Early Recognition of Apical Ballooning Syndrome by Global Longitudinal Strain Using Speckle Tracking Imaging - The Evil Eye Pattern, a Case Series

We report 4 cases of patients diagnosed with stress-induced cardiomyopathy and the pattern of typical apical ballooning syndrome (ABS), who presented to our institution with chest pain, mildly elevated cardiac enzymes and ischemic electrocardiographic changes, found to have severe hypokinesis or akinesis of the mid to apical segments with dynamic basal segments on two-dimensional (2D) echocardiography along with a global longitudinal strain (GLS) pattern markedly different from the typical left anterior descending artery (LAD) myocardial infarction pattern. All of them had a similar GLS pattern on presentation, which was easy to recognize on the polar map the day of the event. Three of the patients underwent left heart catheterization and found to have nonobstructive coronary artery disease (CAD). We discuss the usefulness of early recognition of ABS using GLS images. Mini-Abstract In this case series we report 4 cases of patients diagnosed with stress induced cardiomyopathy apical ballooning syndrome (ABS), who presented to our institution with chest pain, mildly elevated cardiac enzymes and ischemic electrocardiographic changes. They were found to have severe hypokinesis or akinesis of the mid to apical segments with dynamic basal segments on echocardiography. A global longitudinal strain (GLS) pattern on polar map was markedly different from the pattern of proximal left anterior descending artery (LAD) myocardial infarction. All of them had a similar GLS pattern on presentation, which was easy to recognize on these polar maps images the day of the event. We discuss the usefulness of early recognition of ABS using global longitudinal strain images.