TY - JOUR
AU - Caramanno,, G
AB - Abstract A 33-year-old man, ex drug addict on methadone therapy. He arrives to emergency department for syncope, reported by his wife reversion of the eyeballs and fine tremors with subsequent recovery of consciousness. A similar episode had happened a year ago. It was performed ECG: sinus bradycardia , 45 bpm, QT 600 msec, QTc 554 msec . Neurological examination performed: no motor deficits, negative Romberg. At brain CT no parenchymal tomodensitometric changes. Median line structures in axis. At the EEG: slight diffuse slow intercritical changes. Prescribed therapy with levetiracetam 500 mg. Cardiological examination and echocardiogram performed within the limits. Laboratory tests showed Trop HS 80 pg / ml. On the basis of the ECG and the slight increase of the troponin he was hospitalized in Cardiology and monitored. The following day, cardiac arrest due to torsade de pointes degenerated into ventricular fibrillation, DC shock was performed with the restoration of electrical and mechanical activity. Urgent coronary angiography was performed with evidence of coronary artery free from angiographically significant stenosis. SERT has been contacted: the patient had not been treated by them for some time and was using excessive doses of self-procuring methadone. In consideration of cardiac arrest from methadone long QT ventricular arrhythmia, ICD implantation was proposed, refused by the patient because he wanted to start detoxification therapy. During the hospitalization, progressive reduction of QT up to normalization in discharge. After a month new access to emergency department for presynopal episode, ECG showed sinus bradycardia with QTC 552 msec; the patient reports continuing to take excessive methadone doses and refuses treatment at a recovery center; considering that the ICD can be life-saving in this typ77e of patient (intractable addiction), we have re-proposed the ICD implant, rejected by the patient.   C2 HIS BUNDLE PACING: PULSE OPTIMIZATION TO REDUCE THE ENERGY COST L Marcantoni L Marcantoni OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO G Pastore G Pastore OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO E Baracca E Baracca OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO F Di Gregorio F Di Gregorio OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO A Barbetta A Barbetta OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO L Roncon L Roncon OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO F Zanon F Zanon OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO; MEDICO S.P.A., RUBANO Background His bundle pacing (HBP) entails physiological ventricular activation, with acknowledged hemodynamic and clinical benefits. However, it may require an increased energy expense. Objective HBP pulse optimization to reduce the battery consumption. Methods HBP safety margin (SM) was curtailed by including an additional ventricular lead in the pacing system, aimed at capture checking and myocardial stimulation only in the event of HBP failure (back-up on demand). A suitable CRT-P device was implanted to allow this approach in patients with preserved atrial function. In 14 cases with AVB, the HBP strength-duration curve was derived for both the mean and nominal threshold voltage, taking into account the waveform exponential decay, which occurs during pulse emission. The charge drain per pulse was worked out as a function of pulse duration, considering a 20% SM with respect to the nominal threshold: it corresponds to the product of the pulse charge times the applied tension multiplier. Results Mean and nominal threshold pulse at 1 ms averaged 1.65 ± 0.81 and 2.16 ± 1.01 V, respectively, with rheobase of 0.86 ± 0.41 V and chronaxie of 0.91 ± 0.47 ms. Although the chronaxie exceeded 1 ms in 30% of the cases, the nominal threshold generally featured just a mild decrease beyond 0.8 ms duration. The figure compares the nominal (Vimp_th) and mean threshold (Vm_th) in a representative case. The pulse duration ensuring 20% SM with minimum consumption averaged 0.59 ± 0.29 ms: 1 ms setting instead of the individual optimal duration implied a mean consumption increase of 41% to achieve the same SM. Conclusion Pulse optimization is advisable and can substantially reduce the energy cost of HBP. C3 THE BACK-UP LEAD IN HIS BUNDLE PACING: EVOLUTION OVER THE YEARS L Marcantoni L Marcantoni OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO G Pastore G Pastore OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO E Baracca E Baracca OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO S Aggio S Aggio OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO L Conte L Conte OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO M Carraro M Carraro OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO M Rinuncini M Rinuncini OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO K D‘Elia K D‘Elia OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO M Galasso M Galasso OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO L Roncon L Roncon OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO F Zanon F Zanon OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO OSPEDALE S.MARIA DELLA MISERICORDIA, ROVIGO Background His bundle pacing (HBP) maintains physiologic activation and prevent dyssynchrony associated with apical pacing. High thresholds and low sensing are the major pitfalls. This is the reason way in selected patients including an additional apical back-up lead is advisable. Objective the study represents a single-centre retrospective analysis of a large experience with HBP focusing on the back-up lead utilization over the years. Methods We retrospectively analyzed 677 patients (mean age 76±8 years; 433 males) implanted with HBP from 2004 to 2019 July. The pts received selective HBP (67%) or non-selective HBP by the 3830 lead. The indication for pacing were AV block 54%, sinus node disease 17%, slow atrial fibrillation 23%, heart failure 6%. Ischemic cardiopathy was found in 26%; hypertension 83%, diabetes in 28% and severe kidney disease in 7% of pts. Average pre-implant QRS duration was 123±32 ms and basal mean EF 56±12 %. Results Considering the overall population, a bipolar back-up lead was implanted in the apex or septum in 266 (39%) patients. Consequently it was required a three chamber PM in pts in sinus rhythm (back-up in RV port and Hisian lead in LV port). The His-Apex delay was set 80 ms in order to deliver His pulses and apical pacing during the myocardial refractory period. 30 pts (11%) received a particular type of three-chamber PM which provides apical back-up stimulus only in case of His capture loss, thus saving device’s longevity. Conversely, we implanted dual chamber PM in pts in atrial fibrillation (back up lead in RV port, Hisian lead in atrial port), programmed in DVI. We recorded a significant decrease of the back-up lead utilization over the years. The number of the back-up lead was strictly related to the operators/centre experience, amounting more than 70% during the first years, reducing to nearly 10% during the last year. Since 2015 the introduction of C315 fixed curve sheath in the clinical practice, strongly contributed to the rapid reduction of the back-up lead utilization thanks to better lead fixation and stability in long term follow-up. The mean longevity of the device was 6±2 years. Conclusions The back-up lead utilization is progressively decreasing. Until now it is strictly related to the operator/centre experience. The presence of the back-up lead could strengthen the Hisian pacing reliability, potentially impacting pacing indication even in advanced conduction disturbances and saving device longevity. C4 LINAC BASED STEREOTACTIC ARRHYTHMIA RADIOABLATION (STAR) OF VENTRICULAR TACHYCARDIA: A CASE REPORT A Di Monaco A Di Monaco OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI N Vitulano N Vitulano OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI F Quadrini F Quadrini OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI F Troisi F Troisi OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI A Surgo A Surgo OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI F Gregucci F Gregucci OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI E Ludovico E Ludovico OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI R Carbonara R Carbonara OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI I Bonaparte I Bonaparte OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI A Fiorentino A Fiorentino OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI M Grimaldi M Grimaldi OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI OSPEDALE GENERALE REGIONALE F. MIULLI, ACQUAVIVA DELLE FONTI Background The STereotactic Arrhythmia Radioablation (STAR) was recently introduced to treat ventricular tachycardia (VT). With precise high-dose of radiation to arrhythmic myocardial substrates, STAR could become more than an option in the next future. Few data are present in literature about this therapeutic option. We reported data regarding the first patient in Italy treated with Linac bases STAR was reported. Methods A 67-year-old man with ischemic cardiomyopathy and low ejection fraction (25%) who developed electrical storm. Catheter ablation was hampered due to left ventricular apical aneurism with thrombosis. The cardiac surgeon considered the intervention not feasible due to excessive risk. VT was treated with STAR. ECG during ventricular ectopies (VEs) and VT were analysed to localized the myocardial interest region. Furthermore, the myocardial arrhythmic substrate (fibrotic area) was defined analysing vitality data obtained by cardiac-gated CT, SPECT and PET-CT. The interest region was located in the inferior region of mid interventricular septum. A 4-D computed tomography scan (2 mm slice thickness) were obtained with patients in the supine position using a personalized immobilization device, including Vac-loc, to evaluated cardiac and respiratory target motion. A dose of 25 Gy in one fraction was prescribed to the planning target volume (PTV). Treatment plan was generated with volumetric modulated arc therapy. IGRT (image guided radiotherapy) and SGRT (surface-guided radiotherapy) were used to reduce set-up error and to monitoring patients during fraction. The treatment plan was delivered in 6 minutes. Results Patient was treated on 6 September 2019. No side effects were documented. At 2 month FU, the intracardiac defibrillator did not record VTs. The VEs decreased from 24000/24h to 123/24h. Conclusion STAR may be useful in patients with VT not suitable for catheter ablation. Further studies are needed to evaluate the safety and clinical benefits of this procedure. C5 LEFT ATRIAL HYPERTENSION INVASIVELY MEASURED DURING PULMONARY VEIN ISOLATION PREDICTS ATRIAL FIBRILLATION RECURRENCE G Mugnai G Mugnai OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO; OSPEDALE PUBBLICO DI BOLZANO, BOLZANO; UNIVERSITAIR ZIEKENHUIS BRUSSEL, BRUSSELS M Manfrin M Manfrin OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO; OSPEDALE PUBBLICO DI BOLZANO, BOLZANO; UNIVERSITAIR ZIEKENHUIS BRUSSEL, BRUSSELS G Chierchia G Chierchia OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO; OSPEDALE PUBBLICO DI BOLZANO, BOLZANO; UNIVERSITAIR ZIEKENHUIS BRUSSEL, BRUSSELS C Bilato C Bilato OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO; OSPEDALE PUBBLICO DI BOLZANO, BOLZANO; UNIVERSITAIR ZIEKENHUIS BRUSSEL, BRUSSELS W Rauhe W Rauhe OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO; OSPEDALE PUBBLICO DI BOLZANO, BOLZANO; UNIVERSITAIR ZIEKENHUIS BRUSSEL, BRUSSELS OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO; OSPEDALE PUBBLICO DI BOLZANO, BOLZANO; UNIVERSITAIR ZIEKENHUIS BRUSSEL, BRUSSELS Aims The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction who underwent PV isolation and its implication for AF catheter ablation. Methods Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure ³15 mm Hg. Results A total of 98 consecutive patients (71 males, 72%; mean age 60.3±8.4 years) were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 10.7±4.5 mmHg; LAH occurred in 24 (24.5%) patients. At a mean follow up of 14.6±7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). Older age, LA volume and LAH were significantly associated with early AF recurrence during the blanking period. However, only LAH independently remained a significant predictor of late AF recurrence (HR 3.02, 1.36-6.72, p = 0.007). Conclusion Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences. C6 CHARACTERIZATION OF THE PULMONARY VEINS RECONNECTION AFTER CRYOABLATION IN THE ATRIAL FIBRILLATION F Panzeri F Panzeri ASST GOM NIGUARDA CA‘ GRANDA, MILANO M Baroni M Baroni ASST GOM NIGUARDA CA‘ GRANDA, MILANO A Testoni A Testoni ASST GOM NIGUARDA CA‘ GRANDA, MILANO F Piccinin F Piccinin ASST GOM NIGUARDA CA‘ GRANDA, MILANO G Colombo G Colombo ASST GOM NIGUARDA CA‘ GRANDA, MILANO G Cattafi G Cattafi ASST GOM NIGUARDA CA‘ GRANDA, MILANO ASST GOM NIGUARDA CA‘ GRANDA, MILANO Background and Aim The pulmonary veins isolation (PVI) represents the main target of atrial fibrillation (AF) ablation therapy. Cryoablation allows the simultaneaous application of energy at the antral level along the entire junction between the left atrium and the pulmonary veins (PV), often with a single application. Although this approach is technically attractive, it implies that the amount of energy is the same along the resulting lesion leading to an important substrate for the pulmonary veins reconnection. The purpose of this study was to identify the most common sites of reconnection of the PV after a cryoablation procedure in patients with AF recurrence. Methods We enrolled 20 patients who underwent a re-do procedure for AF recurrence after a first index PVI alone using Artic Front Advance 2 system. A three-dimensional (3D) electroanatomical map (Carto 3, Biosense Webster, Diamond Bar – CA) was performed in all patients. Results All 20 patients had at least one reconnected PV with median of 2 reconnected veins per patient. Figure 2 and figure 3 shows the sites of the reconnection gaps. The right inferior pulmonary vein (RIPV) was the most reconnected vein (80% of patients), while the right superior pulmonary vein (RSPV) was the least reconnected (50% of patients) [P = 0.028]. Three patients had only one reconnected PV, in all cases the right inferior one. Five patients had all pulmonary veins reconnected. Considering the quadrants, the RIPV had the largest number of reconnected segments (37/80), while the RPSV had the fewest number (15/80). Figure 4. The inferior pulmonary veins were more reconnected than the superior ones (33/152 total segments vs 64/152, p = 0.0001). The superior pulmonary veins were found to be more connected in the upper quadrants than in the lower ones (23/76 vs 10/76 p = 0.01), while there was no statistically significant difference for the lower veins (29/76 vs 35/76 p = 0.3). The two patients with left pulmonary veins originating with a common trunk had at least one reconnection gap at this level. Conclusions We found that the right inferior pulmonary vein is the most reconnected vein. The mechanism behind the different incidence of reconnection of the veins is intrinsic to the procedure of cryoablation. C7 TRANSCATHETER ABLATION FOR REFRACTORY ATRIAL FIBRILLATION: A NON-RANDOMIZED COMPARISON STUDY BETWEEN CONTACT FORCE RADIOFREQUENCY METHOD WITH ABLATION INDEX AND CRYOBALOON M Toniolo M Toniolo AZIENDA OSPEDALIERA S.MARIA DELLA MISERICORDIA, UDINE M Burelli M Burelli AZIENDA OSPEDALIERA S.MARIA DELLA MISERICORDIA, UDINE L Rebellato L Rebellato AZIENDA OSPEDALIERA S.MARIA DELLA MISERICORDIA, UDINE E Daleffe E Daleffe AZIENDA OSPEDALIERA S.MARIA DELLA MISERICORDIA, UDINE A Proclemer A Proclemer AZIENDA OSPEDALIERA S.MARIA DELLA MISERICORDIA, UDINE AZIENDA OSPEDALIERA S.MARIA DELLA MISERICORDIA, UDINE Background In recent years, cryobaloon pulmonary vein isolation has been proposed as a valid alternative to the radiofrequency ablation procedure: in most of the studies proposed so far, an inferiority of the first method compared to the second has never been demonstrated in terms of clinical success. RF ablation, however, has seen a significant change in its operating protocol, from the use of standard catheters to the introduction of contact force-sensing catheters, up to the use of standardized indices such as the Ablation Index (AI): currently AI represents the most effective predictor of pulmonary vein isolation. The aim of our study was to compare cryoablation with RF ablation with these new operational protocols in terms of clinical success, understood both as the absence of recurrence and as an improvement in the patient's quality of life, and safety, understood as complication rate of the two procedures. Methods 105 patients with paroxysmal and persistent atrial fibrillation (AF) refractory to antiarrhythmic therapy were included, 49 underwent radiofrequency ablation (82% male; average age at ablation 59.5 ± 9.7 years; 76% patients with paroxysmal AF) while 56 patients underwent cryoablation (73% male; average age at the time of ablation 60.5 ± 9.6 years; paroxysmal AF patients were 95%). Radiofrequency ablation was delivered targeting interlesion distance ≤ 6 mm and Ablation Index value ≥ 350 on the posterior wall and ≥ 450 on the anterior wall. Results Comparing the "cryoablation" and "RF ablation" groups, there was no statistically significant difference in terms of absence of recurrence of AF at 12 months after a single procedure (log-rank test, P = 0.949), considering a three-month blanking period. As for the "cryoablation" group, at one year, 63% of the patients were free from FA, while, considering the "RF ablation" group, at one year, 64% of the patients were free from FA. As regards the safety endpoint, complications were recorded in 5 patients of the "cryoablation" group, of which 1 major (a cardiac tamponade treated with pericardiocentesis), while in the patients of the "RF ablation" group, only 3 patients had complications, of which none major. Going to analyze the clinical improvement, understood as a reduction equal to or greater than 80% of the arrhythmic burden, there was no significant difference between the two groups (log-rank test, P = 0.413). One year after the procedure, 82.5% of patients experienced clinical improvement in the "cryoablation" group, against 78% improved patients in the "RF ablation" group. Conclusions With this study we observed the substantial equivalence of contact force radiofrequency method with ablation index compared to cryoablation, both in terms of efficacy both in terms of safety of the procedure: the results obtained suggest a low complication rate in both groups. MYOCARDIAL INFARCTION 1C8 CORONARY SINUS REDUCER: THE ITALIAN MULTICENTER EXPERIENCE G D‘Amico G D‘Amico OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA M Massussi M Massussi OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA S Andreaggi S Andreaggi OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA F De Marco F De Marco OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA F Sgura F Sgura OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA A Ielasi A Ielasi OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA S Ghiringhelli S Ghiringhelli OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA T Lancialonga T Lancialonga OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA A Cafaro A Cafaro OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA A Picchi A Picchi OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA M Tebaldi M Tebaldi OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA M Cerrito M Cerrito OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA S Saccà S Saccà OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA S Berti S Berti OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA M Ciardetti M Ciardetti OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA R Latini R Latini OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA B Cortese B Cortese OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA A Gaspardone A Gaspardone OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA G Stefanini G Stefanini OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA F Giannini F Giannini OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA OSPEDALE DELL‘ANGELO, MESTRE; OSPEDALE UNIVERSITARIO PADOVA, PADOVA; POLICLINICO SAN DONATO, MILANO; POLICLINICO DI MODENA, MODENA; A.O. BOLOGNINI, MILANO; OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VASERE; OSPEDALE F.MIULLI, ACQUAVIVA DELLE FONTI; AZIENDA USL 9 DI GROSSETO, GROSSETO; A.O.U DI FERRARA, FERRARA; OSPEDALE DI MESSINA, MESSINA; OSPEDALE DI MIRANO, MIRANO; FONDAZIONE MONASTERIO, MASSA CARRARA; OSPEDALE FATEBENEFRATELLI, MILANO; OSPEDALE SANT‘EUGENIO, ROMA; HUMANITAS, ROZZANO; MARIA CECILIA HOSPITAL, COTIGNOLA Introduction The Reducer is a stainless-steel device designed to create a focal narrowing in the lumen of the CS to generate a pressure gradient across it. In the presence of myocardial ischemia, the device is intended to improve perfusion to ischemic territories of the myocardium, thus alleviating the symptoms of angina. The use of the device has been recently described as an effective option for the treatment of refractory angina in the 2019 ESC guidelines for the diagnosis and the management of chronic coronary syndromes. The aim of our study was to assess the efficacy and the safety of the Reducer in a large multi-center cohort of patients affected by refractory angina. Methods 183 patients were treated with coronary sinus Reducer implantation at 16 Italian centers. We define technical success as the successful delivery and deployment of the reducer to the intended site. Safety endpoint was the combination of technical success with the absence of the need for clinically-driven intervention to address a SAE prior to hospital discharge. Efficacy endpoint was the reduction in angina severity (CCS class status), the improvement of quality of life (Seattle Angina Questionnaire) at follow up and the reduction of anti-anginal therapy at follow up. Results Technical success was achieved in 180 (98%) patients and procedural success was reached in 175 (95%) patients with 1 coronary sinus perforation, 5 device embolization and 3 cases of second device implanted. At a median follow up of 564 days 144 patients (83%) had at least 1class reduction in CCS scale and 87 patients (50%) had at least 2 class reduction in CCS scale. Regarding quality of life, all Seattle Angina Questionnaire items improved significantly (p < 0.001 for all) at follow up. Conclusions In this real world, multicenter cohort of patients the implantation of the coronary sinus reducer resulted safe and was associated with a significant reduction of angina symptoms and improvement of quality of life. Our data are consistent with the previous studies on Reducer device efficacy and safety. C9 PERCUTANEOUS CORONARY INTERVENTION WITH AGENTTM PACLITAXEL-COATED BALLOON: A REAL-WORLD MULTI-CENTRE EXPERIENCE G Iannopollo G Iannopollo INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO F Giannini F Giannini INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO F Ponticelli F Ponticelli INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO B Pagliaro B Pagliaro INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO G Tzanis G Tzanis INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO G Gallone G Gallone INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO M Montorfano M Montorfano INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO A Colombo A Colombo INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO A Durante A Durante INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN; DIVISION OF CARDIOLOGY, LABORATORY OF INTERVENTIONAL CARDIOLOGY, MAGGIORE HOSPITAL, BOLOGNA, ITALY, MILANO,BOLOGNA; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY, MILANO,COTIGNOLA; UNIVERSITÀ VITA–SALUTE SAN RAFFAELE, MILANO, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; CARDIO CENTER, HUMANITAS RESEARCH HOSPITAL, ROZZANO–MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY; HENRY DUNANT HOSPITAL, ATHENS, GREECE, MILANO, ATENE; INTERVENTIONAL CARDIOLOGY UNIT, SAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY, MILANO; INTERVENTIONAL CARDIOLOGY UNIT, GVM CARE & RESEARCH MARIA CECILIA HOSPITAL, COTIGNOLA, ITALY; EMO GVM CENTRO CUORE COLUMBUS, MILAN, ITALY, COTIGNOLA, MILANO; CARDIOLOGY DIVISION, VALDUCE HOSPITAL, COMO, ITALY, COMO Background The AgentTM paclitaxel-coated balloon is a new drug-coated balloon (DCB), with limited real-world available data. Our study sought to assess the safety and efficacy of this new DCB during percutaneous coronary intervention (PCI) in different coronary lesions types in a prospective registry. Methods and Results All comers patients undergoing PCI with use of AgentTM DCB in 3 Italian centers between September 2014 and March 2018 were included in this registry. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, recurrent nonfatal myocardial infarction (MI) and target lesion revascularization (TLR). DCB procedural lesion success was also evaluated. Among 354 patients (with 450 lesions treated with 508 DCBs) included in the registry, AgentTM DCBs were used for the treatment of in-stent restenosis (ISR), small vessel disease (SVD), bifurcation lesions (BL) and “stent-like result” (SLR) lesions obtained after balloon pre-dilatation in 34%, 29%, 26%, 11%, respectively. The implant of Agent DCBs was safe and with a high DCB lesion success (92%). 1-year MACE was 5.7% in the overall population. Higher MACE (8.3%) were observed in the ISR group, as compared to SVD group (3.6%, p = 0.028), with a trend of higher events rates as compared to both BL (3.7%, p = 0.09) and SLR groups (5.5%, p = 0.54). Conclusions The use of AgentTM DCB during PCI appears safe and effective in a large real-world registry. These results were maintained in all subgroups with a slightly higher trend of events rates in the ISR setting, consistent with the higher risk nature of this subset. C10 SHORT AND LONG-TERM OUTCOME AFTER PCI WITH DES IN EDERLY PATIENTS C Auguadro C Auguadro OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO D Presutti D Presutti OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO B Cortese B Cortese OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO S Biscaglia S Biscaglia OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO M Serenelli M Serenelli OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO G Campo G Campo OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO A Ielasi A Ielasi OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO F D‘Ascenzo F D‘Ascenzo OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO E Cerrato E Cerrato OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO U Barbero U Barbero OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO S Pezzilli S Pezzilli OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO M Bianco M Bianco OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO A Latini A Latini OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO L Ferri L Ferri OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO C Templin C Templin OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO S Bronzato S Bronzato OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO A Durante A Durante OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO OSPEDALE VALDUCE, COMO; CLINICA SAN CARLO, PADERNO DUGNANO; OSPEDALE FERRARA, FERRARA; UNIVERSITÀ FERRARA, FERRARA; ICSA, MILANO; MOLINETTE, TORINO; OSPEDALE RIVOLI, RIVOLI; OSPEDALE, ORBASSANO; OSPEDALE, TORINO; OSPEDALE ORBASSANO, ORBASSANO; FATEBENEFRATELLI, MILANO; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE ZURIGO, ZURIGO; STUDIO MEDICO LAMBRODODICI, MILANO Background Increasing number of elderly patients with many comorbidities undergo percutaneous coronary interventions (PCI), in the majority of cases this occurs in the setting of acute coronary syndromes. Bleeding risk is higher in elderly pts than in younger, however, the use of new generations of DES allows to reduce the duration of DAPT without significant increase of stent thrombosis. Objectives of the study were 1. to determine the in-hospital and long-term outcome of elderly pts undergoing PCI with DES; 2. to determine the incidence of bleeding complicantions both in-hospital and during follow-up. Population and Methods Study population included 2098 pts >80 years old (mean age 83.2 ± 2.9 yrs) who underwent PCI+DES. After the procedure all pts received Aspirin (100 mg/die) in addition to Clopidrogel (75mg/die) or Ticagrelor (90mgmg/die) for mean time of 6 to 12 months. The events taken into consideration before hospital discharge were: total mortality, cardiac death, bleedindg events and acute renal failure. During follow-up we defined as MACE the occurrence of cardiac death, non-fatal myocardial infarction (MI), unstable angina. Results Stable angina and/or inducible myocardial ischemia was present in 55% of pts; the remaing 45% were acute pts. Previous myocardial revascularization was present in 37.5% of pts. Coronary angiography was performed with radial access in 67% of cases; 1-vessel disease was documented in 20%, 2-vessels in 35% and 3-vessels in 45% of pts. Complete revascularization was done in 52% of pts. The majority of pts (96%) did not have complications before discharge. In-hospital death occurred in 1.2% of the global population with cardiac death documented in 1% of pts. Bleeding complications occurred in 0.8% (all minor bleeding) and acute renal failure in 2% of pts. One-year follow-up was performed in 97% of pts. DAPT was prolonged until 1 year in 60%. During follow-up the incidence of total mortality was 8.4%, cardiac death occurred in 3.6% of pts. MACE occurred in 13.2% of pts. New revascularizations (TVR o TLR) were performed in 8% of pts. The incidence of bleeding events was 6.8% with need for transfusion in 2.5% of cases. Conclusions in elderly pts who undervent PCI with DES the incidence of post-procedural complications before hospital discharge was very low; also the incidence of MACE and bleeding complicantions during 1-year follow-up was low. These results support the safety of PCI with DES in elderly populations. C11 SECONDARY PREVENTION MEDICAL THERAPY AND OUTCOMES IN PATIENTS WITH MYOCARDIAL INFARCTION WITH NON-OBSTRUCTIVE CORONARY ARTERY DISEASE P Paolisso P Paolisso CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA L Bergamaschi L Bergamaschi CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA G Saturi G Saturi CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA E D‘Angelo E D‘Angelo CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA I Magnani I Magnani CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA S Toniolo S Toniolo CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA A Stefanizzi A Stefanizzi CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA F Angeli F Angeli CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA F Donati F Donati CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA L Bartoli L Bartoli CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA P Rucci P Rucci CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA C Pizzi C Pizzi CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA N Galiè N Galiè CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; CARDIOLOGIA – POLICLINICO SANT‘ORSOLA – MALPIGHI, BOLOGNA; STATISTICA MEDICA – UNIVERSITÀ ALMA MATER STUDIORUM – BOLOGNA, BOLOGNA Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with relevant long term major cardiovascular events. Nevertheless, clinical data on optimal medical therapy for secondary prevention in MINOCA patients are lacking. Purpose To investigate prospectively the associations between secondary prevention treatments at discharge and mid-term outcomes in MINOCA. Methods Out of 1141 patients with acute myocardial infarction (MI) undergoing early coronary angiography between 2016 and 2018, we identified 88 patients with diagnosis of MINOCA, according to 2016 ESC MINOCA Position Paper criteria. Second-level diagnostic work-up including cardiac magnetic resonance was performed. The association between treatment and outcome was evaluated by using Cox proportional hazards models. All confirmed MINOCA were followed in our outpatient clinics. The primary end-points were all-cause mortality, re-hospitalization for MI and a composite outcome including all-cause mortality, hospitalization for MI and ischemic stroke (MACE). Results Out of 1141 AMI who underwent coronary angiography, 134 were initially diagnosed as MINOCA. MINOCA were significantly less treated with secondary prevention treatments compared to ob-4 coronary artery disease (CAD) MI (respectively, 42.1 vs 81.8% for DAPT; 75.5% vs 89.6% for β-blockers; 64.7% vs 80.3% for RAAS inhibitor and 63.9% vs 83% for statins). According to the diagnostic work-up completed during the first month after discharge, we reached a final sample of 88 patients with confirmed MINOCA. During an average follow-up of 19.35±10.65 months, all-cause mortality occurred in 11 (12.5%) patients, re-MI in 4 (4.5%), ischemic stroke in no patient and MACE in 15 (17.0%) patients. RAAS inhibitors and statins were significantly associated with longer survival in a Kaplan-Meier analysis. On the contrary, no increase in survival was associated with the use of β-blockers, and DAPT. Cox multivariable analysis, including all secondary prevention drugs, showed that only RAAS inhibitors were associated with reduced all cause-mortality and MACE. Conclusion RAAS inhibitors provides mid-term beneficial effects