Abstract 2973: Myocardial Perfusion in Apical Ballooning Syndrome: Predictor of Myocardial Injury
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 correlates with the extent of myocardial injury.
Methods and Results- We evaluated 42 consecutive patients, all female, with a diagnosis of ABS and technically adequate angiograms for the assessment of the TIMI myocardial perfusion grade (TMPG), an index of myocardial perfusion. 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 (table⇓). Patients with abnormal TMPG had higher peak troponin level compared to patients with normal TMPG (0.84 ± 0.68 ngmL vs 0.42 ± 0.33 ngmL, p = 0.047). Similarly, ST elevation or deep T wave inversion on the ECG was more common in patients with abnormal perfusion; 86% vs 46%, p = 0.006.
Conclusion- 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.