Keywords

CardiomyopathyStressMagnetic resonance imaging

Abbreviations

ABS

Apical ballooning syndrome

ACS

Acute coronary syndrome

AHA

American Heart Association

AMI

Acute myocardial infarction

IVUS

Intravascular ultrasound

LVEDP

Left ventricular end-diastolic pressure

MDE

Myocardial delayed enhancement

RWMA

Regional wall motion abnormalities

SBP

Systolic blood pressure

SSFP

Steady state free precession

TI

Inversion time

Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Imran S. Syed
    • 1
  • Abhiram Prasad
    • 1
  • Jae K. Oh
    • 1
  • Matthew W. Martinez
    • 1
  • DaLi Feng
    • 1
  • Arashk Motiei
    • 1
  • James D. Glockner
    • 2
  • Jerome F. Breen
    • 2
  • Paul R. Julsrud
    • 2
  1. 1.Division of Cardiovascular DiseasesMayo ClinicRochesterUSA
  2. 2.Division of RadiologyMayo ClinicRochesterUSA