on outcomes in MINOCA patients; in contrast, DAPT, β-blocker and statin therapy had no effects on mortality and MACE. C12 PROGNOSTIC DIFFERENCES IN MYOCARDIAL INFARCTION WITH NON-OBSTRUCTIVE CORONARY ARTERIES (MINOCA) DUE TO CORONARY CAUSES VERSUS SUPPLY-DEMAND MISMATCH L Bergamaschi L Bergamaschi POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA P Paolisso P Paolisso POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA S Toniolo S Toniolo POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA A Stefanizzi A Stefanizzi POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA F Donati F Donati POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA F Angeli F Angeli POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA L Bartoli L Bartoli POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA A Foà A Foà POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA A Rinaldi A Rinaldi POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA C Pizzi C Pizzi POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA N Galiè N Galiè POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA POLICLINICO S.ORSOLA MALPIGHI, BOLOGNA Background and Purpose Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is a heterogeneous entity accounting for coronary (MINOCA-Co) and non-coronary conditions related to discrepancy (MINOCA-NCo). Clinical and prognostic implications of these two different subgroups are still unknown. Methods Between 2016 and 2018 we prospectively enrolled all patients admitted to our Center who fulfilled the 2016 ESC diagnostic criteria for MINOCA. According to pre-specified criteria regarding supply-demand mismatch, the study cohort was divided into MINOCA-NCo and MINOCA-Co. We evaluated all-cause and cardiovascular mortality included re-infarction. Results Among 1093 acute myocardial infarction, we enrolled 97 MINOCA. The median follow-up time was 19.8 ± 4.6 months. MINOCA-Co was the more prevalent entity with 63 (65%) patients while 34 (35%) were MINOCA-NCo. The two subgroups showed similar baseline characteristics and classic cardiovascular risk factors. Peripheral vasculopathy (14.6% vs. 3.9%; p = 0.04) and chronic obstructive pulmonary disease (29.3% vs. 7,8%; p = 0.002) were more prevalent in MINOCA-NCo. At admission, MINOCA-Co more frequently presented sinus rhythm (91.6% vs 73.5% p = 0.015) but there was no significant difference regarding the presence of ST-segment elevation. No difference was found regarding the infarct size assessed by mean ejection fraction and troponin values. At 2-year follow-up, a total of 11 (11,3%) deaths from all causes was recorded: 4 patients (6.3%) in MINOCA-Co and 7 patients (20,6%) in MINOCA-NCo group (p = 0.04). Cardiovascular-related deaths were also more frequent in MINOCA-NCo group (12.1% vs 1.8%; p = 0.04). Considering a composite endpoint (all-cause deaths + re-infarction), MINOCA-NCo still showed a worse outcome at two years (27.3% vs 10.9%, p = 0.04). Multivariate analysis adjusted for age and sex revealed that discrepancy was an independent predictor for all-cause deaths and re-infarction (HR 3.31; 95% CI 1.05-10.48; p = 0.04). Also, we found that all MINOCA were not properly treated regarding antiplatelet drugs (prescribed in 88% of all population), dual antiplatelet therapy (64%), statins (71.1%), beta-blockers (75%) and ACE-inhibitors/Sartans (69.7%) without significant differences in the two subgroups considered. Conclusions MINOCA is not a benign condition. MINOCA-NCo due to discrepancy had the worst outcome, compared to MINOCA-Co, and requires even better management and attention during follow-up. CARDIAC SURGERYC13 VERY LONG TERM RESULTS OF SURGERY FOR INFECTIVE ENDOCARDITIS: SINGLE CENTER EXPERIENCE A Rubino A Rubino DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI A Della Corte A Della Corte DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI E Della Ratta E Della Ratta DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI G Falivene G Falivene DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI A Iaccarino A Iaccarino DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI R Ashurov R Ashurov DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI C Bancone C Bancone DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI L De Santo L De Santo DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI M De Feo M De Feo DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI DIP. SCIENZE MEDICHE TRASLAZIONALI – UNIVERSITÀ DEGLI STUDI DELLA CAMPANIA L. VANVITELLI, NAPOLI; OSPEDALE MONALDI, NAPOLI Background Infective endocarditis is a dreadful condition, associated with increased operative mortality. Although antibiotical and technological advancements significantly improved the immediate outcomes, little is known on the long term results after surgery. Therefore, the main aim of this study was to assess the very long term outcomes after surgery for infective endocarditis, in a single center, high-volume institution. Methods From February 1979 to July 2019, data from 885 consecutive patients operated on for infective endocarditis in a single center have been included in a prospective institutional database, including preoperative infective details. Hospital outcomes during index hospitalization as well as at last available follow-up were recorded. Results Mean age was 52.5±15.8, median Additive Euroscore was 8 (IQR 5-11), Logistic Euroscore 8.8% (IQR 4.4-22.6), Euroscore II 7.8% (IQR 2.9-20.7). Main indications for surgery were hemopdynamic compromission (315 patients) and Heart Failure (197 patients). 523 patients (58.6%) were operated on an urgency basis, whereas 167 (18.7%) on emergency. Hemocoltures were positive in 528 (59.5%) cases, with Streptococci and Staphilococci as the main bacteria involved (242, 27.3% and 271, 24.4% respectively). A single valve was involved in 709 cases (80.1%), mainly aortic (42.9%) and mitral (30.2%). Operative mortality was 15.7% and was cardiac related in 97 cases and secondary to sepsis in 19. Neurological events accounted for 7 deaths. After 30 years, (follow-up 92.4% complete) overall actuarial survival was 32.8±3.6%, with significantly better outcomes for native valve endocarditis compared to prosthesis (37.3% vs 21.4%, p < 0.001). No differences were observed stratifying according to 10-year interval of operation (p = 0.14) and for numnber of valve involved (p = 0.06). Freedom from reinfection was 77.1±2.4% (native 84.2% vs prosthesis 51.3%, p < 0.001). Due to the extensiveness of follow-up, freedom from reoperation was 1.1±0.5%, with no differences between native vs prosthetic involvement (1.2% vs 0.9%, p = 0.08) but increased incidence in case of multiple valve involvement (one valve 1.2 vs 2+ valves 0.9%, p = 0.005). Conclusions Excellent long-term results can be achieved after surgery for infective endocarditis. Native valve endocarditis is associated to significantly better outcomes, in terms of long-term survival and freedom from infections. Reoperation rate is increased when 2 ore more valves are involved. C14 CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH CONCOMITANT SOLID TUMORS: EARLY AND LONG-TERM RESULTS A Garatti A Garatti IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA M D‘Ovidio M D‘Ovidio IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA G Saitto G Saitto IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA A Daprati A Daprati IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA A Canziani A Canziani IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA E Mossuto E Mossuto IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA C De Vincentiis C De Vincentiis IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA A Parolari A Parolari IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA L Menicanti L Menicanti IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA IRCCS POLICLINICO SAN DONATO, SAN DONATO M.SE; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO/ ASL ROMA1, ROMA Objective To analyze a consecutive series of patients with solid organ tumors undergoing CABG, defining the risk factor for early and long-term outcomes. Methods Between 2005-2016, a consecutive series of 4079 patients underwent isolated CABG at our institution. Among 103 patients(2.5%) with active malignancy, we enrolled 82 patients(mean age 71±7 years;) with solid organ tumors, divided in four subgroups: lung(9 pts–11%), gastro-enteric(16 pts–20%), urinary(48 pts–58%) and other solid tumors(9 pts-11%). A deterministic record linkage, between the clinical database and the National Hospital Information System, allowed identification of long-term survival and freedom from MACE(acute MI, repeated PCI and HF admission). Results The most common forms of cancer were prostate, colon and lung carcinoma. Compared to general-CABG patients, neoplastic patients were significantly older and with a higher rate of comorbidities, without significant differences among the cancer subgroups. Thirty-day mortality was significantly higher in cancer patients(4.9%vs1.8%) compared to general-CABG population. However, at logistic regression analysis, cancer resulted an independent risk factor for postoperative pulmonary dysfunction but not for in-hospital mortality. Median FU was:58±12 months. Overall 5-years survival was 60%, with a dismal 30% survival only in lung tumours. Five-year freedom from MACE was 70%, without significant differences among subgroups and was comparable to the general-CABG population. Resolution of coronaropathy allowed safe cancer surgical resection in 80% of the population. Conclusion Based on the present study, CABG should not be denied in patients with solid organ tumours, advocating worse prognosis or less graft durability. Further studies with larger numbers are warranted. C15 IMPLANTABLE LVAD SUPPORT DOES NOT AFFECT OUTCOMES AFTER HEART TRANSPLANT T Bottio T Bottio UNIVERSITÀ DI PADOVA, PADOVA M Carrozzini M Carrozzini UNIVERSITÀ DI PADOVA, PADOVA A Gambino A Gambino UNIVERSITÀ DI PADOVA, PADOVA G Toscano G Toscano UNIVERSITÀ DI PADOVA, PADOVA V Tarzia V Tarzia UNIVERSITÀ DI PADOVA, PADOVA R Caraffa R Caraffa UNIVERSITÀ DI PADOVA, PADOVA O Bifulco O Bifulco UNIVERSITÀ DI PADOVA, PADOVA J Bejko J Bejko UNIVERSITÀ DI PADOVA, PADOVA D Gregori D Gregori UNIVERSITÀ DI PADOVA, PADOVA G Gerosa G Gerosa UNIVERSITÀ DI PADOVA, PADOVA UNIVERSITÀ DI PADOVA, PADOVA Background Left-Ventricular-Assist-Devices (LVADs) have been increasingly used as bridge-to-transplant, yet whether their use affects outcomes after HTx is unclear. The aim of the present study was to analyze the post-HTx outcomes of patients with or without previous support with an LVAD. Materials and Methods We reviewed all patients who underwent HTx between January-2012 and December-2017. Exclusion criteria were: anatomical/technical contraindications to LVAD and bridge-to-candidacy implant strategy. Outcomes considered were early and mid-term survival and rate of adverse events. Results We included 138 patients: 46 previously implanted with a continuous-flow LVAD (LVAD group) and 92 not (No-LVAD group). LVAD patients were younger and more frequently male. Cardiac risk factors were similarly distributed amongst the two groups. Donor characteristics were similar. Mean time of follow-up was 26±22 months. Kaplan-Meier survival was comparable between groups (log-rank p = 0.67) with 12-month survival of 81% (CI95%: 72% - 89%) in No-LVAD group and 85% in LVAD group (CI95%: 74% - 95%). Thirty-day death was similar (9% LVAD vs 4% No-LVAD, p = 0.44), as well as ICU-stay (p = 0.05) and hospital-stay (p = 0.08). Rates of adverse events were comparable. LVAD patients showed a higher rate of donor specific antibody development (32% vs 12%, p = 0.03). Conclusions Post-HTx survival was comparable between patients previously assisted with LVAD or not. Rate of early and mid-term adverse events was similar, as well. C16 SEPTAL MYECTOMY AND TRANS-AORTIC MITRAL VALVE REPAIR IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY: MID-TERM SINGLE CENTER EXPERIENCE J Alfonsi J Alfonsi CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA C Lofiego C Lofiego CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA F Vagnarelli F Vagnarelli CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA N Schicchi N Schicchi CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA P Berretta P Berretta CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA M Cefarelli M Cefarelli CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA G Perna G Perna CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA M Di Eusanio M Di Eusanio CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA CARDIOCHIRURGIA – OSPEDALI RIUNITI – UMBERTO LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I – LANCISI, ANCONA; CARDIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; RADIOLOGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA; CARDIOCHIRURGIA – OSPEDALI RIUNITI UMBERTO I LANCISI, ANCONA Background In Hypertrophic Obstructive Cardiomyopathy (HOCM), left ventricular outflow tract obstruction (LVOTO) results from a complex interaction between the septum and the abnormal mitral valve apparatus. Therefore, combined septal myectomy and mitral valve repair are often necessary to relieve LVOT obstruction and improve patients’ prognosis Matherials and Methods Between October 2017 and October 2019, 26 patients underwent septal myectomy at the Lancisi Cardiovascular Center. After excluding 5 patients requiring mitral valve replacement due to valvular organic/infective disease, we assessed mid term clinical/echocardiographic outcomes of 21 patients receiving septal myectomy and trans-aortic mitral valve repair with papillary muscle (PMs) mobilization and anterior mitral leaflet secondary chordal cutting. Mean age was 65 years, 10 patients were male. Ten patients were in NYHA class II and 11 in NYHA class III; 7 experienced syncope and 7 angina. Pre-operative echocardiography revealed IVSd= 22mm (16-31 mm), rest LVOT gradient=68 mmHg (11-135), LVEF%=69% (45-80), PAPs=43 mmHg (22-65); LAVol=55ml/m2 (32-85). 18 patients had mitral regurgitation > =2, and 17 PMs/chords abnormalities. Results All patients but one survived at follow up (100% complete, mean time 12 months) with only one in-hospital death due to postoperative stroke. At follow up a clear improvement of symptoms was observed with all patients being in NYHA class I-II; echocardiography revealed mean LVOT gradient=17 mmHg; only 3 patients had mild/moderate mitral insufficiency with all others having none. Conclusions Mid term outcome of patients undergoing septal myectomy and trans-aortic mitral valve repair appears satisfactory with stable relief of LVOT obstruction and low mortality/morbidity rates. C17 BILATERAL INTERNAL THORACIC ARTERY USE FOR COMBINED CORONARY SURGERY G Gatti G Gatti AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL S Michelotti S Michelotti AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL C Zilio C Zilio AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL A Fiore A Fiore AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL A Perrotti A Perrotti AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL S Chocron S Chocron AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL T Folliguet T Folliguet AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL A Pappalardo A Pappalardo AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, TRIESTE; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL, PARIS; UNIVERSITY HOSPITAL JEAN–MINJOZ, BESANCON; UNIVERSITY HOSPITAL HENRI–MONDOR, CRETEIL Background The use of bilateral internal thoracic artery (BITA) grafting concomitant with other cardiac operations is regarded as a risky strategy. Additionally, long-term advantages of BITA use remain unproven. Methods Pooled results from three series of patients (totaling 1123 patients, mean age, 71.3 years; mean EuroSCORE II, 7.4%) undergoing combined coronary surgery using BITA were reviewed. Predictors of immediate/long-term adverse outcome were identified by multivariable analyses. Results In-hospital/30-day mortality was 7.9% and 6.3%, respectively. Diabetes on insulin (P = 0.045), severe renal impairment (P < 0.0001), extracardiac arteriopathy (P = 0.0058), New York Heart Association class III−IV (P = 0.017), recent myocardial infarction (P = 0.0009), left ventricular dysfunction (P = 0.0054), pulmonary hypertension (P = 0.0016), active infective endocarditis (P = 0.0011), and prolonged cross-clamp time (P = 0.04) were predictors of in-hospital death. Multiple transfusion (27.3%), prolonged mechanical ventilation/reintubation (16.7%), acute kidney injury (11.5%), and sternal wound infections (10.4%) were relevant postoperative complications. Any neurological dysfunction occurred in 5.4% of cases. Median follow-up was of 4.2 years. Female sex, chronic dialysis, extracardiac arteriopathy, and left ventricular dysfunction were predictors of both cardiac/cerebrovascular death and major adverse cardiac/cerebrovascular events (MACCE). Ten-year adjusted survival free of cardiac/cerebrovascular death, cerebrovascular accident after discharge, and MACCE was 84.2%, 94.8% and 54.6%, respectively. Conclusions BITA grafting concomitant with other cardiac operations may be performed with satisfactory results. Long-term outcomes mostly depend on sex, preoperative comorbidities, and baseline cardiac function. C18 LONG TERM RESULTS OF SURGICAL MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH LEFT VENTRICULAR DYSFUCTION: A MONOCENTRIC ANALYSIS A Garatti A Garatti IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA A Daprati A Daprati IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA M D‘Ovidio M D‘Ovidio IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA A Canziani A Canziani IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA S Castelvecchio S Castelvecchio IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA M Scarpanti M Scarpanti IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA L Menicanti L Menicanti IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA IRCCS POLICLINICO SAN DONATO, MILANO; DIPARTIMENTO DI EPIDEMIOLOGIA DEL LAZIO – ASL ROMA 1, ROMA Background To analyze the impact of preoperative LV dysfunction on the early and long-term outcome in a population of isolated sequential CABG Methods Between 2005-2016 a consecutive series of 4079 patients with chronic triple-vessel disease underwent isolated, on-pump-CABG. The patients were divided into four classes based on the preoperative EF: Class I (EF ≥ 50%, 2771 pts, mean EF = 57±6%), Class II (40%≤EF<50%, 708 pts, mean EF = 44±3%), Class III (30%≤EF<40%, 285 pts, mean EF = 35±3%) and class IV (EF ≤ 30%, 152 pts, mean EF = 24±4%). We performed an anonymous record linkage with the National Hospital Information System, for identification of the follow-up outcomes [long-term survival and freedom from MACE (acute MI, Repeated revascularization (PCI or CABG), HF admission). Follow-up was 96% completed. Results From Class I to IV we observed a significant increase in preoperative risk factor incidence [diabetes (23% to 30%), COPD (5% to 13%), renal impairment(GFR:81 to 63 ml/min)] and clinical severity ad admission [NYHA Class III-IV(6% to 22%), previous acute MI(17% to 28%) and unstable angina(6 to 10%)]. Perioperative complications increased significantly among classes (32% to 76%,p<.001). Inotropes (12 to 74%) and IABP use (1 to 21%) were significantly greater in Class IV (p<.001). Stroke incidence was not significantly different among the classes (0.3-0.6%,p=.74), while postoperative low cardiac output syndrome significantly increased from class I to IV(9 to 59%, p<.001). Finally 30-days mortality was not significantly different between class I and III (1.2-3%) but raised significantly in Class IV (7.3%). Long-term mortality increased significantly from Class I to III (19 to 38%,p<.001) but was comparable between class III and IV(p=.97). No significant differences existed among classes in term of freedom from angina, acute MI and repeated revascularization. Finally freedom from HF-admission increased significantly between class I and III (13 to 58%,p<.001) but not between class III and IV(p=.89 – Figure 1). Conclusions CABG in patients with LV dysfunction can be performed with acceptable operative mortality and excellent long-term results, even in patients with severely impaired EF. The EF threshold of 40% or lower seems to impact on long-term outcomes irrespective of EF value per se. However, even in very low EF class, 10-years survival and freedom from HF are greater than 50%, suggesting that CABG can improve the natural history of severe ischemic cardiomyopathy. C19 COMPLEX AORTIC ROOT SURGERY FOR INFECTIVE ENDOCARDITIS: PRELIMINARY EXPERIENCE WITH SUB-ANNULAR IMPLANTATION OF A 100% PERICARDIAL VALVE CONDUIT IN ANCONA M Cefarelli M Cefarelli CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA P Berretta P Berretta CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA J Alfonsi J Alfonsi CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA L Montecchiani L Montecchiani CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA F Capestro F Capestro CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA C Zingaro C Zingaro CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA M Pierri M Pierri CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA A D‘Alfonso A D‘Alfonso CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA M Di Eusanio M Di Eusanio CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA CARDIOCHIRURGIA OSPEDALI RIUNITI–UMBERTO I LANCISI, ANCONA Introduction Infective endocarditis (IE) with extensive annular disruption and aortic root involvement is an ominous condition associated with very high hospital mortality (20-40%). Aortic valve and root replacement with valved composite graft represents the most common intervention with surgical challenges including suture placement through infected friable tissues, respect of the anterior mitral leaflet at the mitro-aortic continuity, effective sealing of the composite graft, and coronary reimplantation, Here we report our results with Bentall surgery using a subannular implantation of a totally pericardial valved conduit (BioIntegral). Methods The study cohort comprised 17 patients (10 males, mean age: 67.1 years) operated at the Lancisi Cardiovascular Center in Ancona between January 2016 and November 2019. Sixteen patients were reoperations (15 first and 1 second reoperation); mean Euroscore-II was 14.8 (range; 1.9-52.8). Following aggressive debridement, a 100% pericardial biological valved conduit was implanted using a sub-annular implantation technique in all cases. Results Thirty-days mortality was 5.8% (1 patient) secondary to multi-organ failure. Four patients experienced atrial fibrillation, 5 required a permanent pacemaker implantation for complete heart block and 3 experienced transitory renal failure. At follow-up 2 patients died due to non-cardiac events. No case of early graft reinfection or structural valve deterioration was detected. Conclusions Considered the high-risk profile of the study cohort, our preliminary favourable results suggest safety and efficacy of our approach. Indeed, we contend that our subannular valved conduit implantation technique allows effective abscess exclusion with respect of the mitral valve while the 100% pericardial conduit, due to its pliability, very well adapts to the irregular surfaces of the left ventricular outflow tract. C20 EARLY, SINGLE CENTER EXPERIENCE WITH OZAKY TECHNIQUE FOR AORTIC VALVE RECONSTRUCTION A Albertini A Albertini MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI E Raviola E Raviola MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI S Calvi S Calvi MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI P Quagliara P Quagliara MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI A Tripodi A Tripodi MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI F Zucchetta F Zucchetta MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI E Mikus E Mikus MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI MARIA CECILIA HOSPITAL, COTIGNOLA; POLICLINICO DI BARI, BARI Objective The Ozaki procedure consists in the aortic valve reconstruction using autologous pericardium. The aim of this study is to report the initial single centre experience and to evaluate the early postoperative surgical outcomes and the hemodynamic performance with this technique. Methods A retrospective/prospective, observational cohort study is undertaken to collect data on consecutive patients treated with Ozaki procedure in our hospital between October 2018 and November 2019. Results A group of 25 patients have been treated with the Ozaki technique at our institute. The mean age was 51.24 ± 15.98 years old (range 21-74) and 76% were male. The predominant pathology was aortic regurgitation (52%) followed by aortic valve stenosis (48%). Eleven patients (40%) had a bicuspid aortic valve, in one a monocuspid valve (4%) was found and 1 patient had endocarditis. Concomitant procedures included: coronary arteries by-pass grafts (6 patients, 24%), ascending aorta replacement (2 patients, 8%), mitral valve repair (5 patients, 20%), interventricular sept miectomy (1 patient, 4%). The mean aortic cross-clamp time and cardiopulmonary bypass time were respectively 130.56 ± 24 and 117.44 ± 20.72 minutes. Mean intubation time was 9.24 ± 4.91 and ICU resulted 2.48 ± 1.16 days. Mean length of post-ICU hospital stay was 5.83 ± 4.44 days. There was no in-hospital mortality. Hemodynamic data at discharge obtained by transthoracic echocardiography showed a peak aortic pressure gradient of 13.07 ± 6.99 mmHg and a mean aortic pressure gradient of 7.36 ± 3.13 mmHg. Aortic valve regurgitation was trivial in 8 patients (33.3%) and no valve stenosis was detected. Conclusions This abstract describes a single centre early experience of Ozaki procedure, showing that it is a feasible and reproducible procedure associated with low mortality and morbidity. Furthermore this procedure fits perfectly with the treatment of different kinds of pathologies, such as stenosis, regurgitation and endocarditis. Hemodynamic results were excellent and patients quality of life improved and early follow-up data at 6 months and one year are encouraging. No anticoagulation is required and all patients, unless they needed for other reasons, have been discharged with a single antiaggregation therapy (usually aspirin 100 grams per day). A larger multicentre study and longer follow up is needed to confirm the results of this finding. HEART FAILURE 1C21 ECHOCARDIOGRAPHIC PHENOTYPES OF ACUTE HFPEF: A PILOT STUDY G Zambelli G Zambelli ASST PAPA GIOVANNI XXIII, BERGAMO M Senni M Senni ASST PAPA GIOVANNI XXIII, BERGAMO M Gori M Gori ASST PAPA GIOVANNI XXIII, BERGAMO A Ghirardi A Ghirardi ASST PAPA GIOVANNI XXIII, BERGAMO A Gavazzi A Gavazzi ASST PAPA GIOVANNI XXIII, BERGAMO A Iacovoni A Iacovoni ASST PAPA GIOVANNI XXIII, BERGAMO ASST PAPA GIOVANNI XXIII, BERGAMO Background Approximately half of the patients with new-onset heart failure (HF) has a preserved ejection fraction (pEF) but no treatment has been found to be effective in this group yet. HFpEF heterogeneity has recently been blamed for this need. Furthermore, despite EF, hospitalization for acute decompensation has a negative prognostic value. In this setting, echocardiogram represents an ubiquitous and comprehensive tool for differential diagnosis of dyspnoea. For these reasons, we investigated, on a real-world population of patients hospitalized for acute HFpEF, (1) which is the extent of changes in echocardiographic parameters necessary to reduce events during follow-up; (2) which are the imaging phenotypes of patients with better prognosis. Methods Between December, 2017 and January, 2019, 55 patients consecutively admitted with a diagnosis of HFpEF according to ESC criteria, were enrolled. We performed a complete transthoracic echocardiogram during admission and before discharge. We then conducted a cluster analysis to discern two distinct phenotypes on the base of 29 parameters. The primary outcome was a composite of death from any cause, total hospitalizations for heart failure or need for diuretic up-titration. Results We found that (1) a decrease in E/e’ of at least 20% during hospitalization is associated with reduced composite outcome independently from age, sex and BNP variations (HR: 0.28, 0.10-0.78). This was not true for the absolute values of E/e’ at admission or discharge; (2) right ventricular dysfunction at admission has a negative predictive value and does not change during hospital stay; (3) the phenotype of patients with greater chamber volumes and a trend towards worse right ventricular function at admission has higher rates of the composite outcome during a mid-term follow-up, even if not significant in our small population. Mean follow-up was 285 days. Conclusions Together with clinical data, echocardiographic monitoring during index hospitalization for HFpEF, is a valuable tool for estimation of fluid volume overload and response to treatment. Namely, an E/E’ reduction of at least 20% reduces the rate of all-cause mortality, hospitalization for acute decompensation and need for diuretic up-titration. In addition, examination at admission may represent a risk stratification tool as it detects imaging phenotypes of patients at higher risk of events who therefore deserve more aggressive therapies and a closer follow-up. C23 SERUM FREE LIGHT CHAINS PREDICT LEFT VENTRICULAR DYSFUNCTION IN PATIENTS WITH STEMI M Perrone M Perrone UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA, ROMA M Pieri M Pieri UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA, ROMA D Sergi D Sergi UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA, ROMA M Marchei M Marchei UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA, ROMA S Bernardini S Bernardini UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA, ROMA F Romeo F Romeo UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA, ROMA UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA, ROMA Background Light chains are proteins produced by plasma cells, also called light chains kappa and lambda, are tied together with other proteins (heavy chains) to form the intact immunoglobulins or antibodies. Recent studies have shown a possible role of combined free light chains (cFLC) as an inflammatory marker in patients with chronic heart failure (HF). HF is a significant contributor to overall mortality in the community, but often patients with chronic HF also have chronic renal failure, which could alter the concentration of cFLC. Methods We evaluated the FLC in patients with STEMI (n?=?113), who were treated with primary angioplasty in the Cardiology Department of the University Hospital "Tor Vergata". For each patient during hospitalization we have determined blood concentration of cFLC, in addition to routine blood tests and we also performed an echocardiogram to evaluate cardiac function. Results We performed cFLC serum concentration in 113 patients with STEMI and observed that the cFLC concentration correlates with Left Ventricle Ejection Fraction (LVEF). We identified that the majority of patients (97%) who had one of the two positive light chains also had a reduced systolic function (LVEF <50%). Conclusions For the first time in this paper we highlight the increase of serum free light chains concentrations in acute ischemic heart failure in patients with STEMI and without kidney failure. The cFLC could be proposed as a new biomarker for left ventricle dysfunction, further studies are required to confirm these results. C24 MONOCENTRIC EXPERIENCE UPDATE ON LIFE VEST IN THE PRIMARY PREVENTION OF SUDDEN DEATH E Savini E Savini U.O. DI CARDIOLOGIA, FERMO D Gabrielli D Gabrielli U.O. DI CARDIOLOGIA, FERMO U.O. DI CARDIOLOGIA, FERMO Introduction Patients with reduced systolic heart failure (HFrEF) FEVS <35% are candidates, according to current guidelines, for the implantation of an ICD for the primary prevention of sudden death, provided that, after therapeutic optimization, have had a substantial improvement in the ejection fraction and have a life expectancy of at least one year. In this context, the wearable defibrillator (Life Vest) can perform a bridge function between discharge and the follow-up time following the same necessary to confirm the indication. Materials and Methods At the Civil Hospital of Fermo at the Cardiology Unit, from November 2016 to December 2019, 21 patients with HFrEF in optimized medical therapy or post-SCA patients undergoing mechanical myocardial revascularization, not yet having the prerequisites for a definitive ICD implant, were discharged with the placement of the Life Vest. Results In the 21 study patients, mean age 59.6 years, 20 male, 12 had primary heart disease and 9 had ischemic genesis, with average FEVS 23.6%, in NYHA Class II-III. In post-implant follow-up, complex ventricular arrhythmias were recorded in a single subject (resolved with appropriate intervention of the wearable defibrillator), the artifacts were recognized as such in 100% of cases. The average daily wearing time of the Life Vest was 23.1 hours. After an average period of 72 days it was removed from all patients. Only in two cases was an ICD implanted: in the patient with complex ventricular arrhythmias and in a subject, carrier of ischemic heart disease, in which FEVS remained below 30% in follow-up; in the remaining patients there was a net improvement in FE (from 23.6 to 40.7% p: 0.001). At the follow-up in December 2019 no subject showed a significant reduction in FE, nor complex ventricular arrhythmias and only three hospitalizations were recorded for exacerbation of heart failure (but with FEVS> 38%). Conclusions Our clinical experience with the Life Vest shows us how it is possible to discharge patients at high risk of fatal arrhythmias early and safely, as this aid is particularly effective in recognizing the latter, appreciated by the patients and with operating costs such as to justify use. C25 PILOT EXPERIENCE OF A NETWORK ORGANIZATION THROUGH HOSPITALS FOR THE ADVANCED TREATMENT OF THE CARDIOGENIC REFRACTORY SHOCK WITH VENO-ARTERIAL ECMO E Catena E Catena OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO A Volontè A Volontè OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO R Colombo R Colombo OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO G Corrado G Corrado OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO F Gentile F Gentile OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO A Russo A Russo OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO A Mafrici A Mafrici OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO A Mangini A Mangini OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO C Antona C Antona OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO OSPEDALE LUIGI SACCO, MILANO; OSPEDALE VALDUCE, COMO; OSPEDALE PASSINI, CINISELLO BALSAMO; OSPEDALE SANT‘ANTONIO ABATE, GALLARATE; OSPEDALE SAN CARLO, MILANO Cardiogenic shock (CS) complicates 7.0 to 8.5% of the acute myocardial infarction (AMI) with a mortality rate between 50% and 80%. More than 30% of patient with AMI autonomously arrive to the Emergency Department and choose the hospital according to the closeness, not to the medical services. In these conditions, the onset of a cardiogenic shock refractory to medical therapy could become life threatening and the patients could not get access to the advance treatment with short term mechanical circulation supports. This study is a clinical pilot experience realized between January 2016 and December 2018 involving Intensive Care and Cardiosurgery units of L. Sacco Hospital in Milan. The aim was to analyze the collaboration through Lombardia’s hospitals with different technological levels in order to offer an advanced treatment with veno-arterial ECMO also in first level centers. A therapeutic protocol was elaborated as a model of “sharing network” based on common diagnostic and therapeutic strategies. The experience was based on the activity of a “shock team”, 24h/24 ready to get to first level centers, to start veno-arterial support and then centralize the patient at the L.Sacco hospital. In the period of observation, 12 patients have been assisted with v-a ECMO and 7 of them reached the weaning. In 5 cases this hasn’t been possible: 3 died during ECMO, in a third level center where they were transferred one died and another is survived after weaning. The mean period in v-a ECMO was 7 days, the mean recovery in Intensive Care unit was 17 days, the mean of hospitalization was 20 days. This experience shows that a network organization allows to assure advanced treatments in patients with refractory cardiogenic shock also in a first level centre. From regional database, it can be assumed that about 50-80 patients for year could benefit from the shock team intervention in Lombardia: they would switch from an almost absolute death to a more than 60% rate of survival. STRUCTURAL INTERVENTIONAL CARDIOLOGYC26 THE ROLE OF ADEQUATE PRE-PROCEDURAL PLANNING AND CORONARY PROTECTION IN THE PRESENCE OF HIGH RISK OF ACUTE CORONARY OCCLUSION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION C Montonati C Montonati A.O. DI PADOVA, PADOVA T Fabris T Fabris A.O. DI PADOVA, PADOVA C Fraccaro C Fraccaro A.O. DI PADOVA, PADOVA A Pavei A Pavei A.O. DI PADOVA, PADOVA G Masiero G Masiero A.O. DI PADOVA, PADOVA G Tarantini G Tarantini A.O. DI PADOVA, PADOVA M Napodano M Napodano A.O. DI PADOVA, PADOVA A.O. DI PADOVA, PADOVA An 80-year-old woman with severe aortic stenosis, and who was symptomatic for dyspnea (NYHA II) and presyncope, was referred for transfemoral transcatheter aortic valve implantation (TAVI). The pre-procedural coronary angiography showed left-dominant artery circulation with normal coronary arteries and anomalous origin of the right coronary artery from the ascending aorta. The computed tomography angiography underlined several anatomical risk factors for acute left main (LM) occlusion after TAVI: 1) bulky aortic cusp calcifications; 2) low-lying left coronary artery (LCA) ostium; 3) sinus of Valsalva diameter < 30 mm; 4) small sinotubular junction. Based on the dimensions of the aortic annulus and on the unfavourable anatomy of the aortic root, we chose the Acurate Neo S (23 mm) bioprosthesis, because it is self-expandable and it has open cell geometry. During the procedure, we performed pre-implant balloon aortic valvuloplasty with associated angiographic control, which indicated a displacement of the left coronary cusp calcifications near the LM ostium. Consequently, we concluded the procedure by placing a coronary wire with a stent in the periphery of the LM as LCA protection to perform, if necessary, the Chimney technique in urgency. We then deployed the aortic prosthetic valve and we performed a post-dilation; no complications incurred. The aortic angiographic and coronary guide catheter controls showed LCA patency, and thus we decided not to stent it. Although the acute coronary occlusion (ACO) rarely presents itself as a complication during TAVI (incidence < 1%), it has a poor prognosis. Indeed, the invasive rescue therapies – including the Chimney technique, which consists in placing a coronary wire with unexpanded stent, distal to LM ostium that could be quickly retrieved and implanted in case of ostium occlusion – are difficult to perform in emergency. Therefore, a careful pre-procedural assessment is essential to reduce the risk of ACO during TAVI, because it permits to select the most suitable prosthesis and to optimize the procedural management dedicating the preventive techniques of coronary protection to the highest-risk cases. C27 A CASE OF “VERY” SIMULTANEOUS TRANSAPICAL TRANSCATHETER AORTIC AND MITRAL VALVE-IN-VALVE IMPLANTATION E Manzan E Manzan A.O.R. SAN CARLO, POTENZA F Prestipino F Prestipino A.O.R. SAN CARLO, POTENZA R D‘Ascoli R D‘Ascoli A.O.R. SAN CARLO, POTENZA G Luzi G Luzi A.O.R. SAN CARLO, POTENZA A.O.R. SAN CARLO, POTENZA Case Report A 72-year-old female was admitted to our Institution with aortic and mitral bioprosthesis dysfunction. She underwent a mitral commisurotomy in 1989 for rheumatic mitral stenosis and in 2012 a redo double valve replacement with aortic 21mm and mitral 27mm Edwards Magna Ease valves. Transesophageal Echocardiogram showed aortic and mitral prosthesis degeneration (aortic mean gradient 61mmHg, mitral mean gradient 12mmHg), preserved left ventricular function and dimensions, dilated right ventricle with normal function and pulmonary hypertension (sPAP 60mmHg). EuroScoreII was 8%. Since her numerous comorbidities (peripheral vascular disease, porcelain aorta, redo) and high surgical risk, the heart team decided to perform a Trans-apical transcatheter aortic and mitral valve-in-valve implantation. After left lateral minithoracotomy in 5th intercostal space, 2 purse-string sutures were applied to left ventricular apex, temporary pacemaker was positioned through right femoral vein, pig catheter was positioned in ascending aorta through right femoral artery. After left ventricular puncture, soft and subsequently stiff guidewires were introduced through the aortic prosthesis and placed in right femoral artery and simultaneously introduced through the mitral prosthesis and placed in the right superior pulmonary vein. A 23mm Edwards SapienXT prosthesis was implanted into the degenerated aortic prosthesis. A 29mm Edwards SapienXT prosthesis was implanted into the degenerated mitral prosthesis. Post-operative transesophageal echocardiography showed no para-valvular leakage and good aortic and mitral prosthesis hemodynamic performance (aortic mean gradient 8mmHg, mitral mean gradient 3mmHg). At 20-month follow up, the patient is in good clinical conditions, echocardiogram shows good hemodynamic performance of both Valve-in-valve prosthesis without PVL. Conclusions Transcatheter valve-in-valve procedures may be a real alternative to redo surgery for degenerated bioprosthesis, especially in high risk patients. Our experience was the first “one stage” double valve-in-valve transcatheter aortic and mitral valve implantation in failing stented bioprosthesis, after contemporary wires positioning in aortic e mitral sites. This strategy reduces procedure time and surgical risk due to 2 separate operations, it minimizes bleeding and reduces iodinated contrast administration. C28 PERCUTANEOUS TREATMENT OF MITRAL INSUFFICIENCY BY MITRACLIP IN PATIENTS WITH ADVANCED HEART FAILURE M Bollettino M Bollettino ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO G Saponara G Saponara ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO E Ammirati E Ammirati ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO J Oreglia J Oreglia ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO S Nava S Nava ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO C Santolamazza C Santolamazza ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO F Soriano F Soriano ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO F Oliva F Oliva ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO M Cipriani M Cipriani ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO M Frigerio M Frigerio ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 2 INSUFFICIENZA CARDIACA E TRAPIANTI, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA CA GRANDA CARDIOLOGIA 1 EMODINAMICA, MILANO Introduction We retrospectively evaluated the efficacy of percutaneous correction with MitraClip (Abbott) system of severe functional mitral insufficiency (IMF) in patients (pcs.) With advanced heart failure (AIC).Two subpopulations were identified on the basis of the inclusion criteria of the COAPT study: COAPT-LIKE (33 pcs.) And NON-COAPT (27 pcs).The primary composite endpoint, consisting of death from cardiovascular causes and hospitalization from heart failure, was assessed both for the entire population and for the 2 subpopulations. Methods and Results From 9/2013 to 9/2019 the Mitraclip device was implanted in 60 patients with moderate-severe mitral insufficiency (IM 4+ 61%) and advanced heart failure (NYHA III 63%, LVEF 27% IQR : 24-32%, LVEDD 64 mm IQR 61-70mm; LVEDV 213 ml IQR 164-213 ml). In the primary analysis it emerged that, after 12 months from the MitraClip implantation intervention, the survival rate (freedom from major events defined as death from cardiovascular causes, hospitalizations for heart failure or heart transplant) was 87% respectively (COAPT-LIKE) and 73% (NON-COAPT) at 24 months. In all patients, at 12 months, a significant improvement in the NYHA functional class (p 0.026), a reduction in the NTproBNP (p 0.016), a reduction in the degree of mitral insufficiency (p 0.001), a reduction in resistance and lung pressures (p 0.011 and p 0.032) associated with an increase in output and cardiac index (p 0.02). From secondary analysis, the COAPT-LIKE group has a higher survival rate both at 12-month follow-up (p 0.013) that at 24 months (p 0.039); a more marked improvement in the NYHA functional class (p 0.023) associated with a greater reduction in absolute terms of the value of NTproBNP (p 0.045); a significant improvement in all hemodynamic parameters of both cardiac performance (p 0.027) and lung resistance (p 0.043) associated with a reduction in lung pressure (p 0.043). Conclusions The results confirm the effectiveness of percutaneous correction of the IMF by MitraClip in patients with AIC. A careful selection of patients, identifying subjects with severe "disproportionate" IM respect to the degree of left ventricular dysfunction and the size of the ventricle (COAPT-LIKE), allows to identify a population with a more effective response also in hemodynamic terms. C29 TRANSCATHETER MITRAL VALVE REPLACEMENT WITH TRANSAPICAL AND TRANSEPTAL APPROACH: RESULTS FROM A MULTICENTRE STUDY M Malerba M Malerba CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA A Daniotti A Daniotti CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA A De Leo A De Leo CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA F Simonetto F Simonetto CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA P Purita P Purita CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA M Barbierato M Barbierato CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA A Pascotto A Pascotto CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA D Mangino D Mangino CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA C Zanchettin C Zanchettin CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA G Tarantini G Tarantini CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA G Gerosa G Gerosa CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA A D‘Onofrio A D‘Onofrio CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA C Cernetti C Cernetti CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA L Favero L Favero CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA N Gasparetto N Gasparetto CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA G Minniti G Minniti CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA A Frigo A Frigo CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA F Ronco F Ronco CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; CARDIOLOGIA, MESTRE; CARDIOCHIRURGIA, MESTRE; CARDIOLOGIA, PADOVA; CARDIOCHIRURGIA, PADOVA; CARDIOCHIRURGIA, TREVISO; BIOSTATISTICA, PADOVA Background Patients with a degenerated mitral valve bioprosthesis could be treated with transcatheter valve replacement, which is less invasive than surgery. Aim of the study. The main aim of the study was to analyze the acute and chronic clinical and echocardiographic findings in patients with a degenerated mitral valve bioprosthesis that underwent transcatheter mitral valve replacement (TMVR) with Valve-in-Valve (ViV) technique, using a trans-septal or trans-apical access. The secondary aim was to compare trans-septal with trans-apical access. Methods The study is an observational retrospective analysis from data of 45 patients that underwent TMVR with ViV technique for degenerated bioprothesis, between 2011 and 2019 in three Veneto centre: Treviso, Mestre and Padua. We collected pre- and post-procedural data, along with follow-up data, using the criteria established by the Mitral Valve Academic Research Consortium (MVARC). Results 45 patients with mean age of 77.9±10.4 years and mean STS surgical score of 6.9±5.6 underwent TMVR-ViV to treat their moderate or severe mitral valve regurgitation due to bioprosthesis degeneration. After the procedure, no patient showed any sign of moderate nor severe mitral valve regurgitation. 91.1% of patients was in NYHA class 3 or 4 before the procedure, shifting to NYHA class 1 or 2 one year after surgery. Technical and device success rates were 95.6% and 88.6%, respectively, whereas 30-day and one-year mortality were 9.1% and 15.6%. The only differences that could be identified stratifying data, according to whether the patient was treated via trans-septal or trans-apical access, were the mean total hospital stay (6.2±4.3 vs. 8.4±3.8) and the intensive care unit stay (1.3±1.0 vs. 3.9±5.1), which were both significantly longer in the trans-apical subgroup. Conclusions The TMVR-ViV procedure is safe and successful in reducing mitral valve regurgitation and NYHA class in patients with bioprosthesis degeneration. Mortality for TMVR was not higher than that of the surgical gold standard procedure. The choice of a trans-septal or trans-apical access was not relevant to determine the clinical and the echocardiographic outcomes, the only exception being a longer mean hospital stay for the trans-apical subgroup of patients. C30 LONG-TERM FOLLOW-UP IN PATIENTS WITH ACUTE ATRIOVENTRICULAR BLOCK AFTER TAVI C Scangiuzzi C Scangiuzzi CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO A Daniotti A Daniotti CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO A De Leo A De Leo CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO V Calzolari V Calzolari CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO L Favero L Favero CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO D Calzolari D Calzolari CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO C Agostini C Agostini CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO M Crosato M Crosato CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO N Gasparetto N Gasparetto CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO C Cernetti C Cernetti CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO CARDIOLOGIA, TREVISO; CARDIOLOGIA, MONTEBELLUNA; MEDICINA INTERNA I, TREVISO Study Background Aortic Valve Stenosis is a disease characterized by the obstruction of the flux from the left ventricle to the aorta during the systolic phase of the cardiac cycle. Clynically, it’s called symptom triad -dyspnea, angyna and syncope- and it usually appears during physical efforts. The showing of symptoms means it is time for a substitution of the valve. Medical therapy and BAV cannot change the pathology’s natural history. Possible alternatives are SAVR and TAVI. One of TAVI’s complications, however, is the appearance of a left bundle branch block and atrioventricular block, which can require the implant of pacemakers. Objective of the Study The goal of this study is to evaluate characteristics and risk factors, which could help us understand the reason for a high percentage of pacemaker implants after undergoing TAVI. We can also identify possible predictors of high ventricular pacing at the follow-up. Materials and Methods This research has been an analytic observational study – specifically, of the longitudinal retrospective type. A database has been created for patients who have undergone TAVI procedure, delving into the follow-up of post-TAVI pacemaker patients. Apart from the follow-up data, different kinds of data have been collected: registry, anamnestic, electrocardiographic, echocardiographic, procedural and biohumoral. Results 604 patients underwent TAVI from July 2009 to July 2019. Patients already wearing a pacemaker before the TAVI were excluded from the analysis. The remaining population is composed of 529 patients, of which 425 without pacemaker and 104 that received an implant after the TAVI. These two sub-populations were then compared through univariate analysis. Multivariate analysis confirmed the predictors of pacemaker implant recognized by literature (depth of valve implantation, relatively bigger native valve diameter and right bundle branch block). Possible predictors of ventricular pacing such as oversize, QRS before TAVI and after TAVI. Meanwhile, the increase of implant depth seems to be related to the percentage of ventricular pacing. The Kaplan-Meier survival curves comparing the two sub-populations appear similar -around 50% of survivors at the 48-month follow-up- showing no correlation between PM implants and mortality. Conclusions This study confirms the data regarding predictive factors of pacemaker implants diffused in literature. It shows that pacemaker implants are not linked to mortality and proposes possible predictive factors of ventricular pacing necessities in the long term. Lastly, it demonstrates that patients with a low valve implant who undergo a pacemaker implant have a higher possibility of recovering the normal atrioventricular conduction at the follow-up. C31 TRANSCATHETER CLOSURE OF COMPLEX IATROGENIC VENTRICULAR SEPTAL DEFECT: A CASE REPORT F Cardaioli F Cardaioli AZIENDA OSPEDALIERA DI PADOVA– UNIVERSITÀ DI PADOVA, PADOVA; ULSS 2, CASTELFRANCO VENETO; AZIENDA OSPEDALIERA DI PADOVA, PADOVA; UNIVERSITÀ DI PADOVA, PADOVA A Barioli A Barioli AZIENDA OSPEDALIERA DI PADOVA– UNIVERSITÀ DI PADOVA, PADOVA; ULSS 2, CASTELFRANCO VENETO; AZIENDA OSPEDALIERA DI PADOVA, PADOVA; UNIVERSITÀ DI PADOVA, PADOVA A Pavei A Pavei AZIENDA OSPEDALIERA DI PADOVA– UNIVERSITÀ DI PADOVA, PADOVA; ULSS 2, CASTELFRANCO VENETO; AZIENDA OSPEDALIERA DI PADOVA, PADOVA; UNIVERSITÀ DI PADOVA, PADOVA G Tarantini G Tarantini AZIENDA OSPEDALIERA DI PADOVA– UNIVERSITÀ DI PADOVA, PADOVA; ULSS 2, CASTELFRANCO VENETO; AZIENDA OSPEDALIERA DI PADOVA, PADOVA; UNIVERSITÀ DI PADOVA, PADOVA AZIENDA OSPEDALIERA DI PADOVA– UNIVERSITÀ DI PADOVA, PADOVA; ULSS 2, CASTELFRANCO VENETO; AZIENDA OSPEDALIERA DI PADOVA, PADOVA; UNIVERSITÀ DI PADOVA, PADOVA Background Latrogenic membranous ventricular septal defects (VSD) are rare complications of cardiothoracic surgery, such as septal myectomy for Hypertrophic Obstructive Cardiomyopathy (HOCM). Transcatheter VSD's closure is considered an appealing alternative to surgery, given the increased mortality associated with repeated surgical procedures, but reports are extremely limited, especially in adult patients. Case Summary We herein describe the case of a 63-yo woman with HOCM, undergoing successful percutaneous closure of an iatrogenic VSD after septal myectomy by using a 25-mm Amplatzer Multi-Fenestrated Septal Occluder - "Cribiform". We describe two percutaneous innovative techniques, namely the “muscular anchoring” and the “buddy wire delivery”, aimed at increasing support and provide stability to the system during percutaneous intervention. Conclusion Trans-catheter closure represents an attractive minimally invasive approach to manage symptomatic iatrogenic VSDs. However, trans-catheter closure devices are not specifically intended for implantation in such iatrogenic defects and, as a consequence, percutaneous procedures can be challenging due to unfavorableanatomical characteristics. Our case is unique because, to our knowledge, is the first reporting the use of these wo techniques, i.e. the “muscular anchoring” and the “buddy wire delivery”, for percutaneous VSD closure, in order to help the operator in crossing tortuous and tunneled defects and in deploying closure devices in case of complex VSD anatomy, respectively. C32 BALLOON AORTIC VALVULOPLASTY IN A HIGH VOLUME CENTER WITHOUT ON-SITE HEART SURGERY: SAFE, FEASIBLE AND EFFECTIVE, OR NOT? D Bernucci D Bernucci AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA F Verardi F Verardi AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA A Capecchi A Capecchi AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA V Lanzilotti V Lanzilotti AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA G Iannopollo G Iannopollo AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA G Nobile G Nobile AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA P Corbo P Corbo AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA M Bruno M Bruno AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA C Pedone C Pedone AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA G Casella G Casella AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA AZIENDA OSPEDALIERA UNIVERSITARIA S.ANNA, CONA; OSPEDALE MAGGIORE, AZIENDA USL DI BOLOGNA, BOLOGNA Background Balloon Aortic Valvuloplasty (BAV) is a palliative procedure for symptomatic patients (pts) with severe aortic stenosis as a bridge to surgery or percutaneous replacement (TAVI), or for pts with hemodynamic instability. Results of BAV without on-site heart surgery could appear questionable. Methods Our prospective observational study evaluated safety and efficacy of BAV in 111 consecutive pts enrolled from January 2016 to November 2019 in a high-volume center without on-site heart surgery. Results Median age was 86 years (IR 82-88), 50% were males. Critical coronary artery disease was observed in 57% of cases (22% three vessel disease, 9% left main). Median left ventricular ejection fraction was 49% (IR 30-59). BAV indications were symptomatic heart failure or pulmonary edema in 65% and cardiogenic shock in 3,5% of cases, respectively. BAV was performed through transfemoral (95,5%) or radial access. During BAV, 12% of pts underwent coronary angioplasty as well. In one case intra-aortic balloon pump was implanted before BAV. BAV was successful in 99% of cases and the peak-to-peak transvalvular gradient decreased from 55,9±21,2 to 26,9±12,7 mmHg. Mechanical closure devices were used in 67,6% of cases (Perclose 58,6%). No major complication (death, stroke or tamponade) was observed during BAV, 6.3% of pts had minor complications. After BAV, 59,5% of pts were referred for TAVI, while only 4,5% underwent surgical replacement. Conclusions BAV could be safely and effectively performed in high volume centers without on-site heart surgery as a bridge to aortic valve replacement or as a rescue procedure in unstable cases. C33 TWO-STAGES POSITIONING AND INFLATION OF THE BALLOON EXPANDING THE BIOPROSTHESIS IN TRANSCATHETER AORTIC VALVE IMPLANTATION IN A SMALL PORCELAIN AORTA E Manzan E Manzan A.O.R. SAN CARLO, POTENZA F Prestipino F Prestipino A.O.R. SAN CARLO, POTENZA R D’Ascoli R D’Ascoli A.O.R. SAN CARLO, POTENZA G Luzi G Luzi A.O.R. SAN CARLO, POTENZA A.O.R. SAN CARLO, POTENZA Case Report A 85-year-old woman was referred to our institution for severe symptomatic aortic stenosis (NYHA III). Mortality EuroScoreII was 7.75% and STS score was 5.86%. Since her numerous comorbidies (peripheral vascular disease, porcelain aorta) and high surgical risk, the heart team decided to performe a Trans-apical TAVI. At CT Multi-planar reconstruction performed with Horos software, virtual basal ring (VBR) dimensions (Area 3.723cm2, Perimeter 6.973cm) and aortic sinus of Valsalva diameters (27x24x25mm) suggested a 23 Edwards Sapien3 valve to be implanted. However, aortic sino-tubular junction (STJ) was small (20x19mm, 19mm above the VBR) and heavily calcified. Its dimensions were compatible with 23 Edwards Sapien3 valve high (18mm) but not with 23 Ascendra Balloon high (29mm) (Figure1). A 23mm Edwards Sapien3 prosthesis was directly implanted (without pre-valvuloplasty) with a two-stages positioning and inflation of the balloon expanding the prosthesis. Under rapid pacing, first balloon-dilatation was performed in standard position till 70% of nominal inflation volume, in order to hook the prosthesis within the native calcified valve in the correct position. Then the balloon was completely deflated and withdrawn down into the left ventricle, with the distal tip just below the calcified and small aortic STJ. In this position, a second balloon-dilatation was performed till 100% of nominal inflation volume to complete prosthesis expansion. Post-operative transesophageal echocardiography proved no para-valvular leakage and good prosthesis hemodynamic performance. Comment With a narrow and calcified STJ, balloon-expandable TAVI may cause ascending aortic dissection or rupture (0.5-1.5%), with high mortality. In this case, we propose a two-step inflation technique for TAVI using the balloon-expandable Edwards Sapien3 valve. The Sapien3 is “first deployed” with an underfilled volume: -1ml, -2ml, -3ml nominal inflation volume in case of mild, moderate or severe STJ calcifications, respectively. Then post-dilation to a nominal inflation volume is performed for the lower half of Sapien3. The center marker of the delivery balloon is positioned at the inflow edge of Sapien3 so that it dilates at the annulus and does not interfere with the outflow edge. Conclusion The two-step inflation technique seemed to be safe and might contribute to prevent STJ injury induced by direct Sapien3 valve contact as well as balloon delivery at the time of TAVI deployment. ECHOCARDIOGRAPHYC34 GLOBAL LONGITUDINAL STRAIN AND PROGNOSIS IN HEART FAILURE WITH REDUCED EJECTION FRACTION: THE IMPACT OF ECHOCARDIOGRAPHIC PHENOTYPES V Serra V Serra CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA E Carluccio E Carluccio CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA P Biagioli P Biagioli CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA R Lauciello R Lauciello CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA C Zuchi C Zuchi CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA A Mengoni A Mengoni CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA N Pugliese N Pugliese CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA A D‘Agostino A D‘Agostino CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA F Dini Lloyd F Dini Lloyd CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA G Ambrosio G Ambrosio CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIAC, THORACIC AND VASCULAR DEPARTMENT, UNIVERSITY OF PISA, PISA Background In heart failure with reduced ejection fraction (HFrEF), speckle-tracking-derived global longitudinal strain (GLS) demonstrated prognostic value independent of, and incremental to, EF. However, disease heterogeneity –as also manifested by differences in echocardiographic patterns- could affect prognosis. Aim This study used cluster analysis to explore the impact of echocardiographic phenotypes on the prognostic power of GLS in HFrEF. Methods and Results In 724 patients with chronic stable HFrEF, unbiased hierarchical cluster analysis was performed at baseline on 10 “phenotypic” echocardiographic variables (except GLS). Median follow-up was 30 months. Primary end-point was all-cause mortality. Association between clusters and outcome was assessed using Cox proportional hazards modeling. Among each cluster, associations between GLS and outcome were examined using interaction testing. Mean age was 66±12 years; 78% were males, mean EF was 30±7%. Cluster analysis identified 3 distinct echocardiographic groups, which differed markedly in clinical characteristics and outcomes after adjustment for EMPHASIS-HF risk score and natriuretic peptide (P < 0.001): Cluster-1 (mild diastolic dysfunction [DD], no pulmonary hypertension, no RV dysfunction) showed the highest survival, Cluster-3 (severe DD, pulmonary hypertension and right ventricular dysfunction) the lowest survival; Cluster-2 (intermediate phenotype) intermediate survival. Within clusters, differential impact of GLS on outcome was observed: the adjusted association of GLS with mortality remained significant in Cluster-1 and in Cluster-2, but no longer in Cluster-3 (P for interaction <0.04). Conclusions The impact of GLS on outcome is not consistent across the whole spectrum of HFrEF patients, as it is strongly influenced by different echocardiographic phenotypes. C35 AN UNCLEAR RIGHT ATRIAL IMAGE IN A PATIENT WITH CARDIOGENIC SHOCK TREATED WITH EXTRA CORPOREAL MEMBRANE OXYGENATION M Scano M Scano CARDIOLOGIA–UTIC, AO BROTZU, CAGLIARI; CARDIOLOGIA, POLICLINICO UNIVERSITARIO D.CASULA, MONSERRATO S Ricci S Ricci CARDIOLOGIA–UTIC, AO BROTZU, CAGLIARI; CARDIOLOGIA, POLICLINICO UNIVERSITARIO D.CASULA, MONSERRATO M Melis M Melis CARDIOLOGIA–UTIC, AO BROTZU, CAGLIARI; CARDIOLOGIA, POLICLINICO UNIVERSITARIO D.CASULA, MONSERRATO M Porcu M Porcu CARDIOLOGIA–UTIC, AO BROTZU, CAGLIARI; CARDIOLOGIA, POLICLINICO UNIVERSITARIO D.CASULA, MONSERRATO CARDIOLOGIA–UTIC, AO BROTZU, CAGLIARI; CARDIOLOGIA, POLICLINICO UNIVERSITARIO D.CASULA, MONSERRATO A 53-year-old woman, hospitalized for cardiogenic shock due to acute severe left ventricular systolic dysfunction with normal coronary arteries, was supported by veno-arterial extracorporeal membrane oxygenation (ECMO). Three hours after the ECMO implantation, PTT was >100 sec and the machine emitted some cavitation alarms (pump flow 3.6 l/min). The transthoracic echocardiography showed a severe left ventricular systolic dysfunction, inconstant opening of the aortic valve and a small right ventricle. The ECMO venous cannula with the tip in the superior vena cava and the Swan-Ganz catheter were well visible inside the right atrium. Furthermore, an unexpected echo finding was reported inside the right atrium: a large (2.5x3cm) ovalar, homogeneous and hypomobile image with regular edges was lying just above the tricuspid valve anulus, close to the inflow ECMO cannula. Differential diagnoses included thrombus, previously unrecognized intracardiac mass or artifacts. The absence of the same image in the previous echocardiographic reports suggested that the diagnosis of a neoplastic mass was unlikely. The diagnosis of thrombus was also doubtful, because of the adequate anticoagulation, demonstrated by the laboratory tests. In order to solve the cavitation alarms, the pump blood flow was reduced during echocardiographic monitoring, showing the distension of the right atrium and the disappearance of the echogenic mass. This test suggested that the ultrasound finding was a "false intracavitary-mass" image related to the right atrium wall suction exerted by the inflow cannula. Although this finding couldn't be unusual in the ICUs of the specialized centre, this case can be useful for the clinical cardiologist in the management of patients with extracorporeal cardiopulmonary support. In front of an echocardiographic imaging of a right atrial mass, "mind" the ECMO pump flow for the differential diagnosis. C36 LARGE VEGETATION ON THE MITRAL VALVE CAUSED BY A RARE BACTERIA: KOCURIA RHIZOPHILA M Rizzo M Rizzo UOC CARDIOLOGIA OSPEDALE SAN PAOLO CIVITAVECCHIA ASL ROMA 4, CIVITAVECCHIA; OSPEDALE SAN PAOLO ASL ROMA 4, CIVITAVECCHIA S Calcagno S Calcagno UOC CARDIOLOGIA OSPEDALE SAN PAOLO CIVITAVECCHIA ASL ROMA 4, CIVITAVECCHIA; OSPEDALE SAN PAOLO ASL ROMA 4, CIVITAVECCHIA G Biscotti G Biscotti UOC CARDIOLOGIA OSPEDALE SAN PAOLO CIVITAVECCHIA ASL ROMA 4, CIVITAVECCHIA; OSPEDALE SAN PAOLO ASL ROMA 4, CIVITAVECCHIA M Di Gennaro M Di Gennaro UOC CARDIOLOGIA OSPEDALE SAN PAOLO CIVITAVECCHIA ASL ROMA 4, CIVITAVECCHIA; OSPEDALE SAN PAOLO ASL ROMA 4, CIVITAVECCHIA UOC CARDIOLOGIA OSPEDALE SAN PAOLO CIVITAVECCHIA ASL ROMA 4, CIVITAVECCHIA; OSPEDALE SAN PAOLO ASL ROMA 4, CIVITAVECCHIA Introduction Kocuria(K.) species are Gram-positive bacteria rarely associated with human disease. In particular, K. rhizophila is important in industrial applications. The first report of K. rhizophilahuman infection was described by Becker et al. in 2008. We present an unusual case ofK. rhizophila endocarditis on a native mitral valve. Case Report A 52-year-old woman with a previous history of ruptured cerebral aneurysm and residual campimetry defect of the left eye was hospitalized for weight loss, anaemia, asthenia and cough. She was apyretic with normal vital signs. Auscultation was significant for a grade 3 pansystolic murmur at the apex. ECG disclosed normal sinus rhythm. Abdominal and thoracic computed tomography with contrast revealed heart enlargement and mild pericardial effusion. A transthoracic echocardiogram showed the presence of an abnormal and irregular mass, mobile, echo-dense on the posterior mitral leaflet with severe mitral regurgitation, left atrial enlargement, small circumferential pericardial effusion; the left ventricular function was normal. A transesophageal echocardiography confirmed the presence of a large mass as well as the presence of the multiple small masses involvement of the mitral–aortic intervalvular fibrosa, the rupture of the mitral chordae tendineae and flail of posterior mitral leaflet. Empiric antibiotic therapy with intravenous vancomycin and gentamicin was started. Three blood cultures resulted positive for K. rhizophila. After 7 days blood cultures showed no growing organism; therefore mitral valve replacement was performed. Postsurgical blood cultures and mitral valve tissue cultures were negative. Discussion A previous literature search identified only 20 cases of K.infections in humans most of which were in immuno-compromised hosts. Since, K.rhizophila is a bacterium isolated from chicken meat treated with oxalic acid, the most suspected source of K. rhizophilais patient contact with contaminated meat and dust from the environment. Since there are no current guidelines for the treatment of K.