JCMR 2020;22:62. Prevalence and pattern of myocardial late enhancement in cardiac magnetic resonance of highly trained endurance athlete-s12968-020-00638-8

s12968-020-00638-8

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This METOCARD-CNIC substudy examined how regional left ventricular circumferential strain changes after first anterior STEMI, using feature-tracking cardiovascular magnetic resonance (CMR) at 1 week and 6 months in 191 patients. The study compared infarct zone and remote zone function, and assessed the influence of early intravenous metoprolol, microvascular obstruction (MVO), intramyocardial hemorrhage (IMH), and adverse left ventricular (LV) remodeling.<br /><br />Overall, infarct zone strain improved significantly from the acute to chronic phase, while remote zone strain stayed essentially unchanged. Patients treated with early intravenous metoprolol had better preserved infarct zone strain both at 1 week and at 6 months compared with controls, suggesting a durable cardioprotective effect. Metoprolol did not significantly affect remote zone strain.<br /><br />Patients with MVO or IMH had worse infarct zone strain at both time points than those without these findings, but infarct zone strain still improved over time regardless of MVO or IMH presence. Remote zone strain was not meaningfully different between patients with or without MVO/IMH.<br /><br />A key finding was that adverse LV remodeling, defined as a 20% increase in LV end-diastolic volume, was associated with worsening remote zone strain over 6 months, whereas infarct zone strain still improved. This suggests that remodeling involves detrimental changes beyond the infarct itself.<br /><br />The authors conclude that feature-tracking CMR regional strain provides a detailed view of post-STEMI myocardial recovery and remodeling, and that early intravenous metoprolol offers lasting protection mainly in the infarcted myocardium.

Keywords

anterior STEMI

left ventricular strain

feature-tracking CMR

infarct zone

remote zone

metoprolol

microvascular obstruction

intramyocardial hemorrhage

adverse LV remodeling

myocardial recovery