5020Prognostic value of left ventricular global circumferential and longitudinal strain with feature tracking cardiovascular magnetic resonance after ST-segment elevation myocardial infarction

Abstract

Introduction: Early metoprolol before reperfusion in anterior ST‐segment elevation myocardial infarction (STEMI) has been associated with better outcomes in the METOCARD‐CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial. Feature tracking cardiovascular magnetic resonance (CMR) permits assessment of left ventricular (LV) global circumferential (GCS) and longitudinal (GLS) strain. Purpose: To evaluate whether global LV strain with feature tracking CMR is associated with prognosis in STEMI patients and whether the association between global LV strain and prognosis is modulated by early intravenous metoprolol. Methods: 214 patients from the METOCARD‐CNIC trial who had a CMR performed 5‐7 days after acute anterior STEMI were evaluated. LV GLS and GCS were measured with feature tracking CMR. The occurrence of major adverse cardiac events (MACE) ‐ composite of death, heart failure readmissions, reinfarction and malignant ventricular arrhythmias ‐ was the primary endpoint. Patients were divided according to the median GCS/GLS values and the randomization status (early intravenous metoprolol vs. control group). The cumulative event rates were estimated using Kaplan‐Meier survival curves and log‐rank testing was used to compare the groups. Results: During a median follow‐up of 2 (interquartile range [IQR] 1.3‐2.4) years, 22 MACE occurred. The median value of LV GCS was ‐13.2% (IQR ‐10.0 to ‐ 16.5%) and the median value of GLS was ‐11.5% (IQR ‐9.4 to ‐13.4%). Patients with LV GCS>‐13.2% or with LV GLS>‐11.5% (more impaired LV systolic function) who did not receive early intravenous metoprolol showed the highest cumulative event rates (Figure 1). Conclusion: Global LV strain assessment with feature tracking CMR after STEMI provides important prognostic information. Patients with impaired LV strain who did not receive early intravenous metoprolol had highest cumulative MACE rates during follow‐up. (Figure Presented) .