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Regional wall motion abnormality in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): importance of biplane left ventriculography for differentiating from spontaneously aborted anterior myocardial infarction

  • Sandeep M. Patel
  • Ryan J. Lennon
  • Abhiram PrasadEmail author
Original Paper

Abstract

Understanding the precise distribution of the regional wall motion abnormality (RWMA) in apical ballooning syndrome (ABS) is important because the cardiomyopathy can mimic an acute anterior ST-elevation myocardial infarction (STEMI). The aim of the study was to quantify the severity and distribution of RWMA in ABS, compare it to anterior STEMI, and correlate with clinical features. RWMA (normal = 1, hypokinetic = 2, akinetic = 3) was quantified from the biplane left ventriculogram using a nine-segment model in 95 ABS and 17 anterior STEMI patients at the time of their presentation. Regional wall motion score index (RWMSI) was higher in ABS [2.1 (1.9, 2.1)] compared to anterior STEMI [2.0 (1.8, 2.0)], P = 0.024]. The region that most clearly differentiated ABS from anterior STEMI was the posterolateral segment (sensitivity 81% and specificity 100%) which was hypocontractile in 81% of ABS, but none of the STEMI patients (P < 0.001). RWMSI in ABS had a modest positive correlation with the troponin T levels (r = 0.23, P = 0.029). Patients with ABS with ST-segment elevation had the highest RWMSI [2.1(2.0, 2.2)], while those with non specific changes had the lowest [1.9 (1.8, 2.1)] (P = 0.007). In conclusion, patients with ABS have greater and more diffuse RWMA compared to anterior STEMI. The presence of systolic dysfunction in the posterolateral segment in the left anterior oblique projection of the left ventriculogram most accurately distinguishes ABS from an anterior STEMI highlighting the utility of biplane angiography for this purpose. The severity of RWMA correlates with the extent of troponin release and ECG abnormality.

Keywords

Apical ballooning syndrome Takotsubo cardiomyopathy Regional wall motion abnormality 

Abbreviations

ABS

Apical ballooning syndrome

ECG

Electrocardiogram

EF

Ejection fraction

LAO

Left anterior oblique

LV

Left ventricle

RAO

Right anterior oblique

RWMA

Regional wall motion abnormality

RWMSI

Regional wall motion score index

STEMI

ST elevation myocardial infarction

Notes

Conflicts of interest

None.

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Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Sandeep M. Patel
    • 1
  • Ryan J. Lennon
    • 1
  • Abhiram Prasad
    • 1
    Email author
  1. 1.The Division of Cardiovascular Diseases, Department of Internal MedicineMayo ClinicRochesterUSA

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