Sress cardiomyopathy:clinical features and imaging findings / 中华放射学杂志

ABSTRACT

Objective One typical case with stress cardiomyopathy was reported and the current knowledge of the syndrome was reviewed to improve relevant knowledge.Methods A 71-year-old female patient presented dyspnea and chest pain due to emotional stress.ECG,echocardiography,selective coronary artery angiography,left ventriculography,~(99)Tc~m-MIBI single photon emission computed tomography (SPECT),~(18)F-FDG SPECT and MRI were performed.Results Electrocardiogram at admission showed ST segment elevation and T wave inversion in leads V1—V4.Pathological Q wave occurred 1 week later,it disappeared 1 month later however and severe T wave inversion occurred.Normal or slightly elevated cardiac enzymes in the blood were found during the course.Left ventriculogram at admission showed left ventricular apical ballooning with LVEF of 30%.The ballooning volume was about 3/4 of left ventricular volume, without any corresponding coronary artery diseases found in coronary angiogram.The abnormal apical ballooning decreased significantly in the follow-up left ventriculogram performed one month later.The LVEF rose up to 63.6%.~(99)Tc~m-MIBI and ~(18)F-FDG SPECT showed mismatch of perfusion and metabolism in the corresponding region,indicating presence of viable myocardium.MRI showed left ventricular apical ballooning without perfusion defect and late enhancement,indicating viability of corresponding myocardium. Conclusions Emotional stress can cause transient left ventricular apical ballooning called"stress cardiomyopathy".Either ~(99)Tc~m-MIBI SPECT associated with ~(18)F-FDG SPECT or delayed enhancement MRI plays an important role in identification of myocardial viability,which can efficiently guide clinical treatment.