Abstract 3933: Mitral Regurgitation in Apical Ballooning Syndrome
Background: Apical ballooning syndrome (ABS) is a unique and novel transient cardiomyopathy. The aims of this study were to determine the incidence and clinical correlates of mitral regurgitation (MR) in ABS.
Methods: MR was quantified at presentation by left ventriculography (Seller’s criteria) in 92 ABS patients identified using the Mayo Clinic diagnostic criteria. Echocardiography was performed at 1 (interquartile range1–2) day and 38 (15–72) days after presentation.
Results: Grade 1, 2, 3 and 4 MR was present in 25 (27%), 15 (16%), 8 (9%) and 5 (5%) of ABS patients, respectively. Grade 3 and 4 MR was associated with lower left ventricle ejection fraction (LVEF) at presentation, higher incidence of left ventricular outflow tract (LVOT) obstruction, clinical heart failure and longer hospitalization (p<0.05) (Table⇓). Among patients with Grade 3 and 4 MR, echocardiography identified LVOT obstruction (n=4), systolic anterior motion of the anterior mitral leaflet (n=3), tethering of the anterior mitral leaflet (n=5) and degenerative mitral valve disease in the rest. Follow up echocardiography in patients with grade 3 and 4 MR demonstrated complete resolution of MR in 54% and mild MR in the remaining.
Conclusion: A significant proportion of ABS patients develop moderately severe to severe MR which, while transient, is associated with more severe left ventricular dysfunction at presentation and greater morbidity. The study underscores the importance of diagnosing MR in ABS.