title: Myocardial perfusion in apical ballooning syndrome correlate of myocardial injury.
abstract: BACKGROUND
  The pathophysiology of the apical ballooning syndrome (ABS) is poorly understood. This study evaluated myocardial perfusion abnormalities at the time of presentation in patients with ABS and examined whether abnormal microvascular blood flow predicts the extent of myocardial injury.
  
  
  METHODS
  We evaluated 42 consecutive patients, all women, with a diagnosis of ABS and technically adequate angiograms for the assessment of the TIMI myocardial perfusion grade (TMPG), an index of myocardial perfusion.
  
  
  RESULTS
  Abnormal myocardial perfusion was present in 29 (69%) patients. There were no differences in age, frequency of conventional coronary atherosclerosis risk factors, left ventricular ejection fraction at either presentation or follow-up, congestive heart failure at presentation, or length of hospital stay between patients with normal versus those with abnormal TMPG. Patients with abnormal TMPG had higher peak troponin level compared with patients with normal TMPG (0.84 +/- 0.68 vs 0.42 +/- 0.33 ng/mL, P = .047). Similarly, ST elevation or deep T-wave inversion on the electrocardiogram was more common in patients with abnormal perfusion (86% vs 46%, P = .006).
  
  
  CONCLUSIONS
  Impaired myocardial perfusion due to abnormal microvascular blood flow is frequently present in patients with ABS and correlates with the extent of myocardial injury. Microvascular dysfunction likely play a pivotal role in the pathogenesis of myocardial stunning in ABS.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Elesber
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Bybee
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Murphy
authors.forename: Gregory
authors.initials: G
authors.lastname: Barsness
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000503:physiopathology; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology