Effect of Early Metoprolol During ST-Segment Elevation Myocardial Infarction on Left Ventricular Strain

Abstract

In patients with anterior STEMI, early administration of intravenous metoprolol before primary PCI was associated with significantly fewer patients with severely depressed LV GCS and GLS, both at 1 week and 6 months. Feature-tracking CMR represents a complementary tool to evaluate the benefits of cardioprotective therapies. (Effect of METOprolol in CARDioproteCtioN During an Acute Myocardial InfarCtion [METOCARD-CNIC]: NCT01311700).

Anterior STEMI associated with decreased strain in remote cardiac myocardium

“…GLS from FT-CMR within the first week after admission has been shown to be a strong and independent predictor of major adverse cardiac events in patients with STEMI [20]. Our findings of improved GLS at 6 months are in concordance with those of Podlesnikar et al [23] who measured GLS with feature tracking CMR within one week and six months after anterior STEMI and found improvement after six months. Our findings are also aligned with previous studies using speckle tracking echocardiography [21,22].…”

“…The study by Podlesnikar et al [23] focused on GLS after anterior STEMI as a way of investigating the effect of metoprolol and did not assess IS. Our study included STEMI in all three coronary arteries and investigated RLS why it adds new knowledge about the longitudinal remodeling over time in relations to infarct location, size, and degree.…”

“…GLS has been studied in the acute phase and at follow up in patients with STEMI using echocardiography [21,22] and in patients with anterior infarctions using FT-CMR [23]. However, it is unknown how the location of the STEMI, defined by culprit lesion coronary perfusion territory, affect GLS assessed with FT-CMR.…”

Infarto Agudo del Miocardio: conducta en el período prehospitalario

“…A la semana los pacientes que recibieron Metoprolol IV tenían strain ventricular izquierdo (expresión de contractilidad) significativamente mejor que los controles. Aunque el strain mejoró a los 6 meses en ambos grupos hubo menos pacientes con peor función ventricular izquierda en el grupo con Metoprolol 32 . En resumen, los BB estarían recomendados en pacientes con hipertensión arterial o si hay isquemia evolutiva, excluyendo pacientes con insuficiencia cardiaca, shock, bradicardia o bloqueo auriculoventricular.…”

Effekt unterschiedlicher Conditioning-Strategien auf myokardiale Funktion und Prognose nach ST-Strecken-Hebungs-Myokardinfarkt

“…In jüngeren Studien zeichnet sich zudem ab, dass die CMR-FT-basierte Analyse der kardialen Funktion bei Patienten mit AMI, dilatativer und ischämischer Kardiomyopathie, Takotsubo-Kardiomyopathie und einer Reihe weiterer kardiovaskulärer Krankheitsbilder einen unabhängigen prognostischen Mehrwert gegenüber etablierten kardiovaskulären Risikofaktoren inklusive der LVEF liefern kann (Backhaus et al 2019b;Buss et al 2015a;de Siqueira et al 2016;Eitel et al 2018;Musa et al 2017;Orwat et al 2014;2016;Romano et al 2018;Stiermaier et al 2018a;2018b;. Unlängst konnten Podlesnikar et al (2019) zeigen, dass die Evaluation der CMR-FT-Parameter eine Evaluation der Effekte kardioprotektiver Therapieregime nach AMI erlaubt.…”