-related endocarditis, our patient was treated with empiric antibiotic therapy. Conclusions This report draws attention to a more ubiquitous emerging microbe pathogen. Much is still unclear about K.species. To the best of our knowledge, we report the first case of endocarditis due to k. rhizophila on a native mitral valve with rupture of cordae tendineae undergone successful mitral valve replacement. C37 PLATIPNEA-ORTODEOXIA SYNDROME IN PATIENT WITH OSTIUM SECUNDUM ASD NOT HEMODYNAMICALLY SIGNIFICANT M Dottori M Dottori A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA D Caraceni D Caraceni A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA L Zuccatosta L Zuccatosta A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA M Serenelli M Serenelli A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA C Lofiego C Lofiego A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA M Paci M Paci A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA F Capestro F Capestro A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA J Alfonsi J Alfonsi A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA S Gasparini S Gasparini A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA M Di Eusanio M Di Eusanio A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA G Perna G Perna A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOLOGIA/EMODINAMICA/UTIC, ANCONA; I.N.R.C.A. I.R.C.C.S. CARDIOLOGIA/UTIC/TELECARDIOLOGIA, ANCONA; A.O.U.O.R UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI CARDIOCHIRURGIA, ANCONA; A.O.U.O.R. UMBERTO I, G.M.LANCISI, G.SALESI PNEUMOLOGIA, ANCONA A 79-year-old man, with hypertension and a prostate neoplasm with bone metastases in drug therapy, for some years reported exertional dyspnea which was also present at rest lately and needed home oxygen therapy for 24 hours a day. Hospitalized in pulmonology, he underwent several tests, all with negative results (spirometry, chest CT angiography, thoraco-abdominal CT scan). A TTE using microbubbles had shown a large right-left interatrial passage at rest compatible with PFO and confirmed with subsequent TEE. Transferred to our department, he performed a cardiac catheterization that documented ASD with a non-hemodynamically significant two-way shunt (mainly left-> right QP / QS = 1.2, right-> left = 0.9) in the absence of pulmonary hypertension and an increase in arteriolar resistance. The coronary angiography was negative. A TEE was repeated showing the presence of a large atrial septal aneurysm with a convexity prevalent on the left and with a large diastasis between septum primum and septum secundum (> 10 mm); OS ASD (8 mm) in antero-superior seat; severe prevalent right-left shunt (in basal conditions); aortic root aneurysm; moderate aortic insufficiency; normal size of the heart cavities. During the examination, with the transition from clino to orthostatism, there was a significant reduction in saturation (from 95 to 88%) with worsening of symptoms. The diagnosis of platipnea-ortodeoxia was then made. Due to the presence of an inadequate morphology to transcatheter closure of the ASD (no anterior rhyme, large atrial septal aneurysm and aortic root aneurysm) the patient underwent direct suturing surgery of the ASD. Currently the patient has resumed leading an unrestricted life of daily activities. Platipnea-ortodeoxia syndrome is rare but should be suspected in case of dyspnea and unexplained desaturation and especially if in relation to postural changes. The most common predisposing anatomical conditions (interatrial communication) may for many years not manifest themselves clinically until conditions (in this case the dilation of the aortic root) overlap that cause distortion at the level of the right atrium of the anatomical relationship between the inferior vena cava and the region of the fossa ovalis, mainly in an orthostatic position, determining a preferential flow path towards the left atrium and desaturation. C38 MAPSE INCREASE DURING DIPYRIDAMOLE PHARMACOLOGICAL STRESS ECHOCARDIOGRAPHY CAN PREDICT CORONARY ARTERY STENOSIS L Moderato L Moderato OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO S Binno S Binno OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO C Sticozzi C Sticozzi OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO A Zanni A Zanni OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO G Pastorini G Pastorini OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO C Dallospedale C Dallospedale OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO D Lazzeroni D Lazzeroni OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO M Piepoli M Piepoli OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO G Comastri G Comastri OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO D Aschieri D Aschieri OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO G Villani G Villani OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO OSPEDALE G. DA SALICETO, PIACENZA; OSPEDALE G DA SALICETO, PIACENZA; UNIVERSITÀ DEGLI STUDI DI PARMA, PARMA; IRCSS DON GNOCCHI, MILANO Background Dipyridamole stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD). Aim of our study was to evaluate whether an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE. Methods We prospectively enrolled 347 patients with suspected CAD that performed a DSE; at rest and peak MAPSE was acquired; coronary flow reserve was measured as the difference between peak and rest velocity on anterior descending coronary artery. Delta Mapse was defined MAPSE stress – Mapse rest. The outcome was the presence of CAD, and was measured by a composite endpoint: presence of coronary artery stenosis > 70%, need for revascularization, acute coronary event. Median follow-up was 12 ±10 months. Results The mean age was 66±11 years, male gender was prevalent (73%); no differences were found in risk factors and left ventricular ejection fraction between two groups. 90 patients met the endpoint during follow-up. Patients with CAD showed a lower (blunted or no increase) MAPSE after dipyridamole infusion, with a significative difference in Delta MAPSE (MAPSE peak-MAPSE rest) between groups (-0,02mm vs 2,3mm p < 0,01) (Figure 1a). By using a Receiver Operating Curve, the Area under the curve was 0,776, with the best cut-off value for CAD prediction at Delta Mapse = +0 mm (sensibility 82%and specificity 54%– p < 0.01- Figure 1b). Compared to CFR and Wall Motion Index (delta peak-rest), the MAPSE seems comparable with the other well-known parameters of presence of CAD. (CFR: AUC=0.800; p > 0.01, WMI AUC 0,835, p < 0,01). Discussion To our knowledge, this is the first study that compared the behavior of MAPSE during dipyridamole infusion in patient. MAPSE is a well-known surrogate of longitudinal systolic function and showed increased sensitivity over traditional methods of systolic performance such as LV-EF; in this context, dipyridamole induced reversible ischaemia could affect prematurely MAPSE then EF or wall motion abnormalities. In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD, on top of other well-known markers of ischemia. Incorporating this easy-to-use parameter could improve the specificity of DSE and strengthen the suspect of reversible ischemia when clear wall motion abnormalities are not found. C39 THE LONG ATRIAL ELECTRO-MECHANICAL INTERVAL AS PREDICTOR OF ATRIAL FIBRILLATION RECURRENCE AFTER CATHETER ABLATION A Canu A Canu AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA V Barletta V Barletta AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA G Zucchelli G Zucchelli AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA M Parollo M Parollo AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA M Giannotti Santoro M Giannotti Santoro AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA V Della Tommasina V Della Tommasina AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA M Bongiorni M Bongiorni AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA AZIENDA OSPEDALIERO–UNIVERSITARIA PISANA – DIPARTIMENTO CARDIO–TORACO–VASCOLARE – PISA, ITALIA, PISA Background Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, and the extent of remodeling has already been found to be associated with higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI), called PA-TDI, has been introduced to assess the total atrial activation time, as a non-invasive surrogate of fibrosis and remodeling. The aim of the study is to investigate the role of PA-TDI interval as predictor of AF ablation efficacy. Methods We retrospectively included patients with paroxysmal symptomatic drug-refractory AF referred to our Institution for catheter ablation procedure with radiofrequency, who presented sinus rhythm at admission. A complete transthoracic echocardiogram was performed before the ablation procedure and the PA-TDI interval was defined as the time-interval from the initiation of the P-wave from the ECG signal provided by the echo machine to the peak A’-wave on the TDI analysis. Results From January 2015 to April 2018, 128 patients (mean age 61.86 ± 9.08 years, 68% male, BSA 1.97 ± 0.21 mq, BMI 26.98 ± 3.86 kg/mq, EF 59 ± 6.06%) with symptomatic drug refractory AF who received radiofrequency catheter ablation were enrolled. During the follow-up of 15.80 ± 6.7 months, 30 patients (23%) developed AF recurrence out of the blanking period. Compared with those without recurrence (group 1), patients with recurrence (group 2) had a larger LA size (mean LA area 22.2 ± 4.6 cmq vs 25 ± 6.6 cmq, p = 0.015; mean indexed LA volume 35 ± 10 ml/mq vs 40 ± 12 ml/mq, p = 0.04) and longer PA-TDI interval (162 ± 33 msec vs. 133 ± 26 msec, p < 0.0001). At multivariate analysis, only the LA area (HR:1.13, 95%CI: 1.01–1.27; p = 0.048) and PA-TDI interval (HR:1.01, 95%CI: 1.03–1.06; P = 0.022) were independent predictors of AF recurrence. A cut-off of PA-TDI > 150 ms identified patients with recurrence after ablation with a sensibility of 82% and specificity of 83% (AUC 0.879). Conclusion The total activation time assessed by PA-TDI is an independent predictor of AF recurrence and can be used to predict the efficacy of transcatheter ablation. C40 DIAGNOSTIC ACCURACY OF THE AREA OF THE VEIN CONTRACTA WITH TRANSTHORACIC 3D COLOR DOPPLER FOR THE DIAGNOSIS OF MEDIUM-SEVERE/SEVERE MITRAL INSUFFICIENCY M De Giorgi M De Giorgi DIVISIONE DI CARDIOLOGIA RIABILITATIVA ISTITUTI CLINICI SCIENTIFICI MAUGERI IRCCS SPA SB – PAVIA M De Salvo M De Salvo DIVISIONE DI CARDIOLOGIA RIABILITATIVA ISTITUTI CLINICI SCIENTIFICI MAUGERI IRCCS SPA SB – PAVIA A Ondei A Ondei DIVISIONE DI CARDIOLOGIA RIABILITATIVA ISTITUTI CLINICI SCIENTIFICI MAUGERI IRCCS SPA SB – PAVIA R Pedretti R Pedretti DIVISIONE DI CARDIOLOGIA RIABILITATIVA ISTITUTI CLINICI SCIENTIFICI MAUGERI IRCCS SPA SB – PAVIA O Catalano O Catalano DIVISIONE DI CARDIOLOGIA RIABILITATIVA ISTITUTI CLINICI SCIENTIFICI MAUGERI IRCCS SPA SB – PAVIA DIVISIONE DI CARDIOLOGIA RIABILITATIVA ISTITUTI CLINICI SCIENTIFICI MAUGERI IRCCS SPA SB – PAVIA Mitral regurgitation (MR) is a common valvulopathy with high morbidity and mortality. The area of the effective regurgitant orifice (EROA), calculated with a colordoppler from the proximal isovelocity surface area (PISA), is a prognostically relevant index, but it tends to underestimate functional MR (seldom with circular regurgitation orifice). 3D echo-color Doppler has recently been used for the direct measurement of the regurgitant orifice (vena contracta area: VCA), generally with a transesophageal approach. In the present study, we evaluated the diagnostic accuracy of the VCA, obtained with transthoracic 3D echo-color Doppler, in the diagnosis of medium-severe/severe MR. Methods Consecutive patients with both degenerative and functional MR more severe than mild were included in the study and underwent transthoracic 2D/3D echo-color-doppler (General Electric Vivid E95; 4V probe). The 3D data set was acquired with vendor default settings and the minimum angle useful to include the mitral valve and part of the aortic valve, maintaining a frame rate&gt; 60 fps. The AVC was measured (average of 3 RR cycles) on a plane perpendicular to the main regurgitation jet, at its point of greatest tapering at the level of the mitral flaps. We assessed the diagnostic accuracy of the AVC with the analysis of the ROC (Receiver Operating Characteristics) curve. The reference used is a multiparameter categorization of the MR (area of the regurgitating jet, direction of the jet, size of the left atrium and diameter of the vein contracta) according to international recommendations. Positive test was considered a score&gt; 9 (medium-severe / severe MR). Results 53 patients, 27 (51%) women and 26 (49%) men, with an average age of 72 (± 13) years were analyzed. The mean ejection fraction of the left ventricle was 50% (± 14%). There were 22 functional MRs (42%) and 31 degenerative (58%). In 17 (32%) cases the MR was medium-severe to severe. The ROC analysis showed an area under the curve equal to 83% (p &lt;0.001). The optimal AVC threshold value for the diagnosis of medium-severe / severe MR was 1.25 cm2, with a sensitivity of 88% and a specificity of 81%. In functional MR the optimal threshold value was higher than in degenerative (1.28 vs 1.13 cm2). Conclusions The direct measurement of AVC obtained with transthoracic 3D echo-color Doppler seems to be an accurate method for the quantification of medium-severe / severe MR. Mitral insufficiency Transthoracic 3D echo-color Doppler Area of the vein contracta (Buck et al. 2006) CARDIOMYOPATHYC42 HEART FAILURE IN AMYLOIDOTIC CARDIOMYOPATHY: A CENTRAL HAEMODYNAMIC AND INSTRUMENTAL CHARACTERIZATION OF THE THREE ETIOLOGIES A Caponetti A Caponetti POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA S Longhi S Longhi POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA C Gagliardi C Gagliardi POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA G Saturi G Saturi POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA A Milandri A Milandri POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA A Ponziani A Ponziani POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA P Massa P Massa POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA M Sguazzotti M Sguazzotti POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA L Bacchi Reggiani L Bacchi Reggiani POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA F Salvi F Salvi POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA C Rapezzi C Rapezzi POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA POLICLINICO SANT‘ORSOLA–MALPIGHI, CARDIOLOGIA, BOLOGNA; OSPEDALE BELLARIA, NEUROLOGIA, BOLOGNA Heart failure (HF) is one of the main features of amyloidotic cardiomyopathy (AC) and it is supposed to carry important prognostic implications. Despite the intrinsic etiologic heterogeneity of AC, HF has been mainly attributed to diastolic dysfunction, but the role played by the different amyloid subtypes of AC and by the clinical and haemodynamic factors remain unclear. We analyzed central haemodynamic, echocardiographic, clinical, ECG details and survival data among the 411 patients diagnosed with AC at our Center (156 AL, 131 hereditary ATTR (h-ATTR), 124 wild-type (wt-ATTR)) . 112 (27%) patients presented advanced HF at first evaluation and showed severe symmetric left ventricle wall thickening (higher values in h-ATTR), non-dilated left ventricle, preserved ejection fraction, pathological myocardial contraction fraction and lower QRS voltages in comparison to patients in NYHA class I-II. Haemodynamically, elevated filing pressures on both cardiac sides were present in patients in NYHA III-IV class of the three etiologies. Survival at 2 years was 35% for AL, 83% for h-ATTR, 65% for wt-TTR. H-ATTR and wt-ATTR etiologies were favorable predictors of survival, while reduced cardiac index and elevated filling pressures were negatively associated with overall survival. The characterization of haemodynamic profile plays a central role in predicting the natural history of AC, since reduced stroke volume and elevated filling pressures are the best predictors of mortality, reflecting a physiopathological restrictive model of the disease. Conversely, left ventricular ejection fraction is rarely frankly abnormal and it is not a reliable marker of poor prognosis. AL amyloidosis shows the worst outcome probably due to a combination of the underlying illness and light chains cardiotoxicity. C43 ROLE OF GENDER IN TRANSTHYRETIN-RELATED AMYLOIDOSIS: DATA FROM THE THAOS REGISTRY G Saturi G Saturi POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA C Gagliardi C Gagliardi POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA A Caponetti A Caponetti POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA S Longhi S Longhi POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA A Milandri A Milandri POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA G Fabbri G Fabbri POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA A Ponziani A Ponziani POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA P Massa P Massa POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA M Sguazzotti M Sguazzotti POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA F Salvi F Salvi POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA C Rapezzi C Rapezzi POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA POLICLINICO S. ORSOLA – MALPIGHI, BOLOGNA; OSPEDALE DI BENTIVOGLIO, BENTIVOGLIO; OSPEDALE DI FERRARA, FERRARA; OSPEDALE BELLARIA – UO DI NEUROLOGIA, BOLOGNA Background Transthyretin amyloidosis (ATTR) is an underdiagnosed disease caused by destabilization of transthyretin due to pathogenic mutations (ATTRm) or aging (ATTRwt). Gender-related differences in human amyloidosis is a relatively little explored topic. Methods Gender differences between ATTR subjects with different genotype and phenotype through 1st April 2019 were explored. Symptomatic ATTRm (n = 3774), asymptomatic ATTRm (n = 644) and ATTRwt (n = 874), were studied within the largest available database on ATTR, the ongoing Transthyretin Amyloid Outcomes Survey (THAOS) international registry. Results Male prevalence was 61% in the entire registry, 53% in ATTRm and 95% in ATTRwt. In the overall cohort, cardiac phenotype was more frequent in males (30.7% vs 10.5%, p < 0.001). Among patients with amyloidotic cardiomyopathy (ATTR-CM), males’prevalence was higher both in ATTRm and in ATTRwt (72% and 95% respectively) but echocardiographic features showed no substantial gender differences. Sensory abnormalities (70.1% vs 64.1%, p < 0.001), autonomic abnormalities (60% vs 48.5%, p < 0.001) and walking disabilities were more frequent among ATTRm males. Carpal tunnel syndrome was more frequent in ATTRm males (18.6% vs 15.5%, p = 0.014). Male-to-female ratio varied within genotype (from 0,61 in V30M to 11,11 in ATTRwt); furthermore, gender imbalance was more evident among symptomatic patients rather than in asymptomatic ones. Male gender, age at presentation and specific genotype were independently significantly associated with the presence of ATTR-CM. Conclusions In ATTR, cardiac involvement is more frequent in men, supporting the hypothesis that some biologic characteristics may “protect” from myocardial amyloid infiltration in women. Further investigations are needed to identify possible underlying mechanisms and orient the research for innovative, gender-tailored therapeutic approaches. C44 DIAGNOSTIC APPROACH IN WILD-TYPE TRANSTHYRETIN CARDIAC AMYLOIDOSIS: A MONOCENTRIC EXPERIENCE A Cipriani A Cipriani UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA M Campagnolo M Campagnolo UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA S Civera S Civera UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA L De Michieli L De Michieli UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA R Vio R Vio UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA D Cecchin D Cecchin UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA K Pilichou K Pilichou UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA L Babuin L Babuin UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA M Perazzolo Marra M Perazzolo Marra UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA S Iliceto S Iliceto UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA C Briani C Briani UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA C Calore C Calore UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; AZIENDA OSPEDALIERA DI PADOVA, PADOVA Introduction The diagnosis of wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is frequently missed or delayed. An histological demonstration of amyloid deposit is often required for a definitive diagnosis, although several non-invasive testing modalities have an established role in the diagnostic pathway of ATTRwt-CA. Aim of the Study To investigate the diagnostic approach and diagnostic delay in patients with ATTRwt-CA between 2015 and 2019 in our hospital. Methods We enrolled all the patients with a definitive diagnosis of ATTRwt-CA. In their diagnostic path, they all underwent family and personal history, physical examination and cardiological evaluation including ECG and echocardiography. Diagnosis was achieved through different diagnostic modalities, including CMR, 99mTc-DPD bone scintigraphy and tissue biopsies (abdominal fat pad, endomyocardial and salivary glands). TTR gene analysis was scheduled to identify any TTR mutations. Moreover, the patients underwent complete neurological examination, with a selected cohort undergoing also neurophysiology and nerve ultrasound. Results Eighteen patients were included (17 males, mean age 75 ± 8 y). All were referred for cardiac symptoms. ECG showed atrial fibrillation in 11 (61%), low QRS voltages in 4 (22%), conduction disturbances in 13 (72%) requiring pacemaker implantation in 6 (33%). Twelve patients (66%) had bilateral carpal tunnel syndrome (CTS). Neurophysiology, available in 8/18 patients, disclosed mild axonal sensory-motor polyneuropathy in 2 patients (11%), persistent bilateral CTS in 3 (17%) and right ulnar nerve axonal neuropathy in 1 (5%). Nerve ultrasound, performed in 7/18 patients, showed increased cross-sectional area of the median nerves in 2 patients (11%) and of sciatic nerves in 1 (5%) with axonal neuropathy. Patients underwent CMR in 12 (67%) cases, bone scintigraphy in 4 (22%) and endomyocardial biopsy in 2 (11%) as first second-level diagnostic test. Abdominal fat pad biopsy was performed in 8 patients (44%), showing in all cases negative results. Genetic test results were available, and negative, in 15 patients. The mean diagnostic delay, from clinical suspicion to diagnosis, was 2.3 ± 1 years. Conclusions Although the increasing awareness among the clinicians of the clinical presentation of ATTRwt-CA and the improvement of the diagnostic modalities, the diagnostic delay is still long. Neurological involvement other than CTS is frequent and should be investigated. C45 SCREENING FOR CARDIAC AMYLOIDOSIS BY A COMBINATION OF TWO COMMONLY AVAILABLE ECHOCARDIOGRAPHIC VARIABLES: THE AMYLI SCORE A Aimo A Aimo SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA V Chubuchny V Chubuchny SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA E Pasanisi E Pasanisi SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA C Petersen C Petersen SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA A Giannoni A Giannoni SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA A Barison A Barison SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA C Taddei C Taddei SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA E Poggianti E Poggianti SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA V Spini V Spini SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA G Vergaro G Vergaro SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA A Valleggi A Valleggi SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA G Mirizzi G Mirizzi SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA C Passino C Passino SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA M Emdin M Emdin SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA Background The main echocardiographic feature of the left ventricle (LV) in cardiac amyloidosis (CA) is diastolic dysfunction due to rigid enlarged ventricular wall with no overt LV enlargement (concentric LV pseudohypertrophy). While each of these elements is neither sensitive nor specific, their combination may hold diagnostic significance for CA. Methods The AMYLI (AMYLoidosis Index) score was defined as a product of E/e’ ratio (as a surrogate of LV filling pressure) and relative wall thickness (RWT, as an estimate of concentric LV hypertrophy). This score was evaluated in a population of 316 consecutive patients undergoing specialized evaluation because of clinical, electrocardiographic and echocardiographic features deemed compatible with CA. Results Patients were aged 78 years (interquartile interval 72-83), and 206 (65%) were men. LV ejection fraction was 55% (46-63%). All patients met the echocardiographic criteria for LV hypertrophy (LV mass indexed ≥115 g/m2 in men, ≥95 g/m2 in women); median LV mass was 144 g/m2 (113-172). CA was ultimately diagnosed in 158 patients (50%: 64 light-chain - AL -amyloidosis, 41%; 94 amyloid transthyretin - ATTR - amyloidosis, 59%). AMYLI score values were 9.58 (5.15-12.82) in the whole cohort, and 11.89 (7.68-14.59) among patients with CA vs. 7.21 (4.20-8.50) among the other patients (p < 0.001). The area under the curve (AUC) was 0.77, and the best cut-off was 7.56 (sensitivity 78%, specificity 67%). Patients with an AMYLI score ≥7.56 had a 13-fold higher risk of CA (relative risk - RR 13.4, 95% confidence interval - CI 7.5-24.1). Score values did not differ significantly between AL and ATTR (11.71, 6.51-15.10 vs. 12.03, 7.96-14.57, respectively; p = 0.152) (Figure), although the AMYLI score seemed more predictive of ATTR than AL (AUC 0.798 vs. 0.723). The 7.56 cut-off had 61% sensitivity and 82% specificity for the diagnosis of AL, and 84% sensitivity and 67% specificity for ATTR. The risk of AL increased by almost 3 folds (RR 2.7, 95% CI 1.5-4.7) for an AMYLI score ≥7.56, and the risk of ATTR by almost 7 folds (RR 6.6, 95% CI 3.9-11.3). Conclusions The AMYLI score, calculated as a product of E/e’ ratio and RWT, hold diagnostic significance among patients with suspected CA, with 7.56 as the best cut-off. Score values do not differ significantly between AL and ATTR amyloidosis, but the score and the 7.56 cut-off perform better for ATTR prediction. C46 CLASSIFICATION OF DIFFERENT TYPES OF HYPERTROPHIC CARDIOMYOPATHY (HCM) RESPONSIBLE FOR ADVANCED HEART FAILURE (ADVHF): FROM THE CLINICAL, MORPHO-FUNCTIONAL AND HISTOPATHOLOGICAL CHARACTERISTICS TO PROGNOSIS AND POTENTIAL NEW THERAPIES G Giuseppe G Giuseppe SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA O Germanova O Germanova SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA N Aspromonte N Aspromonte SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA P Sabouret P Sabouret SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA A Cappelletti A Cappelletti SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA I Vranic I Vranic SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA S Zieroth S Zieroth SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA M Metra M Metra SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA A Margonato A Margonato SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; SAMARA STATE MEDICAL UNIVERSITY, SAMARA, RUSSIAN FEDERATION, SAMARA; POLYCLINIC AGOSTINO GEMELLI, CARDIOLOGY UNIT, ROME, ITALY, ROMA; HOPITAL LA PITIE SALPETRIERE, PARIS, FRANCE, PARIS; SAN RAFFAELE HOSPITAL AND SCIENTIFIC INSTITUTE (IRCCS), HEART FAILURE UNIT AND DIVISION OF CARDIOLOGY, CARDIOTHORACIC AND VASCULAR DEPARTMENT, MILAN, ITALY, MILANO; CLINICAL CENTRE OF SERBIA, CARDIOLOGY DEPARTMENT, BELGRADE, SERBIA, BELGRADE; ST. BONIFACE GENERAL HOSPITAL, HEART FAILURE AND TRANSPLANT CLINICS, SECTION OF CARDIOLOGY, WINNIPEG, CANADA, WINNIPEG; UNIVERSITY OF BRESCIA, CARDIOLOGY, DEPARTMENT OF MEDICAL AND SURGICAL SPECIALTIES, RADIOLOGICAL SCIENCES AND PUBLIC HEALTH, BRESCIA Background AdvHF in HCM was overlooked. We classified the HCM clinical-pathological profiles responsible for AdvHF in 3 groups: 1) End-stage HCM (ES-HCM) defined by an EF ≤ 50%; 2) LVOT obstruction despite optimal therapy (Refractory HOCM); 3) Nonobstructive HCM with preserved EF (HNOCMpEF). Purpose Based on a systematic revision of all published manuscripts on this topic, this study describes prevalence & outcomes of the 3 main HCM phenotypes responsible for AdvHF, HTx, LVAD implantation & HF-death with the contemporary management of HCM. Methods The study screened 130 manuscripts in MEDLINE & EMBASE on AdvHF in HCM patients (from 2000 till December 2019), in adult patients. The authors identified 8 manuscripts for the analysis. 