In-hospital initiation of beta-blocker therapy in STEMI patients with cardiogenic shock improved LV global longitudinal strain by 4.6% (14.2% vs. 9.6%, p<0.001).
Does in-hospital initiation of beta-blocker therapy improve LV global longitudinal strain in patients with cardiogenic shock complicating STEMI treated with primary PCI?
In-hospital initiation of beta-blockers in patients with cardiogenic shock post-STEMI treated with primary PCI is associated with improved left ventricular global longitudinal strain.
Abstract Background Beta-blocker therapy is associated with improved left ventricular (LV) function in patients with ST-segment elevation myocardial infarction (STEMI) who treated with primary percutaneous coronary intervention (PCI), however, it is mainly avoided in patients who experienced cardiogenic shock (CS). Purpose In the present study, we aimed to investigate the impact of in-hospital initiation of beta-blocker therapy additional to inotropic agents in patients who experienced CS after STEMI treated with primary PCI. Methods Patients who experienced CS after STEMI treated with primary PCI. Patients were classified into two groups according to the in-hospital initiation of beta-blocker therapy. 2D-echocardiography was performed within 48 hours from hospitalization and LV myocardial performance was evaluated by LV global longitudinal strain (GLS) using speckle-tracking echocardiography. Results A total of 50 patients were selected (64±15 years old and 76% male). Age (66±14 vs. 62±15, p=0.369), heart rate (69±30 bpm vs. 79±40 bpm, p=0.379), blood pressure (104/64±41/22 mmHg vs. 103/64±54/35 mmHg, p=0.949/0.977), and usage of intravenous inotropic agents (74% vs. 73%, p=0.947) were comparable, while peak cTnI (71 34-132 ng/ml vs. 135 64-489 ng/ml, p=0.036) and final TIMI 3 flow (83% vs. 50%, p=0.013) were significantly different between patients who received beta-blocker therapy during their hospitalization and patients who didn’t. The LV GLS was significantly improved in patients who received beta-blocker therapy during hospitalization compared to patients who didn't (14.2±3.5% vs. 9.6±4.8%, p0.001). After adjustment of above mentioned predictors, in-hospital initiation of beta-blocker therapy was associated with improved LV GLS in patients with CS after STEMI treated with primary PCI (β=2.57, 95% CI 0.25-4.90, p=0.031). Conclusions In-hospital initiation of beta-blocker therapy additional to intravenous inotropic agents in patients who experienced CS after STEMI treated with primary PCI could improve LV myocardial performance.
Bum-Erdene et al. (2025) studied this question. In-hospital initiation of beta-blocker therapy in STEMI patients with cardiogenic shock improved LV global longitudinal strain by 4.6% (14.2% vs. 9.6%, p<0.001).