Diagnosis of subacute ventricular wall rupture after acute myocardial infarction: sensitivity and specificity of clinical, hemodynamic and echocardiographic criteria

Coronary Care Unit, Hospital La Paz, Universidad Autonoma de Madrid, Spain.

When ventricular free wall rupture after acute myocardial infarction is not followed by sudden death, it is referred to as subacute ventricular rupture. The sensitivity and specificity of clinical, hemodynamic and echocardiographic diagnostic variables obtained at bedside are unknown and were therefore prospectively studied in 1,247 consecutive patients with acute myocardial infarction including 33 patients with subacute ventricular rupture diagnosed at operation (group A) and 1,214 patients without ventricular rupture (at operation, postmortem study or at discharge) (group B). The incidence of syncope, recurrent chest pain, hypotension, electromechanical dissociation, cardiac tamponade, pericardial effusion, high acoustic intrapericardial echoes, right atrial and right ventricular wall compression identified in two-dimensional echocardiograms and hemopericardium demonstrated during pericardiocentesis was higher in group A than in group B (p less than 0.00001). The presence of cardiac tamponade, pericardial effusion greater than 5 mm, high density intrapericardial echoes or right atrial or right ventricular wall compression had a high diagnostic sensitivity (greater than or equal to 70%) and specificity (greater than 90%). The number of false positive diagnoses was always high for each diagnostic variable alone (greater than 20%), but the combination of clinical (hypotension), hemodynamic (cardiac tamponade) and echocardiographic variables allowed a sensitivity of greater than or equal to 65% with a small number of false positive diagnoses (less than 10%) and provided useful information for therapeutic decisions. The diagnosis of subacute ventricular rupture requires a surgical decision. Twenty-five (76%) of the 33 patients with subacute ventricular rupture survived the surgical procedure and 16 (48.5%) are long-term survivors. Thus, subacute ventricular wall rupture is a relatively frequent complication after acute myocardial infarction that can be accurately diagnosed and successfully treated.

This article has been cited by other articles:

				A. K. Agnihotri, J. C. Madsen, and W. M. Daggett Jr Surgical Treatment of Complications of Acute Myocardial Infarction: Postinfarction Ventricular Septal Defect and Free Wall Rupture Card. Surg. Adult, January 1, 2008; 3(2008): 753 - 784. [Full Text]

				G. Weissman, C. C. Kwon, R. K. Shaw, and J. F. Setaro Free-Wall Rupture of the Myocardium Following Infarction: A Changing Clinical Portrait in the Reperfusion Era: A Case Report Angiology, October 1, 2006; 57(5): 636 - 642. [Abstract] [PDF]

				C. Leva, P. G. Bruno, C. Gallorini, I. Lazzarini, G. Musazzi, L. Vittonati, L. Rizzo, and G. Di Credico Complete myocardial revascularization and sutureless technique for left ventricular free wall rupture: clinical and echocardiographic results Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 408 - 412. [Abstract] [Full Text] [PDF]

				H. Bueno, M. Martinez-Selles, E. Perez-David, and R. Lopez-Palop Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction Eur. Heart J., September 1, 2005; 26(17): 1705 - 1711. [Abstract] [Full Text] [PDF]

				K. P. Bouki, G. Pavlakis, and E. Papasteriadis Management of Cardiogenic Shock Due to Acute Coronary Syndromes Angiology, March 1, 2005; 56(2): 123 - 130. [Abstract] [PDF]

				Endorsed by the European Society of Intensive Care, Authors/Task Force Members, M. S. Nieminen, M. Bohm, M. R. Cowie, H. Drexler, G. S. Filippatos, G. Jondeau, Y. Hasin, J. Lopez-Sendon, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology Eur. Heart J., February 2, 2005; 26(4): 384 - 416. [Full Text] [PDF]

				T A Helmy, W J Nicholson, S Lick, and B F Uretsky Contained myocardial rupture: a variant linking complete and incomplete rupture Heart, February 1, 2005; 91(2): e13 - e13. [Abstract] [Full Text] [PDF]

				X.-M. Gao, Q. Xu, H. Kiriazis, A. M. Dart, and X.-J. Du Mouse model of post-infarct ventricular rupture: time course, strain- and gender-dependency, tensile strength, and histopathology Cardiovasc Res, February 1, 2005; 65(2): 469 - 477. [Abstract] [Full Text] [PDF]

				A. Aris Surgical repair of left ventricular free wall rupture MMCTS, January 4, 2005; 2005(0104): 653. [Abstract] [Full Text] [PDF]

				J. Pindado, P. Marcos-Alberca, M. Rey, R. Rabago, C. de Diego, B. Ibanez, M. Cordoba, and J. Farre Incomplete myocardial rupture after coronary embolism of an isolated single coronary artery Eur J Echocardiogr, January 1, 2005; 6(1): 72 - 74. [Abstract] [Full Text] [PDF]