205 patients with AdvHF due to HCM were included in the main analysis. AdvHF was defined by severe NYHA class (III & IV) because in all the manuscripts this definition was used. Mean follow-up = 7.6 years. Results Figure 1: Prevalence of phenotypes responsible for AdvHF and HTx/LVAD implantation/HF-Death. Notice on the right the combined outcome split in two HTx/LVAD implantation separated from HF-Death. Of 205 HCM patients, 119 (58%) underwent HTx, LVAD implantation or died for HF. Figure 2: Outcome per each clinical phenotype. Conclusion AdvHF in HCM has an ominous prognosis, indeed 58% of patients underwent HTx/LVAD implantation or died for HF. AdvHF in HOCM has a good outcome with contemporary management. Less than 1/3 of cases of AdvHF in HCM were determined by HNOCMpEF due to massive hypertrophy & restrictive physiology and only 16.4% of them died due to HF. Nowadays, ES-HCM represents the main cause of AdvHF in HCM (64.9% of all HCM patients) & the major determinant for poor outcome (74.8% of Htx/LVAD/HF-death) among all HCM patients. Although it has been managed with HTx or LVAD implantation, 1/3 of these patients died for HF. This reflects poor attention & portrays an unmet need for HCM patients, in particular for ES-HCM patients that are younger than all other HCM patients. A recent study showed that an extensive amount of fibrosis is the major determinant of ES-evolution. Taken together these findings show the importance of a strict follow-up for HCM patients in order to timely identify ES-HCM & to an early start the standard HF therapeutic armamentarium. Finally, developing specific therapies with the main target to significantly reduce the burden of myocardial fibrosis & stop adverse remodeling it’s extremely important. CARDIO-ONCOLOGYC47 HYPERGLYCEMIA INCREASES IPILIMUMAB AND NIVOLUMAB-INDUCED CARDIOTOXICITY MODULATING GROWTH FACTORS AND NLRP3 EXPRESSION IN CARDIOMYOCYTES V Quagliariello V Quagliariello DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI M De Laurentiis M De Laurentiis DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI P Ascierto P Ascierto DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI A Bonelli A Bonelli DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI A Caronna A Caronna DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI C Lombari C Lombari DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI G Conforti G Conforti DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI R Iaffaioli R Iaffaioli DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI G Botti G Botti DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI N Maurea N Maurea DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; BREAST UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; MELANOMA UNIT, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPLES; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI Background Type 2 diabetes, obesity and metabolic syndrome are negative prognostic factors in cancer patients. Immune checkpoint inhibitors (ICIs) that target cytotoxic T lymphocyte antigen 4, programmed cell death-1, and PD-ligand 1 have revolutionized cancer treatment, achieving unprecedented efficacy in multiple malignancies. However ICIs are characterized by a broad spectrum of toxicity reactions, termed immune-related adverse events (irAEs) like cardiotoxicity and induction of diabetes. Purpose We aimed to study if hyperglycemia could enhance ICI-induced cardiotoxicity in cardiomyocites and if the treatment with an SGLT-2 inhibitor (empagliflozin) could be able to revert these effects during hyperglycemic condition Methods HL-1 adult cardiomyocytes were exposed to ipilimumad or nivolumab (100 nM) at 25 mM glucose (High Glucose; HG) or 5.5 mM glucose (Low Glucose; LG) for 72 h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity; NLRP3, p65/NF-kB and leukotrienes expression through ELISA method. Results We found that ipilimumab and nivolumab-induced cardiotoxicity was enhanced by 2,3 and 2,7-fold by 25 mM glucose (High Glucose; HG) compared to 5.5 mM glucose (Low Glucose; LG) in human adult cardiomyocytes. Moreover, during high glucose condition, cardiomyocytes exposed to ICI, increases the expression of NLRP3, p65/NF-kB, leukotrienes and cytokines involved in cell deadh and heart failure. Notably, hyperglycemia increases significantly the intracellular calcium (iCa2+) content in cardiomyocytes during incubation with ipilimumab and nivolumab, probably increasing the metabolic susceptibility to damages induced by ICI. Shifting from HG to LG, as well as the administration of 50 nM empagliflozin (anti SGLT2 drug with hypoglycemic properties) reduced the magnitude of cardiotoxic effects, indicating cardioprotective properties during ICI. Conclusion The results obtained are, to our knowledge, the first evidence demonstrating that hyperglycemia exacerbates ICI-induced cardiotoxicity and set the stage to preclinical and clinical trials aimed to decrease glucose through dietary or lifestyle changes or through new pharmacological treatments (gliflozins). C48 LEFT VENTRICULAR DYSFUNCTION IN CARDIAC METASTATIC MELANOMA: NIVOLUMAB INDUCED IMMUNOTOXICITY OR DIRECT MYOCARDIAL DAMAGE? G Citarelli G Citarelli OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI G Parisi G Parisi OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI D De Laura D De Laura OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI V Lavolpe V Lavolpe OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI L De Gennaro L De Gennaro OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI M Resta M Resta OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI M Sassara M Sassara OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI F Tota F Tota OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI N Locuratolo N Locuratolo OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI P Caldarola P Caldarola OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI OSPEDALE SAN PAOLO, BARI; OSPEDALE SARCONE, TERLIZZI; DIPARTIMENTO DI SMBNOS, BARI Background Nivolumab in an anti-PD-1 monoclonal antibody that activates the immune system by stimulating T-cell proliferation. Although systemic and cardiac adverse events are described, cardiac toxicity from Nivolumab is rare with poorly understood etiopathogenetic mechanism. Case Report 51 year old man, with history of arterial hypertension. In November 2018, diagnosis of advanced stage axillary cutaneous melanoma with cardiac metastatic involvement (lateral wall of left ventricle, interatrial septum and chordae tendineae). The patient presented normal left ventricular ejection fraction at transthoracic echocardiogragm. After surgical removal of the axillary lesion, the patient began immunoteraphy with Nivolumab 240 mg (4 cycles). In February 2019 the patient was hospitalized for sustained ventricular tachycardia treated with DC shock. During hospital stay, there was worsening of left ventricle ejection fraction on transthoracic echocardiogram (LVEF 25%) and significant increase in high sensitivity troponin and NT-proBNP values. We therefore hypothesized an immune-mediated myocarditis and thus started treatment with prednicolone 1 mg/Kg iv, ramipril, metoprolol, potassium canreonate and amiodarone. TTE was repeated before patient discharge, showing a slight improvement of global left ventricle systolic function (LVEF 40%). Spleckle tracking echocardiography evidenced a global longitudinal strain GLS of -12.2 and absolute values of left ventricle longitudinal strain reduced at level of anterior interventricular septum and anterolateral wall. Given the need to continue immunotherapy, a subcutaneous ICD was implanted. May 2019: we observed a slight additional improvement of LVEF and GLS value (-15%) and consensual reduction of metastatic lesions at the level of interatrial septum, mitral valve anterior leaflet and chordae tendineae. Cardiac magnetic resonance could not be performed due to patient claustrophobia. Discussion According to the literature, cardiac complications develop in less than 1% of patients treated with anti-PD-1 antibodies, with an incidence of 0.06% in the case of Nivolumab. Anecdotal are also the cases of myocarditis induced by Nivolumab and its potential pro-arrhythmic effect is controversial. The case tackles the issue of differential diagnosis between nivolumab cardiotoxicity and direct myocardial damage induced by cardiac metastases. The improvement in LVEF coincided with the regression of metastatic cardiac lesions, even in the absence of interruption of immunomodulatory therapy. Conclusions We report an emblematic example of complex differential diagnosis between Nivolumab cardiotoxicity and direct metastatic myocardial damage. C49 AN ENIGMATIC MASS IN THE RIGHT ATRIUM P Verallo P Verallo UOC CARDIOLOGIA/UTIC OSPEDALE SAN SEBASTIANO MARTIRE, FRASCATI; UOC DI GINECOLOGIA ONCOLOGICA UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA D Frongillo D Frongillo UOC CARDIOLOGIA/UTIC OSPEDALE SAN SEBASTIANO MARTIRE, FRASCATI; UOC DI GINECOLOGIA ONCOLOGICA UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA G Scambia G Scambia UOC CARDIOLOGIA/UTIC OSPEDALE SAN SEBASTIANO MARTIRE, FRASCATI; UOC DI GINECOLOGIA ONCOLOGICA UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA C Ronsini C Ronsini UOC CARDIOLOGIA/UTIC OSPEDALE SAN SEBASTIANO MARTIRE, FRASCATI; UOC DI GINECOLOGIA ONCOLOGICA UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA M Vittorini M Vittorini UOC CARDIOLOGIA/UTIC OSPEDALE SAN SEBASTIANO MARTIRE, FRASCATI; UOC DI GINECOLOGIA ONCOLOGICA UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA G Sarli G Sarli UOC CARDIOLOGIA/UTIC OSPEDALE SAN SEBASTIANO MARTIRE, FRASCATI; UOC DI GINECOLOGIA ONCOLOGICA UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA UOC CARDIOLOGIA/UTIC OSPEDALE SAN SEBASTIANO MARTIRE, FRASCATI; UOC DI GINECOLOGIA ONCOLOGICA UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA Cardiac masses (CM) in most cases consist of thrombi, vegetation and tumors. Cancer cardiac metastases (CM) are more common than primitive tumors. Gestational choriocarcinoma (GC) is a trophoblastic tumor secondary to pregnancy, voluntary termination, hydatidiform mole. Among the suggestive signs, the persistence of high values of chorionic gonadotropins (CG). In exceptional cases the GC can metastasize to the lungs 80%, liver 10%, brain 10%, other organs. C50 PRESCRIPTION PATTERN AMONG ONCOLOGIC PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION M Toma M Toma MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA S Giovinazzo S Giovinazzo MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA D Sirello D Sirello MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA G Tini G Tini MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA G La Malfa G La Malfa MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA E Arboscello E Arboscello MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA I Porto I Porto MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA P Spallarossa P Spallarossa MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA P Ameri P Ameri MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA MALATTIE DELL‘APPARATO CARDIOVASCOLARE, DIPARTIMENTO CARDIO–TORACO–VASCOLARE, IRCCS POLICLINICO SAN MARTINO, GENOVA; AREA MEDICA CRITICA, DIPARTIMENTO DI EMERGENZA E ACCETTAZIONE, IRCCS POLICLINICO SAN MARTINO, GENOVA Background Direct oral anticoagulants (DOAC) are the standard of care for the prophylaxis of non-valvular atrial fibrillation (NVAF)-related cardioembolism, but their use in oncological patients has been limited so far, with a significant proportion still receiving vitamin K antagonists (VKA) or low molecular weight heparin (LMWH). Methods By retrospectively reviewing the records of 3,197 subjects evaluated in a cardio-oncology unit between January 2017 and July 2019, we selected those presenting at the first visit with NVAF not triggered by surgical procedures, CHA2DS2-VASc ≥1 for men and ≥2 for women, cancer on active treatment, and no concomitant intracardiac thrombus. The following were considered as contraindications to DOAC: severe chronic kidney disease (estimated glomerular filtration rate <30 mL/m/1.73m2); anti-neoplastic therapy unknown or with potential moderate-to-severe adverse interactions; cirrhosis or liver metastases. Clinical characteristics of patients appropriately on DOACs (group 1), on VKA or LMWH with at least 1 contraindication to DOAC (group 2), and on VKA or LMWH despite not having contraindications to DOACs (group 3) were compared by chi-square or ANOVA, as appropriate. Results One-hundred ninety five (6.1%) patients met the inclusion criteria. Eighty-seven (44.6%) were in group 1, 52 (26.7%) in group 2 (16 on VKA and 36 on LMWH), and 32 (16.4%) in group 3 (8 on VKA and 24 on LMWH). Finally, 24 (12.3%) did not receive anticoagulation for various reasons: spontaneous bleeding (5), anaemia and/or thrombocytopenia (5), frailty (4), CHA2DS2-VASc 1 (3), pharmacological interactions (1), and single, short episode of paroxysmal NVAF (1); in 5 patients the lack of anticoagulation was not clearly motivated. The only significant baseline differences between the 3 groups were serum creatinine concentration (1±0.3 vs. 1.4±0.8 vs. 1±0.3 mg/dL, respectively, P = 0.001) and renin-angiotensin system inhibitor use (61% vs. 44% vs. 34%, P = 0.001). Of note, only 3% of subjects in group 1 received an inappropriate DOAC dose, while LMWH was under-dosed for 25% of patients in group 2 and 50% of patients in group 3 (P < 0.001). Conclusions In a dedicated cardio-oncology unit, DOAC and VKA are most often appropriately prescribed to cancer patients with NVAF. However, there is residual use of LMWH, not infrequently at non-anticoagulant dosage. This is a non-evidence based common practice in clinical oncology that clearly represents room for improvement. C51 MALIGNANCY ONSET AFTER ACUTE CORONARY SYNDROME: INCIDENCE AND SITES IN COMPARISON TO GENERAL POPULATION. (THE ABC-4* STUDY ON HEART DISEASE). (*ABC IS THE ACRONYM FOR ADRIA, BASSANO, CONEGLIANO, AND PADOVA HOSPITALS) H Mahmoud H Mahmoud THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO G Berton G Berton THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO R Cordiano R Cordiano THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO R Palmieri R Palmieri THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO F Cavuto F Cavuto THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO M Mahmoud M Mahmoud THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO M Pasquinucci M Pasquinucci THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO N Sitta N Sitta THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO G Preti G Preti THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO A Cati A Cati THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; CONEGLIANO GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, CONEGLIANO; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; ADRIA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL – THE ABC HEART DISEASE FOUNDATION–ONLUS, BASSANO DEL GRAPPA; MINIA UNIVERSITY HOSPITAL, MINIA; CONEGLIANO GENERAL HOSPITAL, CONEGLIANO Introduction Little is known about the long-term non-cardiac outcome after ACS. Purpose To report the incidence and sites of malignancy in patients long after ACS and to compare them to the worldwide and Italian general population. Methods The present study includes 527 patients admitted with ACS to intensive coronary care units of Adria, Bassano del Grappa, Conegliano general hospitals and discharged alive. Patients were free from malignancy at enrollment. They completed 20 years of follow-up virtually without drop-outs. All malignant neoplasms were recorded prospectively. Second neoplasms were not considered in this analysis. Results The total person-years of follow-up was 9431 years. During follow-up, 101 (19.2%) developed neoplasia. The overall incidence rate (IR) of malignancy was 11 cases/1000 person-years, which seems to be higher than the crude IR in the general adult population worldwide and in Italy, as they were 3 and 8 cases/1000 person-years respectively (1). The most frequent cancer sites in our patients were colorectal, lung, prostate, breast and pancreas. While in general Italian population breast, colorectal, prostate, lung and bladder cancers were the most frequent malignancies (1) (Figure 1). Conclusion We observed a higher long-term risk of malignancy in an unselected sample of patients after ACS as compared to the general population. References 1 Cancer today 2019 . Available from: http://gco.iarc.fr/today/home. CLINICAL EMERGENCIESC52 INTRA-HOSPITAL EMERGENCY:NEW TRAINING APPROACHES V Boccini V Boccini OSPEDALE DEL CUORE DI MASSA – FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA A Giannini A Giannini OSPEDALE DEL CUORE DI MASSA – FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA S Banti S Banti OSPEDALE DEL CUORE DI MASSA – FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA F Tongiani F Tongiani OSPEDALE DEL CUORE DI MASSA – FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA OSPEDALE DEL CUORE DI MASSA – FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA Introduction A study on in-hospital cardiac arrests showed insufficient CPR quality compared to the requirements of international guidelines, however there was an increase from 23.1% in 2012 to 25.5% in 2015 in post-cardiac arrest survival rate . The L.G.R. Tuscany led to the implementation of the Intra-hospital Emergency Team (TEM) whose role is considered particularly relevant in this time- dependent care pathway. FTGM corporate strategies are oriented towards the training of all nursing staff of the department in order to enhance their skills and early intercept a condition of clinical deterioration in so maintaining high levels of survival. The corporate training plan provides the BLS-D course and other specific courses on the management of a clinical emergency. Target Mapping the adherence to the training path of the nursing staff of the depatment in the three-year period between 2017-2019. Investigate the perception of the nursing staff of our ward in relation to the training course envisaged for the acquisition of skills on the management of intra- hospital emergencies (E.I.). Materials and Methods The course on E.I. in the ward is structured in small groups made up of nursing staff, led by a cardiologist, a resuscitator and an expert nurse. Topics covered include basic ECG interpretation, conditions of arrest, definition of team roles, treatment and management of an emergency with simulations of clinical cases. The mapping was carried out by evaluating the percentage of nurses' attendance at the training courses with the structuring of a questionnaire to investigate the perception of the nursing staff towards the training course in an emergency. Results The results on the first objective are described: Course BLS-D and Course E.I. 100% participation in the ward: 2017 - 100%; 2018 – 65%; 2019 - 98%. The results on the second objective are ongoing. Conclusion Planning training with this methodology has improved skills and actively involved the staff in the subjective evaluation of the ongoing training. The future will be structured to attribute to other health profiles (TSRM, OSS, Physiotherapists) present in the defined role in management and logistics in E. I. the assessment will be completed by measuring the outcomes of assistance through specific indicators (.no cases; mortality; no. higher intensity transfer of care. C53 SUDDEN CARDIAC ARREST IN PIACENZA, ANALYSIS OF 5576 CASES FROM 1999 TO 2018 D Aschieri D Aschieri U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA V Pelizzoni V Pelizzoni U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA S Nani S Nani U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA E Bersani E Bersani U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA S Bertocchi S Bertocchi U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA L Moderato L Moderato U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA P Novara P Novara U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA B Matrone B Matrone U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA A Capucci A Capucci U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA U.O. CARDIOLOGIA, CASTELSANGIOVANNI; UO CARDIOLOGIA, PIACENZA; 118 EMERGENZA TERRITORIALE, PIACENZA; UO DIREZIONE GENERALE, PIACENZA; OSPEDALE TORRETTE, ANCONA Introduction Out-of-hospital cardiac arrest affects 1/1000 inhabitants, with a high mortality mainly due to the delay in the arrival of first responders. There are not many updated records on cardiac arrest cases in Italy. From our 20-years of experience in Progetto Vita we have obtained some epidemiological data that can be a starting point for the organization of early defibrillation projects. AIM. To evaluate the epidemiological and demographic characteristics of the population affected by sudden cardiac arrest in the city and province of Piacenza in the last 20 years. Methods We analyzed the cases of sudden cardiac arrest recorded in the database of Progetto vita, with the documents recorded to the 118 operations center in Piacenza from 1999 to 2018. The province of Piacenza currently has 282,879 inhabitants. Were considered the following parameters: age, gender, place, time and presentation rate at the arrival of the rescuers. Results 5576 patients suffered from cardiac arrest from 1 June 1999 to 31 December 2018. 2087 events occurred in the city (37.4%) and 3489 in the province (62.6%). 2341/5576 were female (42%) and 3235/5576 male (58%). The average age of the patients was 75.7 ± 14.3 years (72.3 + 14.4 years for males and 80.3 + 12.8 years for females). The rate of first response upon arrival of the rescue was: asystole in 2925/5576 (52.5%), fibrillation / ventricular tachycardia (FV / TV) in 691/5576 (12.4%), electrical activity without pulse ( PEA) in 218/5576 (3.9%), other in 1742/5576 (31.2%). 4942 cases occurred at home (88.7%), 292 cases on the street (5.2%), 130 cases in public places (2.3%), 39 cases at workplaces (0.7%), 23 cases in sports facilities (0.4%), 150 cases in other places (2.7%), no cases in schools. The ACCs were distributed in the time slots as shown in table 1. The incidence peaks are from 7 to 8 (n. 346 = 6.2%), from 8 to 9 (n. 392 = 7%), from 9 to 10 (n. 378 = 6.8%), from 10 to 11 (n. 306 = 5.5%) and from 12 to 13 (n. 362 = 6.5%). 32% of cases are concentrated in these 5 time slots. Conclusions In the area of Piacenza and the province, an average of 286 cardiac arrest cases occur per year (1/980 inhabitants / year), of which 88.9% are at home. The hourly incidence appears higher in the morning (breakfast time) and pre-lunch. This analysis confirms the importance of an AED available at home for a timely intervention, since most cases occur at home. C54 PM10 LEVELS AND OUT-OF-HOSPITAL CARDIAC ARREST IN A LARGE COHORT OF PATIENTS FROM PROGETTO VITA PIACENZA L Moderato L Moderato OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI A Biagi A Biagi OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI B Matrone B Matrone OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI T Spezzano T Spezzano OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI D Lazzeroni D Lazzeroni OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI C Sticozzi C Sticozzi OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI V Pelizzoni V Pelizzoni OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI G Villani G Villani OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI M Piepoli M Piepoli OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI D Aschieri D Aschieri OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; IRCSS FONDAZIONE DON GNOCCHI MILANO, PARMA; OSPEDALE GUGLIELMO DA SALICETO, PIACENZA; OSPEDALE DI CASTEL SAN GIOVANNI, CASTEL SAN GIOVANNI Introduction Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. It accounts for up to 50% of all cardiovascular deaths. The incidence of OHCA in Italy is about 1.51 arrests/1000 admission/year. Recent studies have sought to find a link between short-term exposure to air pollutants and OHCA. It is well established that ambient air pollution triggers cardiovascular fatal and nonfatal events. but the results are still controversial. Most studies on this subject were performed in developed countries with only a paucity of data from Asia, where air pollution is increasingly becoming a major healthcare issue. In a recent study in Korea, Increased ambient levels of PM2.5 were significantly associated with increased risk of OHCA within 1 to 2 days of exposure. Aim The objective of this study was to investigate the impact of short-term exposure to outdoor air pollutants on the incidence of OHCA in Piacenza, Italy. Outcomes were the incidence of cardiac arrest. Methods PM10 levels were extracted from Environmental Protection Agency (ARPA) local monitoring stations; OHCA were extracted from Progetto Vita Database of Cardiac arrest. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI). PM10 levels exceeded the 50 µg/m3 “safe” threshold recommended by the WHO and Italian legislation for 535 days, (17,5%) during the whole period. Results 880 OHCA occurred on 750 days, with 2174 control days. Mean age of OHCA patients was 76+/- 15 years. Concentration of PM10 were significantly higher on days with occurrence of OHCA ( 37.7+/-22 µg/m3 vs 32.7 +/- 19 µg/m3 p <0.0001). PM10 concentration was higher during winter and autumn then during summer and spring (respectively 45 +/-3 and 41 +/- 2 vs 25+/-1 and 27+/- 2 µg/m3) Risk of OHCA presentation was significantly increased by high concentration of PM10, OR 1,009 (95%CI 1.004-1.015), and was independent from temperature or season (p = 0,01). Linear regression analysis showed a 1% increase of relative risk of cardiac arrest for each µg/m3 increase in PM10 levels (Figure 1). Moreover, dividing PM10 values in quintiles, a 1.9 fold higher risk of cardiac arrest has been showed in the highest quintile (Highest quintile cut-off: >48µg/m3) (Figure 2). Conclusions The results of this study confirm the link between OHCA and PM10 in large cohort of patients from a high pollution area. The link between the two variables was present also for “safe” value of PM10. C55 OUT-OF- HOSPITAL CARDIAC ARREST (OHCA) IN TRIESTE: INCIDENCE AND OUTCOME S Franco S Franco SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE S Scapol S Scapol SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE C Pegani C Pegani SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE V Antonaglia V Antonaglia SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE A Peratoner A Peratoner SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE E Roman Pognuz E Roman Pognuz SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE A Iorio A Iorio SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE S Rakar S Rakar SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE G Sinagra G Sinagra SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE SC CARDIOLOGIA AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, TRIESTE; SOC CLINICA DI ANESTESIA E RIANIMAZIONE ASUIUD, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASU GI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE URGENZE TERRITORIALI ASUGI, TRIESTE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA ASUGI, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA GIOVANNI XXIII, BERGAMO; SC CARDIOLOGIA ASUGI, TRIESTE Background Despite progress in pre-hospital management and post resuscitation care, treatment of OHCA remains challenging. The analysis of the performance of the local EMS allows to detect improvement strategies. The aims of our study were to determine the incidence and outcome of OHCA in the Province of Trieste and to identify factors contributing to survival. Methods and Results Our retrospective observational study was conducted on all the OHCA patients who underwent Cardiopulmonary Resuscitation (CPR) by the EMS in the province of Trieste from 2011 to 30th June 2019. The data were retrieved from different sources, according to Utstein’s guidelines. Univariate and multivariate analysis were used to identify predictive factors of pre-hospital and in hospital mortality. During the study period, 651 OHCA occurred and nearly the 80% were of presumed cardiac origin (78%.508 pts). Of those, 359(71%) were treated by the local EMS, which corresponds to an incidence of 0,44/1000/year. Most patients were male (61%) with a mean age of 72±15 years. The majority (67%) occurred at home and were witnessed (64%), with a high rate of bystander CPR (61%, mostly dispatch-CPR). Shockable rhythms were only 28%. The great majority were treated with adrenaline (89%, 70%≥3mg). ROSC and survival to hospital discharge were 24% and 8,9%, respectively. Notably 7,5% died in ED or during the first 24 hours from hospital admission. The age, the presence of witnesses and bystander CPR were predictors of ROSC. Whereas, occurrence in public places, shockable rhythm and high dose adrenaline were related to both pre-hospital and in hospital mortality. High dose adrenaline was the strongest independent predictor of both the above-mentioned outcomes (OR 6,1 95%CI 2,7-14.0, OR 5,4 95%CI1,1-25,7). STEMI ECG, Coronary Artery Angiography and PCI were related to in-hospital survival. PCI was a strong predictor at multivariate regression, too (OR 0,146 95% CI 0,03-0,7). Conclusions Despite a high rate of bystander CPR and an effective post resuscitation care, survival from OHCA is low. The high rate of cases in which resuscitation was attempted and the deaths in the earliest phase of hospitalization may highlight the use of too extensive criteria for CPR. The early evaluation of variables related to pre-hospital and in hospital mortality, may contribute to a better selection of patients that can benefit from intensive care and to avoid overtreatment in those with scarce chance of survival. C56 CARDIOPULMONARY RESUSCITATION PERFORMED BY TRAINED OR NON-TRAINED PEOPLE AND PATIENT NEUROLOGICAL SURVIVAL OUTCOME IN CARDIAC ARREST: A MONOCENTRIC OBSERVATIONAL-RETROSPECTIVE STUDY N Gasparetto N Gasparetto CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO S Simionato S Simionato CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO D Betta D Betta CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO G Minniti G Minniti CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO S Orazio S Orazio CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO G Zilio G Zilio CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO F Marson F Marson CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO A Farnia A Farnia CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO P Rosi P Rosi CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO C Cernetti C Cernetti CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO CARDIOLOGIA, TREVISO; CARDIOCHIRURGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO Background Cardiac arrest (CA) is a clinical condition characterized by the sudden loss of cardiac mechanical activity. High quality cardiopulmonary resuscitation (CPR) followed by early defibrillation is the key to improve survival with good neurological outcome. Purpose The aim of this study is mainly to understand if CPR performed by a trained person is significantly related with a favourable neurological outcome, expressed with the CPC scale (Cerebral Performance Categories), compared with non-trained people or people that performed CPR with the guide of Emergency Medical Service (EMS). Methods In this observational-retrospective study of all consecutive OHCA patients. We analyse 277 cases of OHCA from March 2009 to June 2019. Results Overall survival at Intensive Cardiac Care Unit (ICCU) discharge was 72% and 30-days survival was 70%, while survival with a good neurological outcome (CPC 1-2) at discharge from the ICCU and at 30 days was 66% and 65% respectively. We find an inverse relation between the good neurological outcome and CPR performed by a non-trained person (OR 10.868; CI 95% (2.78-42.62); p = 0.001) regardless the presence of witnesses. In the 57% of the cases RCP was performed by non-trained people (or people that perform CPR guided by EMS), while in the remaining 43% by trained people. CPC value was 1 or 2 in the 56,4% cases of RCP performed by a trained person and 43,6% cases of RCP performed by a non-trained person; CPC value was 3, 4 or 5 in the 17,6% cases of RCP performed by a trained person and 82,4% cases of RCP performed by a non-trained person. There was no difference even in the separate analysis of non-trained people, CPR guided by EMS and trained people. Conclusion(s) Although intra-hospital therapeutic interventions are essential for CA patients, our data confirm that the first rings in the survival chain play a decisive role in patient's neurological outcome. The most important thing is to invest in diffusion of CPR culture and public access defibrillator systems that allow a significant improvement in chances of survival of OHCA patients. Chest compressions performed by a non-trained person (or guided by EMS) are less effective than CRP performed by a trained person. The creation of community lay rescuers and an inter-hospital network are very important to act quickly and accurately, in order to give a chance of survival with a good neurological outcome. C57 LONG-TERM SURVIVAL AFTER AN OUT-OF-HOSPITAL CARDIAC ARREST. AN UTSTEIN-BASED ANALYSIS E Baldi E Baldi UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA S Buratti S Buratti UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA E Contri E Contri UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA F Canevari F Canevari UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA S Compagnoni S Compagnoni UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA R Primi R Primi UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA M Pagani M Pagani UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA B Lusona B Lusona UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA F Mojoli F Mojoli UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA R Bertona R Bertona UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA R Osti R Osti UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA A Palo A Palo UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA L Oltrona Visconti L Oltrona Visconti UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA S Savastano S Savastano UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA UNIVERSITÀ DI PAVIA / FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AREU – AAT 118 PAVIA C/O FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, VOGHERA Purpose The majority of out-of-hospital cardiac arrest (OHCA) registries provide a follow-up limited at 1 month, so the subsequent survival remains an unexplored challenge. We sought to evaluate the long-term outcome after OHCA via an Utstein-based cardiac arrest registry. Methods We enrolled in the Cardiac Arrest Registry of the Province of Pavia (about 550000 inhabitants in northern Italy) all the patients who suffered an OHCA from any aetiology in whom CPR was attempted. The primary endpoint was the survival at 1 month and the secondary endpoints were the survival at 6 months and then every year until 5 years after OHCA. Results 1774 resuscitation attempts for confirmed OHCAs were collected in the first 45 months (October 2014–June 2018). 