Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Eitel
Ingo
I
Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany. ingoeitel@gmx.de
Behrendt
Florian
F
Schindler
Kathrin
K
Kivelitz
Dietmar
D
Gutberlet
Matthias
M
Schuler
Gerhard
G
Thiele
Holger
H
D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000368:Aged; D006328:Cardiac Catheterization; D003287:Contrast Media; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D003971:Diastole / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D009205:Myocarditis / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D013599:Systole / Q000502:physiology; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*
D003287:Contrast Media; D019786:Gadolinium DTPA