TY - JOUR 
A1 - Podlesnikar, Tomaz
AU - Pizarro, Gonzalo
AU - Fernández Jiménez, Rodrigo
AU - Montero Cabezas, José M.
AU - Sánchez González, Javier
AU - Bucciarelli Ducci, Chiara
AU - Ajmone Marsan, Nina
AU - Fras, Zlatko
AU - Bax, Jeroen J.
AU - Delgado, Victoria
AU - Et al.
T1 - Effect of Early Metoprolol During ST-Segment Elevation Myocardial Infarction on Left Ventricular Strain: Feature-Tracking Cardiovascular Magnetic Resonance Substudy From the METOCARD-CNIC Trial
Y1 - 2018
SN - 1936-878X

UR - http://hdl.handle.net/11268/8778
AB - Objectives
This study sought to evaluate the effect of early intravenous metoprolol on left ventricular (LV) strain assessed with feature-tracking cardiovascular magnetic resonance (CMR).

Background
Early intravenous metoprolol before primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) portends better outcomes in the METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial.

Methods
A total of 197 patients with acute anterior STEMI who were enrolled in the METOCARD-CNIC trial (100 allocated to intravenous metoprolol before primary PCI and 97 control patients) were evaluated. LV global circumferential strain (GCS) and global longitudinal strain (GLS) were measured with feature-tracking CMR at 1 week and 6 months after STEMI and compared between randomization groups.

Results
Patients who received early intravenous metoprolol had significantly more preserved LV strain compared with the control patients at 1 week after STEMI (GCS −13.9 ± 3.8% vs. −12.6 ± 3.9%, respectively; p = 0.013; GLS −11.9 ± 2.8% vs. −10.9 ± 3.2%, respectively; p = 0.032). In both groups, LV strain significantly improved during follow-up (mean difference between 6-month and 1-week strain for the metoprolol group: GCS −2.9%, 95% confidence interval [CI]: −3.5% to −2.4%; GLS: −2.9%, 95% CI: −3.4% to −2.4%; both p < 0.001; the control group: GCS −3.4%, 95% CI: −3.9% to −2.8%; GLS −3.4%, 95% CI: −3.9% to −3.0%; both p < 0.001). When dividing the overall cohort of patients in quartiles of GCS and GLS, there were significantly fewer patients in the first quartile (i.e., the worst LV systolic function) who received early intravenous metoprolol compared with control patients at 1 week and 6 months (p < 0.05 for GCS and GLS at both time points).

Conclusions
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]: NCT013117009)
KW - Cardiología
KW - Resonancia magnética nuclear (Física)
KW - Infarto de miocardio
KW - Enfermedad cardiovascular
KW - Tecnología médica
KW - Sistema cardiovascular
LA - eng
ER -