59.7% of the patients were males with a mean age of 73.4 ± 16 years. The mean EMS response time was 11:31 ± 5:09 mins. The vast majority of OHCA occurs at home (78.8%) with a medical etiology (93%). A bystander witnessed the event in 56.1% and the EMS in 15.6%. Bystander CPR rate was 39.5%, whilst an AED was used before EMS in 2.5%. The first rhythm was shockable in 18.2% (90.7% VF, 2.5% VT without pulse, 6.8% AED shockable). Survival was significantly higher for shockable Utstein categories ( p < 0.01) both when considering survival from the event (left panel) and from hospital discharge (right panel). Interestingly, survival continued to decrease also in shockable rhythm categories over time, from 90% in the first year to about 80% at four years. Conclusions OHCA with shockable rhythm showed a better survival both from the event and from hospital discharge. However, our results demonstrated that survival after OHCA can change over the time in all the Utstein categories, so we believe that a longer follow-up should be encouraged by next Utstein style revision. C58 SHOCKABLE VS NON-SHOCKABLE RHYTHM AND PATIENT NEUROLOGICAL SURVIVAL OUTCOME IN CARDIAC ARREST: A MONOCENTRIC OBSERVATIONAL-RETROSPECTIVE STUDY N Gasparetto N Gasparetto CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO S Simionato S Simionato CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO D Betta D Betta CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO S Orazio S Orazio CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO G Zilio G Zilio CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO F Marson F Marson CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO L Favero L Favero CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO M Possamai M Possamai CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO A Daniotti A Daniotti CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO A Farnia A Farnia CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO P Rosi P Rosi CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO C Cernetti C Cernetti CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO CARDIOLOGIA, TREVISO; SERVIZIO URGENZA ED EMERGENZA MEDICA, TREVISO; ANESTESIA E RIANIMAZIONE, TREVISO Background Cardiac arrest (CA) is a clinical condition characterized by the sudden loss of cardiac mechanical activity. The initial heart rhythm in CA could be shockable (ventricular fibrillation and pulseless ventricular tachycardia) or non-shockable (asystole and pulseless electrical activity). Aims The aim of this study is mainly to analyse the clinical features and therapeutic approach of out-of-hospital cardiac arrest (OHCA) patients. We want to understand if there is a relation between an initial shockable rhythm and a favourable neurological outcome, expressed with the CPC scale. We hope to identify a clear and shared way to manage patients who are victims of CA with shockable or non-shockable rhythm. Methods This is a monocentric observational-retrospective study of all consecutive OHCA patients treated with manual CPR or with mechanical chest compression device. We analyse 277 cases of OHCA from March 2009 to June 2019. Results In 86.3% of cases the CA was due to a shockable rhythm. Mechanical chest compression device was positioned in 21% of cases. One of the variables related with a good neurological outcome is an initial shockable rhythm (OR 0.033; CI 95% (0.006-0.194); p < 0.001). If we consider the subgroup of patient treated with mechanical chest compression, this variable remains statistically significant (OR 0.102; 95% CI (0.018-0.571); p = 0.009). CPC value was 1 or 2 in the 100% cases of shockable rhythm, while none of the patient with non-shockable rhythm treated with mechanical chest compression had a good neurological outcome. CPC value was 3, 4, or 5 in the 74,4% cases of shockable rhythm and 25,6% in cases of non-shockable rhythm. Conclusions From data analysis, we find that an initial shockable rhythm is strongly related with a good neurological outcome. Patients with CA with initial non-shockable rhythms are characterised by a significantly higher mortality than shockable rhythms, independently of manual or mechanical CRP. C59 CORONARY ANGIOGRAPHY (CGA) AND PERCUTANEOUS CORONARY INTERVENTION (PCI) AFTER OUT-OF-HOSPITAL CARDIAC ARREST (OHCA): PATIENTS SELECTION AND OUTCOME S Franco S Franco SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO S Scapol S Scapol SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO C Pegani C Pegani SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO V Antonaglia V Antonaglia SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO A Peratoner A Peratoner SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO E Roman Pognuz E Roman Pognuz SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO A Perkan A Perkan SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO G Vitrella G Vitrella SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO E Fabris E Fabris SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO A Iorio A Iorio SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO S Rakar S Rakar SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO G Sinagra G Sinagra SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO SC CARDIOLOGIA ASUGI, TRIESTE; SC CLINICA ANESTESIA E RIANIMAZIONE, UDINE; SSD PRONTO SOCCORSO OSPEDALE MAGGIORE E GESTIONE DELLE URGENZE TERRITORIALI, TRIESTE; AZIENDA REGIONALE DI COORDINAMENTO PER LA SALUTE, UDINE; SC ANESTESIA RIANIMAZIONE TERAPIA ANTALGICA, TRIESTE; CARDIOLOGIA AZIENDA OSPEDALIERA PAPA GIOVANNI XIII, BERGAMO Background Acute coronary thrombotic occlusion is the main cause of cardiac arrest. Coronary artery angiography (CGA) with percutaneous coronary intervention (PCI) have demonstrated to increase survival in patients resuscitated from out-of-hospital cardiac arrest (OHCA) and are strongly recommended in all patients with suspected ischemia and no obvious extracardiac cause, regardless of ECG pattern. Aim We aimed to verify selection’s criteria to CGA in a population of patients resuscitated from OHCA admitted in a single hub hospital in Trieste. Methods and Results Retrospective observational study, which included all patients resuscitated from OHCA admitted alive at Cattinara Hospital (Trieste) from 1°Jenuary 2016 to 30 June 2019. The selection of patients for CGA was performed according to a local protocol, which states direct access to cath lab for STEMI ECG patients and after exclusion of extracardiac causes for those with noSTEMI ECG. Sixty-seven patients were included in the analysis. Mean age 63 + 16, 69% were male, 89% GCS 3, 76% had FV/TV as initial rhythm. Thirty-nine% (26 pts) had a STE-MI pattern at first ECG recorded post ROSC. CGA was performed in 49 pts (73%). All patients with ECG STEMI underwent CGA and more than half of those with noSTEMI ECG (23 pts; 57%). Eighteen pts (69%) in the STEMI group and 3 (13%) in the no-STEMI were treated with PCI, with a ratio between PCI and CGA of 2 out of 3 and 1 out of 8 respectively. Survival rates were 58% for STEMI and 9% for noSTEMI group. Fourty-five (88%) of patients with shockable rhythm underwent CGA, 44% (20pts) were treated with PCI, survival rate was 36%. Overall 32 pts (48%) were alive at hospital discharge. These patients were more likely to have a STEMI ECG pattern (59% vs 20%, p < 0,001) and were more frequently studied by CGA (87,5% vs 60% p = 0,01) and treated with PCI (53% vs 11% p = 0,001). Both CGA and PCI were predictors of in-hospital survival at univariate analysis (OR 0,214 95% CI 0,062-0,746, OR 0,152 95% CI 0,040-0,574 respectively). At multivariate analysis only PCI was independently related to survival (OR 0,146 95%CI 0,032-0,668). Conclusions CGA and PCI seem to improve survival in properly selected patients resuscitated from OHCA. HEART FAILURE 2C60 MINERALCORTICOID RECEPTOR ANTAGONIST WITHDRAWAL FOR HYPERKALEMIA AND MORTALITY IN PATIENTS WITH HEART FAILURE F Lisi F Lisi SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI G Parisi G Parisi SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI M Gioia M Gioia SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI L Amato L Amato SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI M Bellino M Bellino SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI D Grande D Grande SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI M Ciccone M Ciccone SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI P Caldarola P Caldarola SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI M Iacoviello M Iacoviello SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI SCUOLA DI CARDIOLOGIA, UNIVERSITY OF BARI, BARI; OSPEDALE DI TERLIZZI, TERLIZZI; OSPEDALE "PERRINO" DI BRINDISI, BRINDISI; OSPEDALE DI SALERNO, SALERNO; SCUOLA DI CARDIOLOGIA UNIVERSITÀ DEGLI STUDI DI BARI, BARI; OSPEDALE "S.PAOLO" DI BARI, BARI; CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI Background Hyperkalemia is one of the most frequent side effects related to renin angiotensin aldosterone system (RAAS) inhibition, and can influence optimization of heart failure therapy. Aim To evaluate the occurrence of hyperkalemia in a series of outpatients with chronic heart failure (HF) and its relationship with RAAS inhibitor therapy. Method We evaluated consecutive outpatients with HF and reduced left ventricular ejection fraction. The incidence of hyperkalemia and consequent changes in RAAS inhibitor therapy were evaluated for each patient. Results A history of hyperkalemia or at least one episode of hyperkalemia during follow-up was observed in 104 of 351 patients. Hyperkalemia mainly influenced mineralocorticoid receptor antagonist (MRA) therapy and, among patients with hyperkalemia, not taking MRA was associated with a greater risk of death on univariate analysis (hazard ratio [HR], 6.39; 95% confidence interval [CI], 2.76–14.79; P< 0.001) and multivariate analysis (HR, 5.24; 95% CI, 1.87–14.72; P= 0.002) after correction for age, ischemic cardiomyopathy, diabetes, systolic arterial pressure, New York Heart Association class 3, left ventricular ejection fraction, presence of hyponatremia, glomerular filtration rate calculated by the EPI formula, presence of N-terminal pro-B-type natriuretic peptide >1000 pg/mL. Conclusion The occurrence of hyperkalemia is common among outpatients with HF and it is the main cause of MRA withdrawal, which is associated with a worse prognosis. In this setting, the possibility of managing hyperkalemia using new classes of drugs could allow continuation of MRA therapy. C61 SURVEY ON THE USE OF DIURETICS IN ACUTE AND CHRONIC HEART FAILURE F Orso F Orso AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO M Canale M Canale AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO F De Sensi F De Sensi AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO G Giannotti G Giannotti AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO G Grippo G Grippo AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO A Iadanza A Iadanza AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO S Lunghetti S Lunghetti AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO L Segreti L Segreti AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO C Sorini Dini C Sorini Dini AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO G Casolo G Casolo AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO AOU CAREGGI, FIRENZE; NUOVO OSPEDALE VERSILIA, LIDO DI CAMAIORE; OSPEDALE DELLA MISERICORDIA, GROSSETO; OSPEDALE DELLA VAL DI NIEVOLE, PESCIA; OSPEDALE SANTO STEFANO, PRATO; A.O.U. SENESE OSPEDALE S. MARIA ALLE SCOTTE, SIENA; STEFANO LUNGHETTI, SIENA; A.O.U. PISANA, PISA; OSPEDALI RIUNITI, LIVORNO Background In the last ESC guidelines on the diagnosis and treatment of acute heart failure diuretics are the only drugs with a class I recommendation for congestion treatment and symptoms improvement in patients with reduced ejection fraction (HFrEF) and in those with preserved ejection fraction (HFpEF). Nevertheless, in the real world there is scarce evidence concerning the use of diuretics and how the response to their treatment is evaluated. AIM To describe in a sample of cardiologists use of diuretics and how the response to their use is evaluated in patients with heart failure. Methods The Tuscan regional section of the national society of hospital cardiologists (ANMCO) elaborated a survey on the use of diuretics in heart failure. The survey, of a total of 20 questions, was sent to the regional representatives of the cardiological units who forwarded to their members. Results A total of 47 questionnaires were filled and sent for analysis. In the acute setting, furosemide is the diuretic more frequently used but with a starting dose varying from 20 mg to 250 mg in the naive patient. In the chronic heart failure patient that is admitted for worsening heart failure with signs of congestion, 37% of cardiologists would double chronic oral dose, 20% would use the same chronic dose administered intravenously and 22% would triplicate chronic oral dose. Diuretic response evaluation is based on signs and symptoms in 93% of cases, frequently associated with urinary volume (71%) and rarely with urinary sodium measurement (7%). The timing of diuretic response was very variable: 65% would control after one hour, 17% at 4-6 hours. Almost 77% would continue with a continuous infusion or with diuretic boluses depending on the clinical situation. For the evaluation of decongestion 48% would use natriuretic peptides, 46% body weight variation, 45% echocardiographic parameters and only 6% haemoconcentration. Also, diuretic resistance management resulted extremely different. Conclusions In clinical practice there is a high variability in the use of diuretics and in the evaluation of the response to their treatment in patients with heart failure. C62 TEMPORAL CHANGES IN CHRONIC HEART FAILURE PHENOTYPES OVER TWO DECADES IN THE ITALIAN NETWORK OF HEART FAILURE (IN-HF) REGISTRY R De Maria R De Maria CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI M Gori M Gori CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI M Marini M Marini CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI L Gonzini L Gonzini CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI M Benvenuto M Benvenuto CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI L Cassaniti L Cassaniti CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI A Municinò A Municinò CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI A Navazio A Navazio CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI E Ammirati E Ammirati CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI G Montana G Montana CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI V Rizzello V Rizzello CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI M Perrelli M Perrelli CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI M Catalano M Catalano CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI D Nassiacos D Nassiacos CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI M Iacoviello M Iacoviello CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UOC CARDIOLOGIA CON UTIC ED EMODINAMICA, AO CANNIZZARO, CATANIA; UOC CARDIOLOGIA, ASST VALLE OLONA, PRESIDIO OSPEDALIERO DI SARONNO, SARONNO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI D. on behalf of the Researchers D. on behalf of the Researchers Background Since the start of the new century, demographic changes and therapeutic progress seem to have modified the clinical characteristics of the general population with chronic heart failure (CHF). Purpose We describe the temporal evolution in the clinical CHF phenotype and its determinants across two decades in the IN-HF registry Methods According to recruitment epoch, patients with ascertained one-year vital staus first enrolled in the registry since January 1999 through May 2018 were classified into 3 cohorts: 1999-2005 (N = 5404); 2006-2011 (N = 3971); 2012-2018 (N = 5448). We analysed temporal changes in the clinical characteristics of 3 age groups: < 65 (n = 5465); 65-79 (n = 6838); 80 + (n = 2520) years old. Results We studied 14823 CHF patients (72.9% men, age 67 + 13 years, LV ejection fraction (LVEF) 37 + 12%). Comparisons by age categories showed with increasing age (<65; 65-79; 80 +) significant (p<.0001) increases in LVEF (36±11, 37±11, 41±13%) and in the proportion of women (22;27;40%), patients with NYHA III-IV (17;22;28%), atrial fibrillation (16;32;44%), history of hypertension (42;59;69%), diabetes (23;32;28%), left bundle brach block (15;19;18%), preserved LVEF (>50%) phenotype (13;15;27%); decreases in LV end-diastolic volume index (95±36, 91±34, 80±32 ml/m2) and in the proportion of subjects with obesity (26-20-14%) and reduced LVEF (<40%) phenotype (64;61;49%). Fig.1 depicts the temporal changes in the age composition of the enrolled population by epoch and age class. Table 1 compares clinical characteristics by epoch within the 3 age groups. During two decades we observed a progressive ageing of the enrolled population. Prevalence of hypertension, obesity, atrial fibrillation, long HF history, severe symptoms increased and proportion of subjects with HFrEF decreased with time across the 3 age categories. Conversely, prevalence of diabetes rose while ischemic aetiology and the proportion of subjects hospitalized for HF in the previous year declined only in the oldest age group. Furthermore the prevalence of HFrEF decreased (p<.0001) within each age group (Fig.2). Conclusions During two decades, the clinical characteristics of CHF patients enrolled in the IN-HF registry have deeply changed. These modifications reflect demographic variations, the evolution of cardiovascular risk factors and improved management strategies and have important treatment implications. C63 TRENDS OF TREATMENT IMPLEMENTATION FOR CHRONIC HEART FAILURE DURING TWO DECADES IN A NATIONWIDE REGISTRY M Gori M Gori CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Iacoviello M Iacoviello CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Gorini M Gorini CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Marini M Marini CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO L Cassaniti L Cassaniti CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Benvenuto M Benvenuto CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO A Municinò A Municinò CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO A Navazio A Navazio CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO E Ammirati E Ammirati CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO V Randazzo V Randazzo CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO G Scopelliti G Scopelliti CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO A Felici A Felici CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO F Ingrillì F Ingrillì CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO F De Cian F De Cian CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO R De Maria R De Maria CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SOD CARDIOLOGIA OSPEDALIERA EMOD. E UTIC, OSPEDALI RIUNITI, ANCONA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; UOSD CARDIOLOGIA–UTIC, OSPEDALE DELL‘ALTA VAL D‘ELSA, POGGIBONSI; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; UOC CARDIOLOGIA E UTIC – VILLA SOFIA, AOR VILLA SOFIA–CERVELLO PRESIDIO CTO, PALERMO; UO CARDIOLOGIA, OSPEDALE SANTA MARIA DEL PRATO, FELTRE; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO D. on behalf of the Researchers D. on behalf of the Researchers Background Despite availability of drug & device therapy for chronic heart failure (CHF), their implementation in clinical practice has been slow and substantial under-treatment of older patients has been described. Methods According to the recruitment epoch, patients first enrolled in the registry since January 1999 through May 2018 were divided into 3 cohorts: 1999-2005 (N = 5404); 2006-2011 (N = 3971); 2012-2018 (N = 5448). We analyzed temporal changes among the 3 cohorts in drug and device therapies in 3 age groups: < 65 (n = 5465); 65-79 (n = 6838); 80 + (n = 2520) years old. Results We studied 14823 CHF patients (72.9% men, age 67±13 years, LV ejection fraction (LVEF) 37±12%), reduced LVEF (<40%) phenotype 60%). Comparisons by age categories showed the following: - the proportion on mineralocorticoid receptor antagonits (MRA) overlapped by age (49;48;50%, p = .53), - significant increase in the proportion of patients who were, with increasing age class (<65; 65-79; 80 +), on furosemide (71;83;90%, p<.0001), on high dose furosemide (out of 8717 with known dose: 29;36;39%, p<.0001), on digitalis (21;25;23%, p = .001), on oral anticoagulants (25;36;41%, p<.0001), on permanent pacing (5;11;18%, p<.0001) on CRT-P (0.9;1.6;1.5%, p = .002); - significant decrease on betablockers (74;68;66%, p<.0001), on renin-angiotensin system inhibitors (ACE-I/ARB/ARNI) (89;86;79%, p<.0001), on ICD (22;17;10%, p<.0001). According to treatment comparisons by epoch within each age category, during twenty years the uptake of guideline-recommended drug and device therapies has steadily grown, while the proportion of subjects on high-dose loop diuretics has increased. Despite the introduction of ARNI in clinical practice in the most recent epoch, the prescription of renin-angiotensin system inhibitors decreased among patients 65 years and older (Figure). Conclusions According to our nationwide registry, during two decades in we observed a consistent implementation of recommended treatments, underscoring the value of the HF network supported by our national scientific society. The decline in the use of renin-angiotensin system inhibitors seems to be connected with temporal changes in the clinical characteristics and disease severity of CHF patients. C64 ELIGIBILITY OF CHRONIC HEART FAILURE OUTPATIENTS TO SGLT2-INHIBITORS THERAPY: A SINGLE-CENTRE EXPERIENCE G Angelini G Angelini SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI M Albanese M Albanese SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI R Ursi R Ursi SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI F Lisi F Lisi SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI L Amato L Amato SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI M Bellino M Bellino SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI G Parisi G Parisi SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI M Gioia M Gioia SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI M Iacoviello M Iacoviello SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI SCUOLA DI CARDIOLOGIA, POLICLINICO DI BARI, BARI; U.O. CARDIOLOGIA UNIVERSITARIA, POLICLINICO DI BARI, BARI Background SGLT-2 inhibitors (SGLT2-i) are a new emerging class of drugs for the prevention of heart failure hospitalizations and improvement of diabetic patients life expectancy. Moreover, it has been recently demonstrated its ability in reducing mortality among chronic heart failure (CHF) outpatients with reduced left ventricular ejection fraction (LVEF), independently from the presence of type 2 diabetes. The aim of our study was to understand the number of CHF outpatients eligible for this therapy according to the enrollment criteria of the main randomized controlled trials (CVOTs) who have tested their efficacy. Methods We retrospectively evaluated all consecutive patients referred to our CHF outpatients clinic between 2014 and 2019. Patients were classified as affected by CHF with reduced (HFrEF), mild reduced (HFmrEF) and preserved (HFpEF) LVEF according with current ESC Guidelines. The diagnosis of type 2 diabetes was according with latest ESC Guidelines. All clinical characteristics considered for the enrollment in the trials (i.e. EMPAREG, CANVAS, DECLARE, CREDENCE and DAPAHF) were recorded. Results We enrolled 515 patients (age 62±13, male 79%, NYHA class 2.3±0.5, LVEF 34±10%). As shown in the table a high prevalence of diabetes was observed in HFrEF as well as in HFpEF and HFmrEF. Moreover, a high percentage of patients met the main enrollment criteria of CVOTs evaluating SGLT2i (table). Conclusions By evaluating our single-centre exploratory study, we observed that among CHF outpatients there is a high prevalence of patients in whom according to their clinical characteristics SGLT2-I therapy could be useful to improve their outcome. In particular, among HFrEF, almost all patients should receive this therapy according to the main enrollment criteria of DAPA-HF. C65 CLINICAL OUTCOMES AND ADVERSE EVENTS IN CONTEMPORARY PATIENTS WITH ADVANCED HEART FAILURE RECEIVING REPEATED, PLANNED LEVOSIMENDAN INFUSIONS FOR SYMPTOMS CONTROL AND AS A BRIDGE TO HEART TRANSPLANTATION G Galeotti G Galeotti SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO A Verde A Verde SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO G Masciocco G Masciocco SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO G Foti G Foti SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO E Perna E Perna SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO E Ammirati E Ammirati SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Cipriani M Cipriani SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Frigerio M Frigerio SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, PISA, E IRCCS POLICLINICO SAN DONATO, SAN DONATO MILANESE, PISA E SAN DONATO MILANESE; DE GASPERIS CARDIO CENTER, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO Background and Aims Repeated, planned infusions of levosimendan (rp-Levo) are utilized mostly in an in-hospital setting in some patients (pts) with advanced heart failure (AHF), to maintain clinical stability and end organ function. Our study aims to evaluate the effectiveness and safety of rp-Levo in outpatients with AHF, and to identify potential predictors of therapeutic efficacy. Methods 75 pts, (53% were listed for Heart Transplant (HTX)), were treated with rp-Levo (0.05-0.15 mcg/kg/min for 24 hours every 4 weeks) at the day-service of a single center, from Jan 2012 to Feb 2019. Actuarial survival and freedom from death or treatment failure, hospital readmissions, trend of laboratory parameters, predictors of treatment failure, and adverse events were evaluated. Results During a median follow-up of 16 months, 24 pts (32 %) died. Kaplan Meier overall actuarial survival was 85% at 1 year, with a significant advantage in HTX-listed pts (Logrank χ 2= 14.609, p < 0.001) vs those treated for symptoms control. After a median of 12 months, 41 pts (55%) met the composite endpoint of death or any treatment failure (LVAD or urgent HTX, switch to another inotrope for refractory HF), without differences between HTX-listed pts and symptoms-control pts. 45 (60%) pts were hospitalized at least one time for a median of 13 (0-33) days spent in hospital (DIH). The DIH of the first 6 months on rp-Levo was significantly lower compared to the 6 months preceding rp-Levo start (p = 0.018). No significant increase in the levels of NT-proBNP, creatinine or bilirubin was found up to 1 year. The variation of NT-proBNP at 3 months was the most accurate parameter in predicting treatment failure (AUC= 0.700, cut off= -14%), being the sole significant independent predictor of treatment failure (HR 1.009, 95%C.I. 1.000-1.017, p = 0.044). Over 1121 administrations, there were 33 drug related adverse events (1 sudden cardiac death, 13 ventricular tachyarrhythmias, 7 supraventricular tachyarrhythmias, 2 bradyarrhythmias, 4 symptomatic hypotensions and 6 acute renal failures). Only 9 of them in the first 10 days from infusion. Conclusions Rp-Levo may be safely delivered in an outpatient setting for maintaining clinical stability and possibly reducing or delaying readmissions in pts with AHF. The trend of NT-proBNP levels on treatment may help in predicting treatment failure. Heart replacement therapies are still fundamental to modify the prognosis of patients with advanced disease. C66 CONGESTIVE HEART FAILURE: MINIMALLY INVASIVE EPICARDIAL CRT. OUR EXPERIENCE A Droghetti A Droghetti ASST MANTOVA/ASST CREMONA, MANTOVA/CREMONA; ASST MANTOVA, MANTOVA; APSS TRENTO, TRENTO P Pepi P Pepi ASST MANTOVA/ASST CREMONA, MANTOVA/CREMONA; ASST MANTOVA, MANTOVA; APSS TRENTO, TRENTO M Marini M Marini ASST MANTOVA/ASST CREMONA, MANTOVA/CREMONA; ASST MANTOVA, MANTOVA; APSS TRENTO, TRENTO D Viggiano D Viggiano ASST MANTOVA/ASST CREMONA, MANTOVA/CREMONA; ASST MANTOVA, MANTOVA; APSS TRENTO, TRENTO ASST MANTOVA/ASST CREMONA, MANTOVA/CREMONA; ASST MANTOVA, MANTOVA; APSS TRENTO, TRENTO Aim The epicardial placement of the left ventricular (LV) lead has been proposed as an alternative approach to the standard cardiac resynchronization therapy (CRT) procedure. In our center we developed a minimally invasive thoracoscopic technique. We reviewed our experience to evaluate the long-term safety and efficacy of the technique. Methods The procedure is performed under general anaesthesia with oro-tracheal intubation and right-sided ventilation. The procedure requires 3 thoracoscopic ports (two 5-mm and one 15-mm). After pericardiotomy at the spot of the epicardial target area, pacing measurements are performed and a spiral screw electrode is anchored at the final pacing site. Finally, the electrode is tunnelled to the pectoral pocket and connected to the device. Results 94 consecutive patients were referred to our center for epicardial LV lead implantation. After pre-operative assessment, 5 patients were excluded because of concomitant conditions precluding surgery or lack of indication to CRT. The remaining 89 patients underwent the surgical procedure. Of them, 57 had undergone a previous unsuccessful LV lead implantation (Group 1). In the remaining 32 patients an effective CRT was discontinued due to LV lead dislodgment (Group 2). The LV lead implantation was successful in all patients (median pacing threshold 0,8 V at 0,5 ms -IQR 0,6-1,2-, no phrenic nerve stimulation) and CRT was successfully established in all but one patient at the end of the procedure. No complications were reported, except for 2 case of transitory peri-elecrode bleeding and 3 cases of ventricular fibrillation induced during the procedure (no sequelae). The median procedure time was 75 min (IQR 55-95). During a median follow-up of 24 [IQR 13-39] months, 21 patients died (comparable rate between Groups: Log-Rank Test, 0,829) Conclusions Our thoracoscopic approach proved to be safe and effective. It represents a viable alternative to the standard transvenous approach in case of failed de-novo implantation and for those patients who positively responded to CRT but experienced an LV lead dislodgment. C67 VENOARTERIAL ECMO VERSUS IMPELLA® IN PATIENTS WITH CARDIOGENIC SHOCK: A METANALYSIS G Lanzillo G Lanzillo STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITA‘ DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA F Fortuni F Fortuni STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITA‘ DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA M Casula M Casula STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITA‘ DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA M Ferrario Ormezzano M Ferrario Ormezzano STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITA‘ DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA L Oltrona Visconti L Oltrona Visconti STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITA‘ DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA M Ferlini M Ferlini STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITA‘ DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITA‘ DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA Introduction Cardiogenic shock (CS) incidence remained stable during last 40 years, with an overall mortality of about 50% of the cases. In this scenario, the correct use of short-term percutaneous mechanical support systems - i.e., VenoArterial ExtraCorporeal Membrane Oxygenation (VA-ECMO) and ventricular unloading system Impella® is still not completely defined; moreover, comparison data between these two systems just derive from observational, non-randomized trials. The aim of our work was to perform a systematic review of the literature and subsequent metanalysis to compare VA-ECMO vs Impella® in patients with CS. Methods Primary endpoint was the overall mortality; secondary endpoints were: percentage of patients successfully weaned from mechanical support; percentage of patients in whom the support was used as “bridge” therapy to ventricular assistance device (VAD) or heart transplant; major vascular complications rate. A random-effect model was used to estimate odds ratio (OR) of outcomes of interest. Results Three retrospective studies were included in our analysis with an overall population of 283 patients, 116 in VA-ECMO group and 167 in Impella® group. Mean age was 54±3 years old, 73% were male patients, 44% underwent intubation. For what concerns aetiology of CS, 56% of patients had ischemic CS; 91% of patient was treated with Intra-aortic balloon pump (IABP). In patients with Impella®, the 5.0/CP model was used in 52% of the cases. Mean duration of mechanical support was 119±64 hours in the VA-ECMO group and 109±72 hours in the Impella® group. At median follow-up time of 12 (IQ range 6.5-30) months there were not statistically significant differences between the two groups in terms of mortality for all causes (OR 0.94, IC 0.58-1.53), successful weaning from support system (OR 0.81, IC 0.49-1.33) and use of support as bridge therapy to VAD (OR 0.61, IC 0.15-2.4) or heart transplant (OR 0.40, IC 0.06-2.4). A significant reduction was observed in terms of major vascular complication in the group treated with Impella® system (OR 0.28, IC 0.12-0.62). Conclusion In patients with ischemic CS, “on-top” of treatment with IABP, there were no significant differences between VA-ECMO and Impella® in terms of mortality, weaning from support system and use of support as bridge therapy to VAD or heart transplant, while a statistically significant reduction of vascular complications was observed in patients treated with Impella® system. MYOCARDIAL INFARCTION 2C69 MARKED INCREASE IN HIGH-SENSITIVITY TROPONIN I (HS-CTNI) IN THE ABSENCE OF EVIDENCE OF ACUTE CORONARY SYNDROME G Marino G Marino AZIENDA OSPEDALIERO UNIVERSITARIA SANT‘ANDREA, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA A Macchiusi A Macchiusi AZIENDA OSPEDALIERO UNIVERSITARIA SANT‘ANDREA, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA M Vitillo M Vitillo AZIENDA OSPEDALIERO UNIVERSITARIA SANT‘ANDREA, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA F Colivicchi F Colivicchi AZIENDA OSPEDALIERO UNIVERSITARIA SANT‘ANDREA, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA