A representative patient with dyskinetic apical contraction. A representative patient with dyskinetic apical contraction. (A) Cine-cardiac MRIs (CMRs) at end-diastole (left) and end-systole (right). The apical wall thinning, dyskinetic apical contraction and apical pouch were apparent. (B) Late gadolinium enhancement (LGE)-CMR images at short-axis view (left) and horizontal long axis view (right). LGE at the left ventricular apex was apparent (white arrows). (C) Standard 12-lead ECG. In addition to high voltage QRS complexes and giant negative T waves, fragmented QRS complexes at III, aVL and aVF leads were apparent (black arrows). Kenichiro Suwa et al. Open Heart 2014;1:e000124 ©2014 by British Cardiovascular Society