European Heart Journal Advance Access published online on September 27, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn433
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Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging
1 Department of Internal Medicine—Cardiology, University of Leipzig—Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
2 Department of Radiology, University of Leipzig—Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
3 Department of Radiology, Asklepios Clinic St Georg, Hamburg, Germany
Received 13 February 2008; revised 22 August 2008; accepted 11 September 2008.
* Corresponding author. Tel: +49 341 865 1428, Fax: +49 341 865 1461, Email: ingoeitel{at}gmx.de
Aims: The apical ballooning syndrome (ABS) is a new diagnostic entity which is increasingly recognized. Precise magnetic resonance imaging (MRI) data are not yet available and there is little evidence for the differential diagnosis of ABS assessed by MRI.
Methods and results: Between January 2005 and January 2008, 6100 consecutive patients with diagnosis of acute coronary syndrome underwent left heart catheterization. In 59 patients (1.0%), coronary angiography revealed normal coronary arteries, but left ventriculography showed left ventricular dysfunction with apical ballooning. These 59 patients underwent cardiac MRI using a 1.5 T MRI scanner. In 13 patients (22.0%), MRI revealed diagnosis of myocardial infarction, in eight patients (13.6%) diagnosis of myocarditis. In all other 38 (64.4%) patients (36 female, age 73 ± 10 years) with suspected ABS, no delayed enhancement or signs of inflammation were detected. Follow-up MRI after 3 months showed a completely normalized left ventricular ejection in all patients with suspected ABS. Similarly, the end-diastolic volume and end-systolic volume improved at follow-up.
Conclusion: Cardiac MRI allows differentiating ABS from other rare causes with unobstructed coronary vessels such as myocarditis and coronary emboli with spontaneous lysis. Therefore, cardiac MRI can add valuable information in all patients with suspected ABS for further differential diagnosis.
Key Words: Apical ballooning syndrome • Takotsubo cardiomyopathy • Magnetic resonance imaging • Acute coronary syndrome
The first two authors have contributed equally to this work.
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