AZIENDA OSPEDALIERO UNIVERSITARIA SANT‘ANDREA, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA; PO SAN FILIPPO NERI – ASL ROMA 1, ROMA High-sensitivity troponins (hs-cTn) are the current reference biomarkers for the diagnosis of acute myocardial infarction. However, it is possible to observe an increase of hs-cTn in conditions other than obstructive coronary disease. Sometimes the presence of heterophile antibodies can interfere with the hs-cTn dosage. We propose a case of a patient suffering from rheumatoid arthritis, hospitalized for syncope. Serial blood samples documented markedly elevated values of type I high-sensitivity troponin (hs-cTnI), with normality of other myocardial injury markers. Echocardiogram, coronary angiography and electrophysiological study were normal. The subsequent use of blocking reagents heterophile antibodies allowed us to define these values as false positives. So to diagnose acute myocardial infarction it is always necessary to contextualize laboratory data, integrating them with clinical informations and other available blood and instrumental tests. Besides, you need to control the release kinetics of cardiac troponins and to compare it with other markers of myocardial injury. Finally you have to consider some potential causes for the formation of heterophile antibodies that could interfere with biomarkers dosage. C70 THE TREATMENT WITH BETA-BLOCKERS AFTER MYOCARDIAL INFARCION WITHOUT REDUCED EJECTION FRACTION (REBOOT) TRIAL. CURRRENT STATUS S Ferraro S Ferraro U.O. CARDIOLOGIA FOR THE REBOOT TRIAL INVESTIGATORS, PIACENZA F Del Giudice F Del Giudice U.O. CARDIOLOGIA FOR THE REBOOT TRIAL INVESTIGATORS, PIACENZA V Pelizzoni V Pelizzoni U.O. CARDIOLOGIA FOR THE REBOOT TRIAL INVESTIGATORS, PIACENZA U.O. CARDIOLOGIA FOR THE REBOOT TRIAL INVESTIGATORS, PIACENZA There is a lack of evidence regarding the benefits of maintenance β-blocker treatment in post-acute myocardial infarction (AMI) patients without reduced left ventricular ejection fraction (LVEF) in the era of invasive management. Design REBOOT is an independent multinational pragmatic, controlled, randomized, open-label, with blinded endpoint adjudication clinical trial testing the benefits of β-blocker maintenance therapy in post-AMI patients (either with or without ST segment elevation) discharged with LVEF >40%. Patients ≥18 years (yr) old undergoing invasive management during admission and without history of heart failure (HF) are eligible to participate. At discharge, patients are 1:1 randomized to either receive β-blocker (agent and dose chosen by the treating physician) or no β-blocker therapy. The primary endpoint is a composite of “all-cause death, nonfatal reAMI, or HF hospitalization” over a minimum follow-up period of 2 yr. Key secondary endpoints are: i) the incidence rate of each individual component of the composite endpoint; ii) cardiovascular death; iii) admission for sustained ventricular tachycardia/ventricular fibrillation; and iv) admission for atrial fibrillation. Events will be adjudicated by a blinded committee. A sample size of 8,468 pts (728 events) was estimated to provide a power of 85% to detect a relative risk reduction of 20% (incidence of primary endpoint in control 10%) and assuming 5% withdrawals. Statistical analyses will be conducted according to the intention-to-treat principle, although a pre-specified per-protocol analysis will also be performed. The Spanish National Center for Cardiovascular Research (CNIC) is the sponsor of the trial, which has no external funding. CNIC coordinates ≥70 Spanish centers, while IRCCS Istituto di Ricerche Farmacologiche Mario Negri coordinate ≥25 Cardiology Centers distributed in 10 different Italian regions. The first pt was included in Spain in October 2018, in Italy in January 2019. The end of enrollment is anticipated in April 2021. At November 2019, 2063 patients had been enrolled from which 271 in Italy (Figure). The baseline characteristics of the included pts are described in the Table. Conclusions The REBOOT trial (NCT03596385) will fill the existing scientific gap on the efficacy of β-blockers after AMI in pts with LVEF > 40% and no HF who are treated according to current standard-of-care. REBOOT trial results might have an impact on clinical practice guidelines. C73 PROGNOSTIC IMPACT OF THE UPSTREAM USE OF GP IIB/IIIA INHIBITORS IN SELECTED PATIENTS PRESENTING WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION A Malagoli A Malagoli OCB, BAGGIOVARA P Magnavacchi P Magnavacchi OCB, BAGGIOVARA S Tondi S Tondi OCB, BAGGIOVARA OCB, BAGGIOVARA Background In 2017 ESC Guidelines for the management of patients presenting with ST-segment elevation myocardial infarction (STEMI), glycoprotein (GP) IIb/IIIa inhibitors should be considered for bailout if there is evidence of no-reflow or a thrombotic complication (Class IIa, Level C). The pre-hospital routine upstream use of GP IIb/IIIa inhibitors before primary PCI has not been demonstrated to offer a benefit and increases bleeding risk compared with routine use in the catheterization laboratory. The aim of the study was to retrospectively evaluate the prognostic impact of upstream use of GP IIb/IIIa inhibitors in selected STEMI patients. Methods We examined 658 consecutive patients (488 male) presenting with anterior ST-segment elevation in a non-PCI centre between October 2008 and December 2018, undergoing primary PCI of left main or proximal left anterior descending coronary artery in our cath-lab. Patients were stratified by using of GP IIb/IIIa inhibitors (upstream, bailout or not using) into 3 groups. Results Upstream use (UU) was present in 14.6% (n = 96), bailout use (BU) was present in 46.3% (n = 305), and not use (NU) was present in 39.1% (n = 257). Baseline characteristics were similar except for hypertension (32.6%, 38,1%, and 52,4% in the UU, BU, and NU groups, respectively). Patients with UU had the lowest all-cause mortality of all groups (Figure 1). Overall 4-year survival in the UU group was 12.9% versus 27% in the BU group, and 38% in the NU group (p<0.001). Conclusion In selected STEMI patients, the upstream use of GP IIb/IIIa inhibitors in a non-PCI centre was significantly associated with better overall survival. C74 WHICH SEVERITY OF CHRONIC KIDNEY DISEASE AND ANAEMIA IS ASSOCIATED WITH A SUBSTANTIAL INCREASE OF MORTALITY IN MALES AND FEMALES WITH STEMI? P Rubartelli P Rubartelli OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA E Bologna E Bologna OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA M Bruzzone M Bruzzone OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA D Bartolini D Bartolini OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA S Bellotti S Bellotti OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA M Fedele M Fedele OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA A Iannone A Iannone OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA L Pastorino L Pastorino OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA; IRCCS SAN MARTINO, GENOVA; OSPEDALE VILLA SCASSI ASL3 GENOVESE, GENOVA Background Pre-existing chronic kidney disease and anaemia are associated to worse prognosis in patients with STEMI treated with primary PCI, However, the relation between the severity of these comorbidities and the mortality risk is not well characterized. Purpose To investigate the association between the values of both glomerular filtration rate (eGFR) and haemoglobin (Hb) versus mortality. Methods Between January 2006 and December 2018, 2138 consecutive patients with STEMI underwent primary PCI at our Centre. Pre-procedural eGFR was estimated with the CKD-EPI equation. The outcome measure was overall mortality at a median follow-up of 1.6 years. Trends in eGFR and Hb versus mortality in males and females were represented using Restricted Cubic Splines. Results Baseline data. Mean age of patients is 67±13 years, 27.2% are females, 25.3% diabetics. Mean eGFR was 76±23 ml/min, mean Hb was 13.9±1.8 g/dl. Contact-to-balloon time was (median, IQR) 84', 68'-107'. - Risk related to eGFR. In both sexes, the risk of mortality rose sharply when the eGFR decreased below 50 ml/min. In females, the risk was higher than in males especially for eGFR below 50 ml/min. However, the shape of the curve was similar. - Risk related to Hb. In males, the association between mortality and Hb had a similar shape, showing a change of slope, though less pronounced, at 10.5 g/dl. For Hb values below 10,5 g/dl the curve is identical in boh sexes. For Hb values above 10.5 g/dl, males maintained a negative association between Hb and mortality, while in females values of Hb > 10.5 g/dl did not show a protective effect. See figure. Conclusions According to our data, the prognostic impact of chronic kidney disease and anaemia increased with their severity. Moreover, a threshold value for both eGFR and Hb, corresponding to a marked increase of risk, could be identified. Males and females presented the same threshold values although shape and values of the curves were not identical. The identification of levels of severity of chronic kidney disease and anaemia with a stronger association with mortality could be useful for a more accurate prognostic stratification of patients with STEMI. C75 HIGHER IN-HOSPITAL FEMALE GENDER MORTALITY IN ST-ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION U Paradossi U Paradossi OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA L Zezza L Zezza OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA A De Caterina A De Caterina OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA C Palmieri C Palmieri OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA G Trianni G Trianni OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA A Rizza A Rizza OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA E Koni E Koni OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA G Benedetti G Benedetti OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA S Berti S Berti OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA OSPEDALE DEL CUORE FTGM, MASSA; OSPEDALE DEL CUORE FTGM, MASSA Aims Whether and how gender difference, once adjusted for covariates, affects mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous angioplasty (pPCI) is still debated. This study was designed to evaluate the impact of gender on in-hospital and one-year mortality in STEMI patients treated with pPCI. Methods and Results A total of 2008 consecutive patients with a STEMI diagnosis were admitted to our hub Hospital and treated with pPCI. We systematically collected data on the time from symptom onset to first medical contact and to the infarct-related artery recanalization, as well as demographic, angiographic and clinical variables from presentation to the discharge. Data on one-year mortality were collected by telephone. In order to evaluate the impact of age on mortality, patients were divided into four groups according to gender and age <65 years and > 65 years. In-hospital and 1-year mortality were 4.4% and 7.8%, respectively. After multivariate analysis, female gender (p < 0.03) and ischemic time (p < 0.01) were identified as independent predictors of in-hospital mortality, together with age (p < 0.004), shock (p < 0.0001), LVEF<40% at presentation (p < 0.0001), and post-PCI TIMI<3 (p < 0.001) Women had a higher in-hospital mortality (8.7 vs 2.8%, p < 0.0001) than men, and both in patients <65 years (3.8 vs 1.2%, p < 0.05) and in those≥65 years (10.4 vs 4.8%, p < 0.001). Compared to males, female patients featured an excess mortality when associated with ≥4 hours of ischemic time (p < 0.0001), with remained constant in the following hours. Women were older than men (74±12 vs 64±12 years, p < 0.0001) and experienced a significantly longer ischemic time (234 vs 204 min, p < 0.0001). Ischemic time significantly increased with age (p < 0.0001), and was associated with in-hospital mortality (p < 0.01), but not with 1-year (p = 0.33)mortality Women also had a higher mortality rate at one-year than men (10.9% vs. 6.7%, p = 0.0076) but age (p < 0.0001), diabetes (p < 0.03), previous PCI/CABG (p < 0.01) and EF < 40% (p < 0.001) were the only independent predictors of 1-year mortality. Conclusion Our data support the hypothesis of a female-specific higher in-hospital mortality in patients after pPCI. We believe that a particular focus and more effort should be given to female patients in the acute phase of STEMI. PHARMACOLOGY AND PHARMACOTHERAPYC76 EFFICACY AND SAFETY OF POTENT P2Y12 INHIBITORS IN PATIENTS TREATED WITH ORAL ANTICOAGULANT THERAPY FOR ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION M Casula M Casula IRCCS POLICLINICO SAN MATTEO – UNIVERSITA‘ DI PAVIA, PAVIA; IRCCS POLICLINICO SAN MATTEO, PAVIA F Fortuni F Fortuni IRCCS POLICLINICO SAN MATTEO – UNIVERSITA‘ DI PAVIA, PAVIA; IRCCS POLICLINICO SAN MATTEO, PAVIA F Fabris F Fabris IRCCS POLICLINICO SAN MATTEO – UNIVERSITA‘ DI PAVIA, PAVIA; IRCCS POLICLINICO SAN MATTEO, PAVIA S Leonardi S Leonardi IRCCS POLICLINICO SAN MATTEO – UNIVERSITA‘ DI PAVIA, PAVIA; IRCCS POLICLINICO SAN MATTEO, PAVIA M Ferlini M Ferlini IRCCS POLICLINICO SAN MATTEO – UNIVERSITA‘ DI PAVIA, PAVIA; IRCCS POLICLINICO SAN MATTEO, PAVIA M Gnecchi M Gnecchi IRCCS POLICLINICO SAN MATTEO – UNIVERSITA‘ DI PAVIA, PAVIA; IRCCS POLICLINICO SAN MATTEO, PAVIA IRCCS POLICLINICO SAN MATTEO – UNIVERSITA‘ DI PAVIA, PAVIA; IRCCS POLICLINICO SAN MATTEO, PAVIA Background Approximately 5-10% of patients treated with oral anticoagulant therapy (OAC) for atrial fibrillation (AF) are also treated with percutaneous coronary intervention (PCI) and consequently need antiplatelet therapy (APT). Although current international guidelines contraindicate the use of potent P2Y12 inhibitors in patients receiving concurrent OAC, the main trials on this topic include a small number of patients treated with ticagrelor and prasugrel. The aim of the present meta-analysis was to evaluate the efficacy and safety profile of potent P2Y12 inhibitors versus clopidogrel in patients on OAC for AF treated with PCI. Methods We searched electronic databases for randomized controlled trials (RCTs) on this topic. The efficacy outcomes were Major Adverse Cardiovascular Events (MACE) as defined in the included trials. The safety outcome was the incidence of any clinically relevant bleeding. We compared patients treated with potent P2Y12 inhibitors with those treated with clopidogrel, regardless of other concomitant antithrombotic therapy. A subgroup analysis was also conducted to evaluate any differences between patients treated with dual antithrombotic therapy (DAT) and those treated with triple antithrombotic therapy (TAT) Results 4 RCTs with a total of 10119 patients (9273 on clopidogrel and 846 on potent P2Y12 inhibitors) were included in the analysis. Mean age was 70.2±1.1 years and the mean follow-up was 11±3.5 months. No statistically significant difference was found for the risk of MACE between patients treated with a potent P2Y12 inhibitor and those treated with clopidogrel (RR 1,02; IC 95% 0,57÷1,82; Fig. 1). Potent P2Y12 inhibitors significantly increased the risk of clinically relevant bleeding compared with clopidogrel (RR 1,30; CI 95% 1,06÷1,59; p = 0,01; NNH 18). In the subgroup analyses, this finding was consistence regardless of associated antithrombotic therapy (i.e. DAT or TAT) (test for subgroup differences: Chi2=0,16 df = 1, p = 0,69). Conclusions In patients on OAC for AF treated with APT for a recent PCI, potent P2Y12 inhibitors increase the risk of clinically relevant bleeding compared with clopidogrel, with no additive benefit in terms of reduction of ischemic events. C77 EFFICACY AND SAFETY OF DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION AND HIGH THROMBOEMBOLIC RISK. A SYSTEMATIC REVIEW M Bellino M Bellino UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI P Scicchitano P Scicchitano UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI A Agea A Agea UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI R Ruggieri R Ruggieri UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI R Nitti R Nitti UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI F Cortese F Cortese UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI M De Palo M De Palo UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI F Massari F Massari UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI D Acanfora D Acanfora UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI G Ricci G Ricci UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI C Acanfora C Acanfora UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI G Casucci G Casucci UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI P Caldarola P Caldarola UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI M Ciccone M Ciccone UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F. PERINEI" ALTAMURA (BA), ALTAMURA; UO CARDIOLOGIA P.O. DI POLICORO, POLICORO; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; UO MEDICINA INTERNA OSPEDALE SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA OSPEDALE CARDARELLI NAPOLI, NAPOLI; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME; UO MEDICINA INTERNA PO SAN FRANCESCO TELESE TERME, TELESE TERME ; UO CARDIOLOGIA P.O. SAN PAOLO BARI, BARI Background The aim of the study was to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in a subgroup of patients with atrial fibrillation (AF), CHADS2 score≥3, advanced age, and heart failure (HF) coming from the main DOACs randomized clinical trials. Methods We searched MEDLINE, MEDLINE In-Process, and Other Non-Indexed Citations. EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials. English-language articles published from 2002 to March 2019 dealing with DOACs for preventing thrombotic events in AF were considered. We did not conduct any statistical analyses as indirect comparison between DOACs represents hypothesis generators. Results This systematic review was restricted to the subgroup of patients with CHADS2 score≥3 (n = 31,203), elderly (n = 24,788), and with HF (n = 29,297) derived from the pivotal trials. Risk index (RI) was calculated. The RI for stroke/systemic embolism was similar in all of the patients treated with DOACs or warfarin. The lowest RI was in rivaroxaban patients (CHADS2 score≥3: RI = 0.04; elderly: RI = 0.09; HF: RI = 0.05). The RIs for bleeding were higher in patients treated with dabigatran (CHADS2 score≥3: RI110=0.23; elderly: RI110=0.22; HF: RI110=0.16. CHADS2 score≥3: RI150=0.30; elderly: RI150=0.24; HF: RI150=0.16). The bleeding RIs were higher with apixaban (CHADS2 score≥3: RI = 0.23; elderly: RI = 0.25; HF: RI = 0.14) and dabigatran (CHADS2score≥3: RI = 0.28; elderly: RI = 0.21; HF: RI = 0.19). Conclusions The use of DOACs is a reasonable alternative to vitamin-K antagonists in AF patients with CHADS2 score≥3, advanced age, and HF. The RI constitutes a useful, additional tool to facilitate clinicians in choosing DOACs or Warfarin in particular category of AF patients. C78 CLINICAL PROFILE OF DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTICOAGULANTS IN UNDERWEIGHT ELDERLY PATIENTS WITH ATRIAL FIBRILLATION: AN ANALYSIS WITH PROPENSITY SCORE WEIGHTING OF A REAL? WORLD MULTICENTER REGISTRY M Di Maio M Di Maio PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES E Attena E Attena PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES C Mazzone C Mazzone PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES A Carbone A Carbone PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES V Parisi V Parisi PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES A Rago A Rago PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES A D‘Onofrio A D‘Onofrio PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES A D‘Andrea A D‘Andrea PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES F Scotto di Uccio F Scotto di Uccio PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES C Baldi C Baldi PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES G Galasso G Galasso PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES G Nigro G Nigro PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES P Golino P Golino PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES V Russo V Russo PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES PRESIDIO OSPEDALIERO "MARIA SS ADDOLORATA", EBOLI; DEPARTMENT OF CARDIOLOGY, HEALTH AUTHORITY NAPLES 2 NORD, NAPLES; CARDIOVASCULAR CENTRE, HEALTH AUTHORITY 1, TRIESTE; DEPARTMENT OF CARDIOLOGY, CLINICA MEDITERRANEA, NAPLES; DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF NAPLES FEDERICO II, NAPLES; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES; DEPARTMENTAL UNIT OF ELECTROPHYSIOLOGY, EVALUATION AND TREATMENT OF ARRHYTHMIAS, MONALDI HOSPITAL, NAPLES; DEPARTMENT OF CARDIOLOGY, UMBERTO I° HOSPITAL, NOCERA INFERIORE; DEPARTMENT OF CARDIOLOGY, OSPEDALE DEL MARE, NAPLES; CARDIOLOGY UNIT, CARDIOVASCULAR AND THORACIC DEPARTMENT, UNIVERSITY HOSPITAL SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO; CHAIR OF CARDIOLOGY, DEPARTMENT OF TRANSLATIONAL MEDICAL SCIENCES, UNIVERSITY OF CAMPANIA LUIGI VANVITELLI – MONALDI HOSPITAL, NAPLES Introduction Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in elderly, underweighted patients affected by AF. The aim of our study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among patients with AF aged ≥ 80 years who weighs 60 kg or less in real life setting. Methods Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followed by the participating centers, through outpatient visits every 3 to 6 months. The database was queried for AF patients aged ≥ 80 years with a weight ≤ 60 kg who received DOACs or VKAs treatment. Differences in baseline clinical characteristics between groups were accounted using the propensity score weighting method. The primary effectiveness endpoint was the occurrence of thromboembolic events (a composite of stroke, transient ischemic attack, systemic embolism); the primary safety endpoint was the occurrence of major bleeding; the secondary endpoints were intracranial hemorrhage and all-cause mortality. Results The database query identified 143 patients treated with VKAs and 136 with DOACs. The mean follow-up was 28.43 ± 13.57 months. After a successful propensity score weighting adjustment, the incidence rate of thromboembolic events was 2.79 per 100 person-years [2.94 in DOAC vs 2.66 in VKA group, adjusted Hazard Ratio 0.81; 95% confidence interval (CI) 0.31 to 2.17; P = 0.682]. The incidence rate of major bleedings was 7.64 per 100 person-years (8.02 in DOAC vs 7.29 in VKA group, adjusted HR 0.95; 95% CI 0.52 to 1.74; P = 0.863). The incidence rate of intracranial hemorrhage (ICH) was 1.77 per 100 person-years (0 in DOAC vs 3.48 in VKA group). Through these incidence rates, we found a positive net clinical benefit (NCB) of DOACs over VKAs, equal to + 4.94. The incidence rate of all-cause mortality was 30.20 per 1000 person-years (22.53 in DOAC vs 37.62 in VKA group, adjusted Hazard Ratio 0.68; 95% CI 0.48 to 0.95; P = 0.026). Conclusions In this study AF patients treated with NOACs showed a different risk profile compared to those treated with VKA. After a successful propensity score weighting adjustment NOACs and VKAs patients showed similar bleeding and thromboembolic risks; nevertheless, NOACs were associated with a lower mortality compared with VKAs. C79 DAPAGLIFLOZIN EXERTS CARDIOPROTECTIVE AND ANTI-INFIAMMATORY EFFECTS DURING EXPOSURE WITH DOXORUBICIN AND TRASTUZUMAB V Quagliariello V Quagliariello DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI A Bonelli A Bonelli DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI A Caronna A Caronna DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI C Lombari C Lombari DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI G Conforti G Conforti DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI R Iaffaioli R Iaffaioli DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI G Botti G Botti DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI N Maurea N Maurea DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI DIVISION OF CARDIOLOGY, ISTITUTO NAZIONALE TUMORI –IRCCS– FONDAZIONE G. PASCALE, NAPOLI; ASSOCIATION FOR MULTIDISCIPLINARY STUDIES IN ONCOLOGY AND MEDITERRANEAN DIET, PIAZZA NICOLA AMORE, NAPOLI; SCIENTIFIC DIRECTION, ISTITUTO NAZIONALE TUMORI– IRCCS– FONDAZIONE G. PASCALE, NAPOLI Background The clinical trial “DECLARE-TIMI 58” demonstrated that dapagliflozin, a Sodium glucose cotransporter 2 inhibitor (SGLT2i), reduces the composite end point of cardiovascular death/hospitalization for heart failure in a broad population of patients with type 2 diabetes mellitus. Purpose We aimed to study if dapagliflozin could exerts cardioprotective and anti-inflammatory effects in doxorubicin and trastuzumab-induced cardiotoxicity through the analysis of multiple biochemical mechanisms. Methods HL-1 adult cardiomyocytes were exposed to subclinical concentration of doxorubicin and trastuzumab (100 nM) alone or in combination with dapagliflozin at 50 nM. After the incubation period, were performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation and of intracellular Ca2+ homeostasis. Moreover, studies on the inflammation state of cardiomyocytes were also performed (activation of NLRP3 inflammasome; transcriptional activation of p65/NF-κB and secretion of cytokines involved in cardiotoxicity (Interleukin 1β, 8 and 6). Results Dapagliflozin increases significantly the cardiomyocytes viability during exposure to doxorubicin and trastuzumab. Its cardioprotective properties are explainable by the reduction of intracellular Ca2+ overload ( -47,6% vs cells treated only to anticancer drugs; p < 0,001), of the lipid peroxidation phenomena (mean reduction of 35-43 % compared to cells exposed only to anticancer drugs; p < 0,001). Moreover, cardiomyocytes exposed to dapagliflozin during anticancer drugs have a reduced expression of pro-inflammatory cytokines involved in cardiotoxicity (- 37,3 % for Interleukin-1β; -39,5 for Interleukin 8 ; -41,3 % for Interleukin 6 ; p < 0,001 for all). Notably, dapagliflozin reduces p65-NF-κB activation (- 36,5% vs cells treated only to anticancer drugs) and inhibits of 27,8 % the expression of NLRP3 inflammasome that consequently improves the mitochondrial homeostasis of cardiomyocytes. Conclusion Dapagliflozin demonstrated cardioprotective properties during doxorubicin and trastuzumab exposure. Dapagliflozin improves the Ca2+ homeostasis and inhibits the pro-inflammatory “NLRP3- NF-κB –cytokines” pathways in cardiac cells. The overall picture obtained provides the proof of concept for translational studies designed to investigate the cardioprotective use of dapagliflozin during anticancer therapies. C80 TOLERABILITY OF SACUBITRIL/VALSARTAN IN ELDERLY PATIENTS: DATA FROM A SMALL CLINICAL REGISTRY G Lucarelli G Lucarelli AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE F Orso F Orso AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE A Herbst A Herbst AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE A Baroncini A Baroncini AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE A Pratesi A Pratesi AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE A Lo Forte A Lo Forte AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE M Migliorini M Migliorini AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE C Ghiara C Ghiara AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE L Martinese L Martinese AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE V Vanni V Vanni AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE R Imbrici R Imbrici AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE M Di Bari M Di Bari AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE A Ungar A Ungar AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE F Fattirolli F Fattirolli AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE S Baldasseroni S Baldasseroni AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE AZIENDA OSPEDALIERO–UNIVERSITARIA CAREGGI, FIRENZE Introduction and Purpose The PARADIGM-HF trial proved the superiority of Sacubitril/Valsartan (Sa/Va) versus Enalapril in reducing mortality and hospitalization for heart failure (HF). In the trial patients receiving Sa/Va had a mean age of 63.8 years. The purpose of our study was to describe the use and tolerability of sacubitril/valsartan in very old ambulatory patients with heart failure with reduced ejection fraction. Methods and Results We retrospectively analysed medical records of old (≥ 70 years) and very old (≥85 years) ambulatory patients affected by heart failure with reduced ejection fraction, managed in our HF outpatient clinic from November 2018 to November 2019. The study population was composed by 70 patients, with mean age of 80.9 years. Among participants, 80% had at least moderate renal insufficiency (mean GFR estimated by CKDEPI equation 47.4 ml/min/1.73m2) and mean serum potassium level of 4.55 mEq/L. Sa/Va was prescribed in 32 patients (45.7%) with a mean age of 77.8 years: among them only 9.4% reached the target dose of 200 mg twice daily; 12.5% reached an intermediate dose of 100 mg twice daily and 78.1 % mantained the minimum dose of 50 mg twice daily. Titration was not possible mainly because of hypotension (28.6) and high blood potassium levels (9.5%), whereas Sa/Va was still in up-titration in 52.4% of the patients. Discontinuation occurred in 7 patients (24.1%): 2 patients for worsening renal function, 2 patients for allergic phenomena correlated with the drug, 2 patients for severe hypotension and 1 patient for severe hyperkalemia. Analysing patients not receiving Sa/Va (54.3%) we found that symptomatic hypotension (33%) and severe renal insufficiency/hyperkalemia (33%) were the most frequent reasons. Conclusions Little is known about titration and tolerability of Sa/Va in the real world population and particularly in elderly patients. In our population more than 10 years older than the patients included in PARADIGM-HF we were able to start Sa/Va in nearly half of the patients and continue it in two thirds of them with a discontinuation rate that was higher than the one observed in the trial. Implementation and up-titration of Sa/Va in this population are strongly influenced by hypotension, severe kidney disease and hyperkalaemia. Age per se should not be a reason for not prescribing Sa/Va. C81 POST-DISCHARGE BLEEDING AFTER AN ACUTE CORONARY SYNDROME AMONG PATIENTS WITH ADVANCED AGE TREATED WITH ASPIRIN AND CLOPIDOGREL OR TICAGRELOR: A REPORT OF 16.653 PATIENTS FROM TWO REAL-WORLD MULTINATIONAL REGISTRIES M Bianco M Bianco A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI E Cerrato E Cerrato A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI A Careggio A Careggio A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI G Quadri G Quadri A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI P Destefanis P Destefanis A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI A Luciano A Luciano A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI F Giacobbe F Giacobbe A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI M Perrelli M Perrelli A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI D Belliggiano D Belliggiano A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI I Meynet I Meynet A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI F D‘Ascenzo F D‘Ascenzo A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI F Varbella F Varbella A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI M Anselmino M Anselmino A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI L Montagna L Montagna A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI A.O.U SAN LUIGI GONZAGA, ORBASSANO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, ORBASSANO/RIVOLI; DIVISIONE DI CARDIOLOGIA – A.O.U SAN LUIGI GONZAGA, ORBASSANO; DIVISIONE DI CARDIOLOGIA – OSPEDALE DEGLI INFERMI DI RIVOLI, RIVOLI; DIVISIONE DI CARDIOLOGIA – CITTÀ DELLA SALUTE E DELLA SCIENZA "MOLINETTE", TORINO; CENTRO UNICO EMODINAMICA – A.O.U SAN LUIGI GONZAGA, ASL TORINO 3, RIVOLI Introduction and Objectives Ticagrelor compared to clopidogrel is feared to cause more bleedings in acute coronary syndrome (ACS) patients, especially in the elderly. We sought to assess the incidence of major bleedings (MB), reinfarction (REAMI) and all cause death in elderly patients with ACS to evaluate the safety and efficacy of ticagrelor versus clopidogrel in a population considered at high risk of events. Methods We collected data by merging together the RENAMI and the BleeMACS, two real-world retrospective registries that enrolled patients discharged with a definitive diagnosis of ACS who underwent percutaneous coronary intervention (PCI) and treated with dual antiplatelet therapy (DAPT). We excluded patients treated with prasugrel and/or oral anticoagulants (OAC) to analyse a more homogeneous population. Primary end points were MB incidence at one year follow-uo (FU). Secondary end points were REAMI, all cause death and a composite of both at one year FU. Results A total of 16.653 patients (13153 patients <75 y.o, 3500 patients ³75 y.o, 1717 patients >80 y.o) were included. Ticagrelor was significantly underused (<75 y.o 20.8% p < 0.001, ³75 y.o 16.3% p < 0.001, ³80 13.9% y.o p < 0.001). The Kaplan-Meier curves did not show an increased incidence of MB connected to ticagrelor use irrespectively of age compared to clopidogrel (p < 0.001). On the contrary a significant reduction of REAMI and all cause death in patients >75 y.o and >80 y.o treated with ticagrelor was present (p < 0.001). Theese results were confirmed after propensity score with matching (PSM) analysis. Finally, at multiple Cox regression analysis age, creatinine >1.5 mg/dl, femoral access and prior bleeding, but not DAPT with ticagrelor, resulted as independent predictor of bleeding. Conclusions Considering these two real-world registries, ticagrelor did not increase MBs compared to clopidogrel while reducing the incidence of REAMI and all cause death in elderly patients with ACS. Age does not seem to represent a contraindication per se to the use of ticagrelor. C82 EFFICACY AND SAFETY OF LEVOSIMENDAN: HYPOTENSION AND SEVERE RENAL FAILURE C Paolini C Paolini OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO G Mugnai G Mugnai OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO C Dalla Valle C Dalla Valle OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO A Dal Grande A Dal Grande OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO E Marchesini E Marchesini OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO C Pellizzari C Pellizzari OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO R Tenaglia R Tenaglia OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO S Cavedon S Cavedon OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO E Bergamin E Bergamin OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO C Bilato C Bilato OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO OSPEDALI DELL‘ OVEST VICENTINO, ARZIGNANO; OSPEDALI DELL‘OVEST VICENTINO, ARZIGNANO Because of its pharmacodynamic and pharmacokinetic characteristics and mechanism of action, levosimendan is more effective than dobutamine in improving haemodynamic, symptoms and short/medium-term survival in patients with acute heart failure, but is contraindicated in severe renal failure or hypotension. 