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

Introduction: Leftventricular(LV)freewallruptureisararebutcatastrophiccomplicationof acuteST-elevationmyocardialinfarc-tion (STEMI) and is still present in the era of aggressive reperfusion therapy. CasePresentation: An81-year-oldmanwithahistoryof hypertensionanddyslipidemiawasadmittedtoourhospitalwithanterior 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 LVejectionfraction(46%). Thispatternof regionalwallmotionabnormalitieswasconfirmedbyspeckle-trackingechocardiography. Fifteen minutes after hospital admission, he suffered sudden cardiac arrest, for which resuscitation was commenced immediately. Repeatechocardiographyrevealedmassivepericardialeffusion,resultingincardiactamponade. Pericardiocentesiswasperformed, but the ensuing resuscitation efforts were unsuccessful. Conclusions: Wepresentauniquerecordingandquantitativeanalysisof theLVwallmotionabnormalitiesimmediatelypreceding freewallruptureinnonrevascularizedanteriorSTEMI.Wehypothesizethatsignificantdifferencesintheregionalfunction,ranging from an akinetic apex to hypercontractile segments adjacent to the necrotic zone, can represent a marker of threatened cardiac rupture.