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Archives of cardiovascular diseases
Volume 104, n° 3
pages 204-205 (mars 2011)
Doi : 10.1016/j.acvd.2010.05.007
Received : 14 April 2010 ;  accepted : 21 May 2010
Correlations between echocardiography and cardiovascular magnetic resonance in a patient with midventricular stress cardiomyopathy
Corrélations entre échocardiographie et imagerie par résonance magnétique chez une patiente présentant une cardiomyopathie médio-ventriculaire induite par le stress
 

Claire Bouleti a, David Attias a, , Jean-Michel Serfaty b, Alec Vahanian a
a Department of Cardiology, Assistance Publique–Hôpitaux de Paris (AP–HP), Bichat–Claude-Bernard Hospital, 46, rue Henri-Huchard, 75018 Paris, France 
b Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP–HP), Bichat–Claude-Bernard Hospital, Paris, France 

Corresponding author. Fax: +33 1 40 25 88 65.

Keywords : Stress cardiomyopathy, Echocardiography, Cardiovascular magnetic resonance

Mots clés : Cardiomyopathie induite par le stress, Échocardiographie, Imagerie par résonance magnétique


A 73-year-old woman without previous medical history was admitted for suspected persistent thoracic anginal pain following a violent suffocating cough. On admission, results of physical examination and per-critical electrocardiogram were normal. Aortic dissection and pulmonary embolism were ruled out by computed tomography scan. The troponin peak reached 3.55μg/l at day one, while an electrocardiogram showed T-wave inversion in the anterior and lateral leads. A transthoracic echocardiogram showed akinesis of the midportion of the lateral, posterior, anteroseptal and anterior walls of the left ventricle while the apical and basal parts of these walls were normocontractile (Panel A) and left ventricular ejection fraction was at 40%. Coronary angiography was normal. Cardiovascular magnetic resonance (CMR) confirmed echocardiographic findings with wall motion abnormalities confined to the midportion (Panel B). High T2 signal was observed within the asynergic myocardium (PanelC) while no regional delayed gadolinium hyperenhancement was observed (Panels D, E). A provisional diagnosis of transient midventricular ballooning syndrome, a peculiar form of stress cardiomyopathy, was then suggested. Six weeks later, CMR and echocardiogram showed disappearance of the segmental wall motion abnormalities with full recovery of the systolic function (Panels F, G), confirming the diagnosis of stress cardiomyopathy.

Videos of CMR and echocardiography at the acute phase and 6 weeks later are available at the online version of the journal (Appendix A).

In our case, CMR was very useful to differentiate stress cardiomyopathy from myocarditis or myocardial infarction with normal coronary arteries. In patients with stress cardiomyopathy, there is usually no delayed hyperenhancement, which is consistent with viable myocardium and the complete recovery seen in our patient. This case illustrates the complementary role of echocardiography and CMR for the diagnosis and follow-up of patients with stress cardiomyopathy. Echocardiography remains the first-line examination for the detection of stress cardiomyopathy, but CMR is a valuable tool and should be considered as a current complementary examination.


Appendix A. Supplementary data

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Video A: transthoracic echocardiography performed during the acute phase. The long-axis parasternal view showed akinesis of the midportion of posterior and anteroseptal walls of the left ventricle while the apical and basal parts of these walls were normocontractile.

Click here to download the file (4.67 Mo)
  

Video B: transthoracic echocardiography performed during the acute phase. The four-chamber view showed an akinesis confined to the midportion of the lateral wall. Left ventricular ejection fraction was calculated at 40%.

Click here to download the file (292 Ko)
  

Video C: cardiovascular magnetic resonance performed during the acute phase. The four-chamber view confirmed the akinesis of the midportion of the lateral wall.

Click here to download the file (1.36 Mo)
  

Video D: transthoracic echocardiography performed 6 weeks later. The long-axis parasternal view showed a complete recovery of systolic function of all the segments from the anteroseptal and posterior walls.

Click here to download the file (1.62 Mo)
  

Video E: transthoracic echocardiography performed 6 weeks later. The four-chamber view showed a complete recovery of the midportion of the lateral wall and a normalization of the ejection fraction, calculated at 65%.

Click here to download the file (301 Ko)
  

Video F: cardiovascular magnetic resonance performed 6 weeks later. The four-chamber view confirmed the complete recovery of the midportion of the lateral wall and the normalization of the ejection fraction.


Conflict of interest statement

None.



Figure 1 : 

Echocardiographic and CMR features at the acute phase of mid-ventricular stress cardiomyopathy (Panels A, B, C, D, E) and six weeks later (Panels F and G).




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