Author + information
- Received April 10, 2018
- Revision received June 21, 2018
- Accepted July 13, 2018
- Published online September 12, 2018.
- Tomaž Podlesnikar, MDa,
- Gonzalo Pizarro, MD, PhDb,c,d,
- Rodrigo Fernández-Jiménez, MD, PhDb,c,g,
- Jose M. Montero-Cabezas, MDa,
- Javier Sánchez-González, MDf,
- Chiara Bucciarelli-Ducci, MD, PhDe,
- Nina Ajmone Marsan, MD, PhDa,
- Zlatko Fras, MD, PhDh,
- Jeroen J. Bax, MD, PhDa,
- Valentin Fuster, MD, PhDb,g,
- Borja Ibáñez, MD, PhDb,c,i and
- Victoria Delgado, MD, PhDa,∗ ()
- aDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
- bCentro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- cCIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- dRuber Juan Bravo Hospital Universidad Europea, Madrid, Spain
- eBristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, United Kingdom
- fPhilips Healthcare, Madrid, Spain
- gZena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- hInternal Medicine Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
- iIIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Victoria Delgado, Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2 2333 ZA, Leiden, the Netherlands.
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]: NCT01311700)
- cardiovascular magnetic resonance
- global circumferential strain
- global longitudinal strain
- intravenous metoprolol
- ST-segment elevation myocardial infarction
The METOCARD-CNIC trial was partially supported by the Centro Nacional de Investigaciones Cardiovasculares (CNIC), through CNIC Translational Grant 01-2009. Other sponsors were the Spanish Ministry of Health and Social Policy (EC10-042), the Mutua Madrileña Foundation (AP8695-2011), and a Master Research Agreement between Philips Healthcare and the CNIC. Dr. Ibáñez is supported in part by the ISCIII Fondo de Investigación Sanitaria grants and ERDF/FEDER funds PI16/02110, DTS17/00136, PI13/01979, and SAF2015-71613-REDI. The CNIC is supported by the Ministerio de Ciencia, Innovación y Universidades (MICINN) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (MINECO award SEV-2015-0505). Dr. Bucciarelli-Ducci is supported by the Bristol National Institute of Health Research (NIHR) Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health Research or Department of Health. Dr. Sánchez-González is a Philips Healthcare employee. Dr. Bucciarelli-Ducci has been a consultant for Circle Cardiovascular Imaging. Dr. Delgado has received speakers fees from Abbott Vascular; and research grants to the Department of Cardiology of the Leiden University Medical Center from Biotronik, Medtronic, Boston Scientific, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 10, 2018.
- Revision received June 21, 2018.
- Accepted July 13, 2018.
- 2018 American College of Cardiology Foundation
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