title: Early metoprolol administration before coronary reperfusion results in increased myocardial salvage: analysis of ischemic myocardium at risk using cardiac magnetic resonance.
abstract: BACKGROUND
  Beta-blockers improve clinical outcome when administered early after acute myocardial infarction. However, whether beta-blockers actually reduce the myocardial infarction size is still in dispute. Cardiac magnetic resonance imaging can accurately depict the left ventricular (LV) ischemic myocardium at risk (T2-weighted hyperintense region) early after myocardial infarction, as well as the extent of necrosis (delayed gadolinium enhancement). The aim of this study was to determine whether early administration of metoprolol could increase myocardial salvage, measured as the difference between the extent of myocardium at risk and myocardial necrosis.
  
  
  RESULTS
  Twelve Yorkshire pigs underwent a 90-minute left anterior descending coronary occlusion, followed by reperfusion. They were randomized to metoprolol (7.5 mg during myocardial infarction) or placebo. Global and regional LV function, extent of myocardium at risk, and myocardial necrosis were quantified by cardiac magnetic resonance imaging studies performed 4 and 22 days after reperfusion in 10 survivors. Despite similar extent of myocardium at risk in metoprolol- and placebo-treated pigs (30.9% of LV versus 30.6%; P=NS), metoprolol resulted in 5-fold-larger salvaged myocardium (32.4% versus 6.2% of myocardium at risk; P=0.015). The LV ejection fraction significantly improved in metoprolol-treated pigs between days 4 and 22 (37.2% versus 43.0%; P=0.037), whereas it remained unchanged in pigs treated with placebo (35.1% versus 35.0%; P=NS). The extent of myocardial salvage was related directly to LV ejection fraction improvement (P=0.031) and regional LV wall motion recovery (P=0.039) at day 22.
  
  
  CONCLUSIONS
  Early metoprolol administration during acute coronary occlusion increases myocardial salvage. The extent of myocardial salvage, measured as the difference between myocardium at risk and myocardial necrosis, was associated with regional and global LV motion improvement.
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Borja
authors.initials: B
authors.lastname: Ibanez
authors.forename: Susanna
authors.initials: S
authors.lastname: Prat-González
authors.forename: Walter S
authors.initials: WS
authors.lastname: Speidl
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilahur
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinero
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cimmino
authors.forename: Mario J
authors.initials: MJ
authors.lastname: García
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Badimon
mesh_terms: D000818:Animals; D008279:Magnetic Resonance Imaging; D008790:Metoprolol / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control*; D015425:Myocardial Reperfusion; D009336:Necrosis; D013318:Stroke Volume; D013552:Swine
chemical_list: D008790:Metoprolol