Caption: Figure 3: Apical 2 chamber view captured at end systole showing basal and apical akinesis
with preserved contractility of the mid ventricular segments.
They include 1) transient hypokinesis, akinesis
, or dyskinesis of the left ventricular mid segments with or without apical involvement, with the regional wall motion abnormalities extending beyond a single epicardial vascular distribution, 2) absence of obstructive coronary disease or angiographic evidence of acute plaque rupture, 3) new EKG abnormalities or elevation in cardiac troponin level and 4) the absence of pheochromocytoma and myocarditis.
Perfusion Rest/Stress Test Results Gated Wall Motion Study Results Abnormal Wall Motion (Hypokinesis or Akinesis
, n = 116) Fixed defects; n = 22 19 (86%) Reversible defects; n = 129 68 (53%) Fixed and reversible defects; n = 30 29 (97%) Normal perfusion; n = 110 0 Perfusion Rest/Stress Test Results Normal Wall Motion (n = 171) Fixed defects; n = 22 2 (9%) Reversible defects; n = 129 59 (46%) Fixed and reversible defects; n = 30 1 (3%) Normal perfusion; n = 110 109 (99%) Perfusion Rest/Stress Test Results Nongated(*) (n = 4) Fixed defects; n = 22 1 (5%) Reversible defects; n = 129 2 (1%) Fixed and reversible defects; n = 30 0 Normal perfusion; n = 110 1 (1%) (*) Nongated patients could not perform gated studies due to irregular heart rate or bradycardia.
This cine display of the heart in near real time allows the observer to identify areas of hypokinesis, akinesis
, and dyskinesis.
Left-sided heart catheterization showed a left ventricular end diastolic pressure of 20 mm Hg and a left ventricular ejection fraction of 50% with anterolateral and apical akinesis
. Coronary angiography showed an eccentric stenosis and a large near-occlusive filling defect compatible with thrombus in the proximal LAD (Figure 2a).
Transient hypokinesis, akinesis
, or dyskinesis of the left ventricular mid segments with or without apical involvement; the regional wall motion abnormalities extending beyond a single epicardial vascular distribution; a stressful trigger often but not always present
Echocardiography revealed satisfactory global left ventricular function (EF 54%), with inferobasal akinesis
. No significant mitral insufficiency was seen.
The patients were at least 18 years of age with LV wall motion abnormalities (anteroapical akinesis
or dyskinesis) secondary to MI, an LV ejection fraction (EF) between 15% and 40% determined by the echocardiography and measured by echocardiography core laboratory (core lab).
Apical ballooning syndrome was defined as having normal coronary arteries and characteristic left ventriculogram (LVG) (ballooning pattern : a0 pical akinesis
with hyperkinesia over the basal region).
The characteristic echocardiogram finding in Takotsubo cardiomyopathy is transient apical ballooning with akinesis
or hypokinesis in the apical and/or mid ventricular regions (typical variant) or isolated midventricular hypokinesis (apical sparing variant).
The cardiac biomarkers were elevated (12 ng/mL for troponin and 123 IU/L for creatine kinase-MB), and echocardiography found an inferior akinesis
with an ejection fraction of 45%.
CMRI short axis (SAX) (Figure 1), two-chamber (2CH) (Figure 2), three-chamber (3CH) (Figure 3), and four-chamber (4CH) (Figure 4) CINE imaging confirm global mild hypokinesis with proximal apical-inferior wall thinning and akinesis
, and mid- and basilar-inferior septum, inferior wall, and posterior-lateral wall myocardial thinning with mild hypokinesis.