Abstract
BackgroundWe aimed to evaluate the effect of early intravenous metoprolol treatment, microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and adverse left ventricular (LV) remodeling on the evolution of infarct and remote zone circumferential strain after acute anterior ST-segment elevation myocardial infarction (STEMI) with feature-tracking cardiovascular magnetic resonance (CMR).MethodsA total of 191 patients with acute anterior STEMI enrolled in the METOCARD-CNIC randomized clinical trial were evaluated. LV infarct zone and remote zone circumferential strain were measured with feature-tracking CMR at 1 week and 6 months after STEMI.ResultsIn the overall population, the infarct zone circumferential strain significantly improved from 1 week to 6 months after STEMI (− 8.6 ± 9.0% to − 14.5 ± 8.0%; P < 0.001), while no changes in the remote zone strain were observed (− 19.5 ± 5.9% to − 19.2 ± 3.9%; P = 0.466). Patients who received early intravenous metoprolol had significantly more preserved infarct zone circumferential strain compared to the controls at 1 week (P = 0.038) and at 6 months (P = 0.033) after STEMI, while no differences in remote zone strain were observed. The infarct zone circumferential strain was significantly impaired in patients with MVO and IMH compared to those without (P < 0.001 at 1 week and 6 months), however it improved between both time points regardless of the presence of MVO or IMH (P < 0.001). In patients who developed adverse LV remodeling (defined as ≥ 20% increase in LV end-diastolic volume) remote zone circumferential strain worsened between 1 week and 6 months after STEMI (P = 0.036), while in the absence of adverse LV remodeling no significant changes in remote zone strain were observed.ConclusionsRegional LV circumferential strain with feature-tracking CMR allowed comprehensive evaluation of the sequelae of an acute STEMI treated with primary percutaneous coronary intervention and demonstrated long-lasting cardioprotective effects of early intravenous metoprolol.Trial registrationClinicalTrials.gov, NCT01311700. Registered 8 March 2011 - Retrospectively registered.
Highlights
We aimed to evaluate the effect of early intravenous metoprolol treatment, microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and adverse left ventricular (LV) remodeling on the evolution of infarct and remote zone circumferential strain after acute anterior ST-segment elevation myocardial infarction (STEMI) with feature-tracking cardiovascular magnetic resonance (CMR)
Regional LV circumferential strain with feature-tracking CMR allowed comprehensive evaluation of the sequelae of an acute STEMI treated with primary percutaneous coronary intervention and demonstrated longlasting cardioprotective effects of early intravenous metoprolol
Evolution of infarct and remote zone circumferential strain In the overall population the infarct zone strain significantly improved from 1 week to 6 months after STEMI (from − 8.6% to − 14.5%, mean difference (MD) -5.9%; 95% confidence interval (CI) -6.9 to − 4.8; P < 0.001), while no significant changes in the remote zone strain were observed
Summary
We aimed to evaluate the effect of early intravenous metoprolol treatment, microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and adverse left ventricular (LV) remodeling on the evolution of infarct and remote zone circumferential strain after acute anterior ST-segment elevation myocardial infarction (STEMI) with feature-tracking cardiovascular magnetic resonance (CMR). Assessment of left ventricular (LV) volumes and function, myocardial edema, infarct extent and transmurality, and microvascular damage can be performed Traditional parameters such as LV volumes and LV ejection fraction and CMR-specific parameters, such as infarct size with late gadolinium enhancement (LGE), presence of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) have demonstrated to predict post-infarction LV remodeling and clinical outcome [2,3,4]. The evolution of LV strain after a ST-segment elevation myocardial infarction (STEMI) within infarcted and remote myocardium has not yet been investigated with featuretracking CMR
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