P882Usefulness of conventional echocardiography in the diagnosis of incomplete rupture of the ventricular wall identified by multidetector computed tomography.


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Abstract

Introduction: Partial, incomplete or contained cardiac rupture (CR) is a complication of acute myocardial infarction (AMI) scarcely known and studied and its clinical significance is unknown. 64-slice multidetector computed tomography (MDCT) permits the identification of disruptions in the integrity of the myocardium or intramyocardial tracts indicating incomplete CR. Echocardiography may be useful in the diagnosis of incomplete CR but its sensitivity and specificity is unknown. Objectives. Analyze the usefulness of echocardiography for the diagnosis of incomplete CR in patients athigh risk of CR compared with the identification of incomplete CR by MDCT. Material and methods: All patients with suspected CR between October 2008 and December 2010 were studied, excluding those with definite diagnosis of complete CR. All patients underwent conventional echocardiography. An expert observer blindly evaluated all echocardiograms. 64-slice MDCT was used as the reference technique.Results: 22 patients (15 men and 7 women of 69.4 +/-11.9 years) at high risk of CR orsuspected CR on a routine echocardiogram were included. 20 patients had an AMI, 1 a stab chest injury and 1 pericardial effusion after percutaneous coronary intervention. In the conventional echocardiogram all patients had pericardial effusion, ventricular aneurysm, myocardial focal thinning as indirect evidence of CR. MDCT identified 5 patients with incomplete CR. Echocardiography identified 7 patients with incomplete RC (3 false positives, 42.8%) and ruled it out in 15 patients (5 false negatives, 33%). Considering MDCT as the reference standard, echocardiography had a sensitivity of 40%, a specificity of 70.6%, a positive predictive value of 28.6% and a negative predictivevalue 80%, with an overall diagnostic accuracy of 63.6%.Conclusions: in patients at high risk of CR, echocardiography has a medium sensitivity and specificity for the identification of incomplete CR compared to MDTC, that due to its high resolution could be considered as the gold standard.

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