				The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]

				A. K. Agnihotri, J. C. Madsen, and W. M. Daggett Jr. Surgical Treatment of Complications of Acute Myocardial Infarction: Postinfarction Ventricular Septal Defect and Free Wall Rupture Card. Surg. Adult, January 1, 2003; 2(2003): 681 - 714. [Full Text]

				A. Yamamuro, T. Akasaka, K. Tamita, K. Yamabe, M. Katayama, T. Takagi, and S. Morioka Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction Circulation, December 10, 2002; 106(24): 3051 - 3056. [Abstract] [Full Text] [PDF]

				V. Mantovani, D. Vanoli, P. Chelazzi, V. Lepore, S. Ferrarese, and A. Sala Post-infarction cardiac rupture: surgical treatment Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 777 - 780. [Abstract] [Full Text] [PDF]

				R. Moreno, J. Lopez-Sendon, E. Garcia, L. P.e. de Isla, E. L.o. de Sa, A. Ortega, M. Moreno, R. Rubio, J. Soriano, M. Abeytua, et al. Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction J. Am. Coll. Cardiol., February 20, 2002; 39(4): 598 - 603. [Abstract] [Full Text] [PDF]

				F. Alamanni, A. Fumero, A. Parolari, P. Trabattoni, A. Cannata, G. Berti, and P. Biglioli Sutureless double-patch-and-glue technique for repair of subacute left ventricular wall rupture after myocardial infarction J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 836 - 837. [Full Text] [PDF]

				M. E. Khalil, E. N. Heller, F. Boctor, E. J. Brown Jr, and I. A. Alhaddad Ventricular Free Wall Rupture in Acute Myocardial Infarction Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2001; 6(3): 231 - 236. [Abstract] [PDF]

				W. M. Park, C. P. Connery, J. S. Hochman, M. D. Tilson, and C. E. Anagnostopoulos Successful repair of myocardial free wall rupture after thrombolytic therapy for acute infarction Ann. Thorac. Surg., October 1, 2000; 70(4): 1345 - 1349. [Abstract] [Full Text] [PDF]

				J. S. Hochman, C. E. Buller, L. A. Sleeper, J. Boland, V. Dzavik, T. A. Sanborn, E. Godfrey, H. D. White, J. Lim, T. LeJemtel, et al. Cardiogenic shock complicating acute myocardial infarction--etiologies, management and outcome: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1063 - 1070. [Abstract] [Full Text] [PDF]

				J. Slater, R. J. Brown, T. A. Antonelli, V. Menon, J. Boland, J. Col, V. Dzavik, M. Greenberg, M. Menegus, C. Connery, et al. Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1117 - 1122. [Abstract] [Full Text] [PDF]

				R. Pretre, A. Linka, R. Jenni, and M. I. Turina Surgical treatment of acquired left ventricular pseudoaneurysms Ann. Thorac. Surg., August 1, 2000; 70(2): 553 - 557. [Abstract] [Full Text] [PDF]

				R. Pretre, P. Benedikt, and M. I. Turina Experience with postinfarction left ventricular free wall rupture Ann. Thorac. Surg., May 1, 2000; 69(5): 1342 - 1345. [Abstract] [Full Text] [PDF]

				J Figueras, J Cortadellas, and J Soler-Soler Left ventricular free wall rupture: clinical presentation and management Heart, May 1, 2000; 83(5): 499 - 504. [Full Text]

				H. S. Mueller, K. Chatterjee, K. B. Davis, M. A. Fifer, C. Franklin, M. A. Greenberg, A. J. Labovitz, P. K. Shah, K. J. Tuman, M. H. Weil, et al. Present use of bedside right heart catheterization in patients with cardiac disease J. Am. Coll. Cardiol., September 1, 1998; 32(3): 840 - 864. [Full Text] [PDF]

				M. J. Reardon, C. L. Carr, A. Diamond, G. V. Letsou, H. J. Safi, R. Espada, and J. C. Baldwin Ischemic Left Ventricular Free Wall Rupture: Prediction, Diagnosis, and Treatment Ann. Thorac. Surg., November 1, 1997; 64(5): 1509 - 1513. [Abstract] [Full Text]

				D. Zahger and E. Milgalter A Broken Heart N. Engl. J. Med., February 1, 1996; 334(5): 319 - 321. [Full Text] [PDF]

				G. Rosato, M. Santomauro, G. Stanco, F. Petillo, R. Sauro, M. Chiariello, N. Spampinato, and D. Rotiroti Subacute Cardiac Rupture Complicating Myocardial Infarction: A Case Report Angiology, February 1, 1996; 47(2): 189 - 196. [Abstract] [PDF]