Strain Echocardiography Immediately Before Acute Left Ventricular Rupture Following Anterior Wall Myocardial Infarction

Left ventricular (LV) free wall rupture is a rare but catastrophic complication of acute ST-elevation myocardial infarction (STEMI) and is still present in the era of aggressive reperfusion therapy.
An 81-year-old man with a history of hypertension and dyslipidemia was admitted to our hospital with anterior STEMI. While being prepared for coronary angiography, the patient underwent a focused 2D and Doppler echocardiographic study, which revealed akinesis in the apical segments of the LV and hyperkinesis in the adjacent segments, with a mild impairment in the LV ejection fraction (46%). This pattern of regional wall motion abnormalities was confirmed by speckle-tracking echocardiography. Fifteen minutes after hospital admission, he suffered sudden cardiac arrest, for which resuscitation was commenced immediately. Repeat echocardiography revealed massive pericardial effusion, resulting in cardiac tamponade. Pericardiocentesis was performed, but the ensuing resuscitation efforts were unsuccessful.
We present a unique recording and quantitative analysis of the LV wall motion abnormalities immediately preceding free wall rupture in nonrevascularized anterior STEMI. We hypothesize that significant differences in the regional function, ranging from an akinetic apex to hypercontractile segments adjacent to the necrotic zone, can represent a marker of threatened cardiac rupture.