Figure 2.

Transthoracic Echocardiogram

Echocardiograms recorded 4 years before (A) and at admission (B to E). (C) The bull’s eye map (with apex at the center of the color-coding map) illustrates segmental longitudinal left ventricular (LV) peak systolic strain values of 16-segment model, which were semiautomatically generated by speckle-tracking analysis of 2-dimensional LV images acquired from apical 2-, 3-, and 4-chamber views, and shows a reduced global longitudinal LV peak systolic strain value, calculated as the mean of these 16 values, of −12.4% (marked with an asterisk) with an apical-to-basal strain ratio, calculated as apical septal longitudinal strain divided by average basal septal (anteroseptal and inferoseptal) longitudinal strain, of 2.2 indicating apical sparing (>2.1). Two separate jets of mitral regurgitation (MR), of which one directed toward the center of the left atrium due to atrial functional MR (small arrow) and another directed eccentrically in connection with the aorta due to chordal rupture (arrowheads), are shown. Asterisks and large arrows indicate pericardial effusion and torn chordae of the mitral valve, respectively.