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- Title
Left ventricular functional recovery of infarcted and remote myocardium after ST-segment elevation myocardial infarction (METOCARD-CNIC randomized clinical trial substudy).
- Authors
Podlesnikar, Tomaž; Pizarro, Gonzalo; Fernández-Jiménez, Rodrigo; Montero-Cabezas, Jose M.; Greif, Nina; Sánchez-González, Javier; Bucciarelli-Ducci, Chiara; Marsan, Nina Ajmone; Fras, Zlatko; Bax, Jeroen J.; Fuster, Valentin; Ibáñez, Borja; Delgado, Victoria
- Abstract
Background: 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). Methods: A 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. Results: In 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. Conclusions: 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 long-lasting cardioprotective effects of early intravenous metoprolol. Trial registration: ClinicalTrials.gov, NCT01311700. Registered 8 March 2011 - Retrospectively registered.
- Subjects
COMPARATIVE studies; CONVALESCENCE; CORONARY arteries; ELECTROCARDIOGRAPHY; LEFT heart ventricle; HEART physiology; HEMORRHAGE; INTRAVENOUS therapy; MAGNETIC resonance imaging; METOPROLOL; MYOCARDIAL infarction; MYOCARDIUM; VENTRICULAR remodeling; RANDOMIZED controlled trials; TREATMENT effectiveness; ACUTE diseases; EARLY medical intervention; DESCRIPTIVE statistics
- Publication
Journal of Cardiovascular Magnetic Resonance (BioMed Central), 2020, Vol 22, Issue 1, p1
- ISSN
1532-429X
- Publication type
Article
- DOI
10.1186/s12968-020-00638-8