Magnetic resonance reveals long-term sequelae of apical ballooning syndrome.
BACKGROUND
The presence of small areas of necrosis has been occasionally reported immediately following apical ballooning syndrome (ABS). However, their persistence at later stages and impact on long-term prognosis are currently unknown.


METHODS
Twenty consecutive patients admitted for ABS between 2004 and 2007 were prospectively evaluated. Demographic, clinical, angiographic, and echocardiographic data were collected during hospital admission. At a mean of 11+/-9 months follow-up, a contrast enhanced cardiac magnetic resonance (ce-CMR) study was performed in 17 cases. The presence of hyperenhancement on ce-CMR images, reflecting irreversible myocardial damage, was recorded by two independent observers.


RESULTS
Two of 3 patients with hyperenhancement on ce-CMR images presented in worse condition, including pulmonary edema or cardiogenic shock, compared to just 2 of 14 patients without hyperenhancement (p=0.052). Segmental wall motion substantially improved in both of those cases; the third patient continued to have hypokinesis in a segment showing hyperenhancement. Segmental wall motion also significantly improved in all patients with no hyperenhancement. At a mean of 20+/-12 months follow-up, no deaths or major adverse cardiac events were documented among patients with or without hyperenhancement.


CONCLUSIONS
Despite segmental wall motion recovery, an area of irreversible myocardial damage can sometimes be identified long after ABS. However, in this limited series of patients, the presence of scar, even when presenting with heart failure and a higher troponin release, was not associated with adverse long-term outcomes as compared to patients with intact myocardium.
Bellera
M Neus
MN
Thorax Institute, IDIBAPS, Barcelona, Spain. mbellera_gotarda@hotmail.com
Ortiz
José T
JT
Caralt
Maria Teresa
MT
Pérez-Rodon
Jordi
J
Mercader
Jaume
J
Fernández-Gómez
Carlos
C
Paré
Carles
C
Heras
Magda
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D003287:Contrast Media; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D020127:Recovery of Function; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D014336:Troponin / Q000097:blood; D016277:Ventricular Function, Left
D003287:Contrast Media; D014336:Troponin