5 patients, 3 males, medium age 80 years, with “end stage” heart failure, were admitted to our department for low-output Heart Failure (LoHF). Ejection Fraction (EF) was between 18 and 31%, blood pressure was between 80/50 and 95/60 mmhg, GFR (glomerular filtration rate) between 22 and 29 ml/min/1.73m2 (n = 3). All patients were in atrial fibrillation, treated with furosemide and poorly responsive to dobutamine. They were treated with levosimendan 0.05 μg/kg/min, without initial bolus. In 3 patients the dosage was increased to 0.1μg/kg/min after a few hours after the start of infusion, in one patient it was necessary to reduce to 0.025 μg/kg/min for a few hours due to symptomatic hypotension (systolic blood pressure 65 mmhg) and in the last one the dose of 0.05 μg/kg/min was maintained for intolerance (symptomatic hypotension) to repeated attempts to increase to 0.1 μg/kg/min. In all subjects a discreet haemodynamic compensation was obtained which allowed the subsequent discharge. All patients tolerated levosimendan infusion. No one experienced worsening renal function or severe hypotension and/or malignant arrhythmias requiring pharmacological intervention and/or CPR (cardiopulmonary resuscitation). In particular, the mean GFR of patients with initial chronic renal failure after infusion remained 30 ml/min/1.73m2 and the mean blood pressure remained substantially unchanged. Three patients requested a new levosimendan treatment after 30 days. Of the 5 patients, only one died a few months after treatment for refractory heart failure, one patient was no longer hospitalised for heart failure and died after 36 months due to complications of femoral fracture and one third died after 1 year, also for complications of femur-fracture. The remaining two patients have not experienced any recurrence of heart failure, respectively 3 and 9 months after treatment. At the moment there are no trials about acute heart failure/levosimendan/chronic renal failure and/or hypotension: our study, although small, could be a useful starting point. C83 SIDE EFFECTS OF TREATMENT WITH PCSK9I, EXPECTED OR UNEXPECTED? C Dalla Valle C Dalla Valle CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO C Paolini C Paolini CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO I Lobascio I Lobascio CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO R Tenaglia R Tenaglia CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO S Cavedon S Cavedon CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO G Dolci G Dolci CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO C Bilato C Bilato CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO CARDIOLOGIA OSPEDALE DI ARZIGNANO ULSS8 BERICA, ARZIGNANO Achieving the therapeutic target of LDL cholesterol is an important goal in patients with high cardiovascular risk. The monoclonal antibodies inhibiting the PCSK9 protein (alirocumab and evolocumab) are extremely effective in reducing LDL cholesterol. According to randomized clinical trials, they also have an excellent tolerability profile, but real world data are limited. The aim of this study is the evaluation of the tolerability of anti PCSK9 in 33 patients (27% women) treated with a median follow-up of 46 weeks, suffering from heterozygous familial hypercholesterolaemia (n = 8; 24%) or from primary hypercholesterolaemia (n = 25; 76%) and 79% (n = 26) with very high cardiovascular risk. The majority of patients treated with PCSK9i were intolerant to statins (n = 20; 60%) and 36% (n = 12) did not take any statins; in 27% (n = 9) even ezetimibe was not tolerated. The mean pretreatment LDL value was 157 mg / dL. During follow-up, evolocumab (n = 17; 52%) or alirocumab (n = 16; 48%) therapy resulted in an average 65% LDL-C reduction (average LDL-C 55 mg / dl). During the observation, the occurrence of adverse events was recorded in 18% of patients (n = 6). This value is much higher (25%) if only patients with previous statin intolerance are considered (n = 5 out of 20 intolerant patients). In particular, 2 (6%) patients presented myalgias and arthralgias in the absence of AST, ALT or CPK elevation, a patient presented myalgias with AST, ALT and CPK elevation after 18 months of treatment, one subject reported insomnia and nightmares, one patient accused the appearance of dysesthesia on the face and a patient, not previously intolerant of statins, experienced an increase in AST and ALT, in the absence of myalgias, which normalized with a reduction in the dosage of atorvastatin. Treatment discontinuation was required in 12% of patients (n = 4). The appearance of adverse events is not related to the antibody used (3 for alirocumab and 3 for evolocumab). These data are substantially superimposable to what is found in the literature, both in patients treated with statins and in intolerant patients. Therefore, even in the real world, PCSK9i are safe and well tolerated. ARRHYTHMIAS, PACINGC84 ORAL ANTICOAGULANT THERAPY IN PATIENTS WITH NEWLY DIAGNOSED NON-VALVULAR ATRIAL FIBRILLATION: COMPARISON OF THE HAS-BLED, ATRIA AND ORBIT BLEEDING RISK SCORES L Bartoli L Bartoli DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA F Angeli F Angeli DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA F Donati F Donati DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA P Paolisso P Paolisso DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA L Bergamaschi L Bergamaschi DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA I Magnani I Magnani DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA S Toniolo S Toniolo DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA E D‘Angelo E D‘Angelo DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA G Saturi G Saturi DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA C Pizzi C Pizzi DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA N Galiè N Galiè DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA, BOLOGNA; DIMES–DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, BOLOGNA Atrial fibrillation is the most common cardiac arrhythmia, associated with increased risk of stroke and ischemic events. Decision-making for anticoagulation needs to balance the risk of stroke against the risk of major bleeding, especially intracranial hemorrhage (ICH). Several bleeding risk scores have been developed, mainly in patients on VKAs. We compared the efficacy of HAS-BLED, ATRIA and ORBIT scores to predict major-bleedings in patients with newly diagnosed non-valvular atrial fibrillation (NVAF) started on vitamin-K antagonists (VKAs) or new oral anticoagulants (NOACs). We analyzed all consecutive AF at our Center from January to December 2017. Only newly diagnosed NVAF starting anticoagulants were enrolled. Major bleedings were defined according to the ISTH definition in non-patients. Above 820 AF, 305 were newly diagnosed NVAF. 36 (11,8%) started VKAs whereas 269 (88,2%) NOACs. The median follow-up was 10.4±3.4 months. We recorded 123 all-bleedings (17,1% in the VKAs and 82,9% in the NOACs) and 11 major-bleedings (5 in the VKAs and 6 in the NOACs). Overall, patients with major bleedings showed a significantly higher mean value of the scores compared to others. Conversely, in the VKA subgroup, only the ATRIA score was significantly higher in patients with major-bleedings (7.4 vs 3.5 p < 0.001; HAS-BLED: 4.4 vs 3.6 p = 0.27; ORBIT 4.4 vs 2.9 p = 0.13). In the NOAC subgroup, patients with major-bleedings events had higher ATRIA (4.0 vs 2.3 p = 0.02) and ORBIT (2.8 vs 1.6 p = 0,04) but not the HAS-BLED (2.5 vs 2.3 p = 0.57) scores. Comparing the elements of the ATRIA, only glomerular filtration rate in the VKAs (p < 0.001) and anemia (p = 0,02) in the NOACs were associated with major bleedings. Multivariate analysis showed that, in the NOAC group, hemoglobin (OR 0.41, 95%CI 0.23–0.75) and, in the VKA group, creatinine (OR 12.76, 95%CI 1.6–101.7) were the independent predictors for major-bleedings. The ATRIA score showed the best efficacy in predicting major bleedings. Hemoglobin and creatinine levels at admission were independent predictors for major bleedings in the NOAC and in the VKA groups, respectively. These findings might be helpful in stratifying the hemorrhagic risk at the beginning of treatment. C86 ICD IN PRIMARY PREVENTION IN IDIOPATHIC DILATED CARDIOMYOPATHY VS ISCHEMIC HEART DISEASE. NEW PERSPECTIVES FROM A SINGLE CENTER LARGE COHORT STUDY F Fioravanti F Fioravanti A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO A Bissolino A Bissolino A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO C Budano C Budano A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO A Andreis A Andreis A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO M Peyracchia M Peyracchia A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO P Golzio P Golzio A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO D Errigo D Errigo A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO S Mazzilli S Mazzilli A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO D Castagno D Castagno A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO M Magnano M Magnano A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO A Saglietto A Saglietto A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO S Mattivi S Mattivi A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO E Roagna E Roagna A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO C Giustetto C Giustetto A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO G De Ferrari G De Ferrari A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO A.O.U. CITTÀ DELLA SALUTE E DELLA SCIENZA, PRESIDIO MOLINETTE, TORINO Introduction Implantable cardioverter-defibrillators (ICDs) showed to reduce arrhythmic deaths in patients with coronary artery disease (CAD) or idiopathic dilated cardiomyopathy (DCMP) but new evidences are challenging this role. Aim of this study was to evaluate any difference in long-term outcome between the two etiologies. Method We included all patients undergoing ICD implantation for primary prevention between January 2010 and December 2018 in our center with CAD or DCMP and at least two follow-up years. Appropriate and inappropriate therapies (shock and antitachycardia pacing – ATP) incidence and long-term survival were assessed. Results 602 consecutive patients were enrolled. 344 had CAD (group A) and 258 had DCMP (group B). Significant differences between the two groups were observed about hypertension (76.7% vs 55.0%, p = 0.001), diabetes (34.3% vs 16.7%, p = 0.001), dyslipidemia (61.0% vs 33.3%, p = 0.001), advanced (IV-V stage) chronic kidney disease (9.2% vs 4.8%, p = 0.02). No statistically significant differences were observed on age, ejection fraction and medical therapy. There was a non-significant trend in atrial fibrillation (A-Fib) prevalence (21.8% vs 27.1%, p = 0.063), driven by paroxysmal A-Fib. During a mean follow-up of 55 ± 41 months, mortality for every cause was significantly higher in group A (p = 0.03). There were no differences in appropriate therapy received (25.0% vs 26.4%, p=ns) even stratifying for shocks (16.0% vs 16.7%, p= ns). Nonetheless, a clear trend emerged for inappropriate ICD intervention (7.0% vs 12.4%, p = 0.02), mainly driven by shock (4.7% vs 10.1%, p = 0.001) in group B patients. Conclusion DCMP patients tend to have lower prevalence of comorbidities and consequent higher survivals when compared with CAD patients. On the other hand, DCMP patients have to deal with more inappropriate ICD shocks. Further studies are needed to assess whether paroxysmal A-Fib plays a prominent role in this trend. C87 THE EXTENT AND LOCATION OF LATE GADOLINIUM ENHANCEMENT PREDICT DEFIBRILLATOR SHOCK AND CARDIAC MORTALITY IN PATIENTS WITH NON-ISCHAEMIC DILATED CARDIOMYOPATHY A Aimo A Aimo SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA A Barison A Barison SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA G Mirizzi G Mirizzi SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA V Castiglione V Castiglione SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA A Ripoli A Ripoli SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA L Panchetti L Panchetti SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA A Rossi A Rossi SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA A Giannoni A Giannoni SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA U Startari U Startari SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA G Aquaro G Aquaro SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA M Emdin M Emdin SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA M Piacenti M Piacenti SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL‘APPARATO CARDIOVASCOLARE, UNIVERSITÀ DI PISA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA Background In non-ischaemic dilated cardiomyopathy (NIDCM), it is uncertain which late gadolinium enhancement (LGE) pattern, extent and location predict ventricular arrhythmias. Methods We analysed data of all NIDCM patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention at our Institution, and undergoing cardiac magnetic resonance within 1 month before implantation. The primary endpoint was appropriate ICD shock, the secondary endpoint was a composite of cardiac death and appropriate shock. Results One hundred eighty-three patients (73% men, median age 66 years) received single-chamber (n = 21, 12%), dual-chamber (n = 34, 19%), biventricular (n = 127, 69%), or subcutaneous devices (n = 1, 1%). LGE (excluding insertion points) was found in 116 patients (63%), accounting for 4% of LV mass (2-11%). Over a 30-month follow-up (10-65), 20 patients (11%) experienced the primary and 30 patients (16%) the secondary endpoint. LGE presence, inferior wall LGE, the number of segments with LGE, the number of segments with 50-75% transmural LGE, and percent LGE mass were univariate predictors of both endpoints. Furthermore, septal LGE predicted the primary, and lateral wall LGE predicted the secondary endpoint, respectively; insertion point LGE did not predict any endpoint. LGE presence predicted ICD shock with 90% sensitivity, 40% specificity, 16% positive predictive value (PPV) and 97% negative predictive value (NPV). Percent LGE mass had an area under the curve of 0.734 for the same endpoint, with 13% as the best cut-off (55% sensitivity, 86% specificity, 32% PPV, 94% NPV). The risk of shock was over 7-fold lower among patients with no LGE or LGE <13%. Survival free from shock decreased progressively from no LGE to LGE <13%, and LGE ≥13% (log-rank 21.3, p < 0.001). Both LGE presence and LGE ≥13% had high NPV (90%, 87% respectively) for the secondary endpoint. Conclusions In patients with NIDCM receiving a defibrillator for primary prevention, LGE presence and extent predicted appropriate ICD shock and cardiac mortality; additionally, specific LGE patterns and locations predicted a worse prognosis. C88 USE OF THE WEARABLE CARDIOVERTER DEFIBRILLATOR: A MONOCENTRIC EXPERIENCE OF ABOUT THREE YEARS C Scudu C Scudu CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI A Scalone A Scalone CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI G Tola G Tola CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI B Schintu B Schintu CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI A Setzu A Setzu CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI M Corda M Corda CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI A Giardina A Giardina CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI N Sanna N Sanna CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI D Pasqualucci D Pasqualucci CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI M Porcu M Porcu CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI CARDIOLOGIA E UTIC AO BROTZU, CAGLIARI Background According to ESC guidelines the use of wearable cardioverter defibrillator (WCD) may be considered (IIb-C) in patients (pts) at potential risk of sudden arrhythmic death, as a bridge to define the indication to an implantable cardiac defibrillator (ICD), transvenous or subcutaneous. We report the experience of our center for a period of over three years. Methods From August 2016 to September 2019 we studied 106 patients (89 M, 17 F), with a median age of 55.9±14.6 y.o. (12 to 78 years) candidates to receive a WCD. Main indications for the use of WCD were ischemic cardiomyopathy (ventricular dysfunction secondary to AMI or with stable CAD submitted to recent PCI) in 39 pts, dilatative cardiomyopathy (DCM) in 29 pts, extraction of ICD leads in 7 pts and other causes in 31 pts (tachycardiomyopathy, myocarditis, congenital/inherited heart disease). All pts underwent remote monitoring (LV Network, Zoll) and clinical follow up to complete diagnostic tests and titration of therapy was planned. The median ejection fraction was 29±12 % (range 10-69%). Twenty-six pts (24%) had atrial fibrillation. Eighty-three pts (78%) were on ACEi/ATIIA/sacubitril-Valsartan, 89 (84%) on beta-blockers, 12 (11%) on amiodarone and 84 (79%) on diuretics. Results The median WCD wear time was 85±55 days (range 3-283), with median daily use of 22.3 hours. Two pts (one affected by DCM and one by valvular heart disease) received appropriate WCD shock for ventricular fibrillation, respectively on the 60th and 31st day of use. Two pts showed spontaneously resolved sustained ventricular tachyarrhythmias. One pt received inappropriate WCD shock therapy for a supraventricular paroxysmal tachycardia. At the end of observation 57 pts (54%) were implanted with an intracardiac or subcutaneous cardioverter defibrillator (22 affected by ischemic cardiomyopathy, 18 by DCM, 12 by other causes and 5 extracted). The most frequent reason not to implant an ICD following WCD was improvement in ejection fraction, which happened in 38 pts (36%); 8 pts refused the definitive implantation of ICD; 1 pt underwent cardiac transplant and 1 pt dead for non-cardiac causes (septic shock). Conclusions In our experience, use of WCD allowed to reassess the indication to ICD in over 1/3 of potential candidates for the definitive implant. WCD adequately protected 2 pts from malignant arrhythmias. The wear time was excellent and the device was well tolerated. CONGENITAL HEART DISEASE AND PEDIATRIC CARDIOLOGYC89 A NEW QUANTITATIVE INDEX FOR THE ASSESSMENT OF THE QUALITY OF AORTIC CUSP TISSUE: THE PLIABILITY INDEX A Quarti A Quarti POLICLINICO DI SANT‘ORSOLA, BOLOGNA A Balducci A Balducci POLICLINICO DI SANT‘ORSOLA, BOLOGNA G Egidy Assenza G Egidy Assenza POLICLINICO DI SANT‘ORSOLA, BOLOGNA C Ciuca C Ciuca POLICLINICO DI SANT‘ORSOLA, BOLOGNA E Angeli E Angeli POLICLINICO DI SANT‘ORSOLA, BOLOGNA L Careddu L Careddu POLICLINICO DI SANT‘ORSOLA, BOLOGNA F Petridis F Petridis POLICLINICO DI SANT‘ORSOLA, BOLOGNA G Gargiulo G Gargiulo POLICLINICO DI SANT‘ORSOLA, BOLOGNA POLICLINICO DI SANT‘ORSOLA, BOLOGNA Introduction Aortic valve (AV) repair has gained in importance in recent years. As a matter of fact, today it is the most used technique to treat aortic valve diseases among infants and adolescents. While, on the one hand, many anatomical considerations relating to the aortic box have been assessed and described completely in the literature, on the other, quantitative parameters are still missing to evaluate the quality of the cusp tissue. Over the past year, we introduced a new cusp quality index which we called Pliability Index, PI. Patients and Methods 32 consecutive patients with severe aortic valve disease were included in the study population and 19 healthy patients were evaluated as control group. Using the long axis parasternal view, we measured the distance between the free margin of each aortic cusp and the aortic wall both during systole (S) and during diastole (D) (fig. 1A,B). PI is calculated as (D-S)/D. The evaluation was carried out following the JASE guidelines in order to reduce intra and inter observer variability. A statistical analysis of all measured data was performed. Furthermore, in a patient cohort, the PI was evaluated as a possible predictor of early valve repair failure. Results The PI did not differ significantly between two different observers. In the control group the PI was 0,70±0,06. Its value was correlated to the aortic valve gradient, therefore to the rigidity of the cusp. In fact, in the stenosis subgroup the PI was between 0,37 and 0,47 among the three cusps and differed significantly from the control group. In the regurgitation group the value varied between 0,53 and 0,55, significantly higher than that calculated among stenotic valves but lower than the control group. Finally, among the repaired aortic valves, preoperative PI proved to be the strongest predictor of early failure of the repair technique. Conclusions In the last year, we used a new quantitative parameter to evaluate the quality of the aortic cusps, called the Pliability Index. The PI is a standardizable value, useful for assessing the rigidity of the cusp tissue. It correlates to the gradient of the aortic valve and varies between the stenotic and regurgitant valve. This is a valuable method to characterize the aortic cusp tissue and could be used as a predictor of aortic valve repair failure. C90 FOLATES TURBS RELATED ENDOTHELIAL DYSFUNCTION AS A POTENTIAL MAIN PATHOGENIC CHARACTER IN PFO RELATED CRYPTOGENIC STROKE L Sgarra L Sgarra OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI T Acquaviva T Acquaviva OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI E De Cillis E De Cillis OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI C Nacci C Nacci OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI M Potenza M Potenza OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI A Xhelo A Xhelo OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI M Montagnani M Montagnani OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI M Ciccone M Ciccone OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI M Grimaldi M Grimaldi OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI A Bortone A Bortone OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI OSPEDALE DON TONINO BELLO – U.O. DI CARDIOLOGIA, MOLFETTA; OSPEDALE CONSORZIALE POLICLINICO DI BARI, BARI; OSPEDALE CONSORZIALE POLICLINICO DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; UNIVERSITA‘ DEGLI STUDI DI BARI – SEZ. DI FARMACOLOGIA, BARI; POLICLINICO CONSORZIALE DI BARI, BARI; UNIVESITÀ DEGLI STUDI DI BARI – U.O. DI CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE REGIONALE MIULLI – U.O.C. DI CARDIOLOGIA, ACQUAVIVA DELLE FONTI; UNIVERSITA‘ DEGLI STUDI DI BARI – U.O. DI EMODINAMICA INTERDIPARTIMENTALE, BARI Aim To evaluate the correlation, in terms of severity, between MTHFR genotype, interatrial septum (IAS) phenotype and the degree of endothelial dysfunction (expressed by L-arginine/asymmetric dimethylarginine (ADMA) ratio) in subject with a history of stroke. Methods and Results L-arginine, ADMA, homocysteine levels and MTHFR genotype were evaluated. IAS phenotype was assessed by transcranial Doppler coupled with transesophageal echocardiography. Of 57 patients, 10 had a septum integrum (SI), 38 carried a patency of foramen ovale (PFO), and 9 a ostium secundum (OS). 16 patients carried the 677T/T genotype, 13 the 677C/T+1298A/C double heterozygosis, 6 the 677C/T heterozygosis, 5 the 1298C/C mutation, and 15 patients the 1298A/C or wild-type MTHFR. The highest the severity of genotype mutation, the more compromised was the interatrial septum according a spectrum septum integrum->large and short PFO tunnel->tight and long PFO tunnel->ostium secundum defect (Fig.1). L-Arginine/ADMA ratio differs across septum phenotype (p < 0.005 – Graph 2 ) and was higher in SI than in PFO or OS patients and (p < 0.05, p < 0.01, respectively). Nonetheless L-Arginine/ADMA ratio differs across MTHFR genotypes (p < 0.0001 – Graph. 1) and resulted lower in the 677T/T and in the 677C/T + 1298A/C subgroups than in 1298A/C and WT healthiest subgroup (p < 0.0001, p < 0.05, respectively). A negative correlation was found between the L-Arginine/ADMA ratio and the PFO tunnel length/height ratio (p < 0.05 ; r = - 0.37; R2= 0.14 – Graph. 3). OS patients carried the most dysfunctional MTHFR genotypes whereas SI patients the least ones; in PFO subjects, the tunnel lenght/height ratio was proportional to the MTHFR-related L-Arginine/ADMA ratio. Conclusions Impaired activity of MTHFR is associated with low L-Arginine/ADMA ratio; in turn, L-arginine/ADMA ratio correlates with IAS phenotype, along a severity spectrum encompassing SI, PFO with short/large tunnel, PFO with long/tight tunnel, and OS. Genetic MTHFR defects may underlie endothelial dysfunction-related IAS abnormalities, and predispose to cryptogenic stroke. C91 CHEST PAIN IN CHILDREN: DO NOT FORGET MYOCARDIAL ISCHEMIA. A CASE REPORT S Moscatelli S Moscatelli ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA G Trocchio G Trocchio ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA A Maggioni A Maggioni ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA M Derchi M Derchi ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA Stagnaro Stagnaro ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA G Tuo G Tuo ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA M Cheli M Cheli ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA G Pomè G Pomè ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA M Marasini M Marasini ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA ISTITUTO GIANNINA GASLINI & OSPEDALE SAN MARTINO & UNIVERSITÀ DEGLI STUDI DI GENOVA, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA; ISTITUTO GIANNINA GASLINI, GENOVA Introduction Myocardial ischemia (MI) is a rare cause of chest pain in childhood. The anatomic substrate ranges from coronary arteries (CA) congenital anomalies to acquired lesions such as aneurisms in Kawasaki Disease (KD). KD is diagnosed through specific clinical criteria, but sometimes its symptoms can be misinterpreted. We describe the case of a teenager with a suspected missed diagnosis of KD in early childhood, who unexpectedly became symptomatic for MI. Clinical Case A 15 y/o Caucasian male patient with a negative past medical history complained retrosternal, oppressive chest pain during a football match. At the Emergency Department the EKG showed sinus rhythm with V2-V4 ST elevation; Lab tests: troponin I (TnI) peak 27 ng/ml,; Transthoracic Echocardiogram (TE) revealed a slightly reduced ejection fraction (EF 50%) and septal and apical hypokinesia. Suspecting an acute myocarditis, a cardiac magnetic resonance was performed: late gadolinium-enhanced (LGE) showed a subendocardial pattern in anterior and posterior medio-basal septum suggestive for ischemic disease. Coronary CT showed proximal occlusion of RCA and a critical stenosis of proximal LAD and giantaneurysms. A coronary angiogram was performed: LCA: fusiform ectasia of the proximal part; LAD: ostial critical stenosis (95%, 3 mm in length) followed by a fusiform and calcific aneurysm (7,7 mm in length), followed by a stenosis (30-40%); CX: proximal ectasia (5 mm in length); RCA: proximal fusiform and calcific aneurysm (11,2 mm x 9,3 mm) followed by total occlusion for 21 mm. The patient underwent bilateral CABG connecting the left mammary artery (MA) with the LAD and the right MA with the RCA. On the 2nd postop day the patient complained atypical chest pain: the diagnostic work up included EKG: diffused ST elevation from V2 to V6, II, III, IV; TnI peak: 2 ng/ml with a decreasing trend; TE: septum dyskinesia. These data were consistent with pericardial irritation. Therapy at discharge: metoprolol, aspirin, captopril, omeprazol, warfarin, furosemid, cholchicine. Conclusion KD may be misdiagnosed in childhood, because of atypical/incomplete presentations; thus, it must be suspected in young patients presenting with myocardial ischemia. CMR can be helpful for the diagnosis. Moreover, the therapeutic approach for coronary stenosis is still under debate; the long term clinical outcome appears to be favorable in CABG, and there are no reports regarding the long term performance of PCI. C92 ANOMALOUS RIGHT CORONARY ARTERY ORIGINATING FROM LEFT SINUS: RISK STRATIFICATION USING IVUS AND FFR TECHNIQUES M Beltrame M Beltrame EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA A Angelozzi A Angelozzi EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA A Maolo A Maolo EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA F Terracciano F Terracciano EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA E Nicolini E Nicolini EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA F Bianco F Bianco EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA G Giusti G Giusti EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA M Pozzi M Pozzi EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA T Piva T Piva EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA EMODINAMICA, OSPEDALI RIUNITI DI ANCONA, ANCONA; EMODINAMICA, OSPEDALE DI MACERATA, MACERATA; CARDIOCHIRURGIA E CARDIOLOGIA PEDIATRICA E CONGENITA, OSPEDALI RIUNITI DI ANCONA, ANCONA Objective To assess the clinical and pathophysiological relevance of the anomalous origin of the right coronary artery from the left sinus (R-ACAOS) in CathLab. Methods and Results We report 5 cases of anomalous origin of the right coronary artery from the left sinus. All the patients presented with typical or atypical angina or arrhythmias. In all the cases there were an intramural course of the abnormal coronary artery at the Multislice computed tomography. They underwent to coronary angiography, intravascular ultrasound (IVUS), baseline FFR (intracoronary adenosine infusion of 200-300 mcg) and Dobutamine stress FFR beginning at 5-10 μg/kg/min and raising the dosage by 5 μg/kg/min at 3 min intervals, for a maximal dose of 20-40 μg/kg/min. Dobutamine stress FFR was significant (≤0.8) in two patients one of whom were surgical treated with unroofing technique. (the other refused surgical treatment) Dobutamina stress FFR was not significant (0,85) in the only pediatric patient (7 years old) but with a riduction compared basline values (1). In view of clinical presentation, coronary anatomy and estimated ischemic and arrhythmic risk, this patient underwent surgery after Heart Team discussion. IVUS confirmed intramural course and showed slite-like origin in 4 patients with variable deegres of sistolic compression. At follow-up (max 20 months) all the patients are alive and asymptomatic. Conclusions IVUS and Dobutamina stress FFR are safe tecniques. They offer anatomical and functional information in patients with symptomatic R-ACAOS and inconclusive non-invasive tests. The evidence of ischemia inducible from invasive tests is likely to indicate an increased risk of sudden cardiac death, although this has not been proven. PULMONARY CIRCULATIONC93 ASSOCIATION BETWEEN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION, CARDIAC REMODELING AND FUNCTIONAL LIMITATION TO PHYSICAL EXERCISE ASSESSED BY CARDIOPULMONARY EXERCISE TEST IN A POPULATION OF ASYMPTOMATIC HYPERTENSIVE SUBJECTS L Sanesi L Sanesi A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA I Dominioni I Dominioni A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA A Cerasari A Cerasari A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA R Sgariglia R Sgariglia A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA S Alessio S Alessio A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA A Cantone A Cantone A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA A Faleburle A Faleburle A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA L Filippucci L Filippucci A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA A Russo A Russo A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA G Pucci G Pucci A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA A Arrivi A Arrivi A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA G Vaudo G Vaudo A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA A.O. SANTA MARIA DI TERNI, TERNI; CENTRO SERVIZI GROCCO USL UMBRIA 1 PERUGIA, PERUGIA Introduction In heart failure, the prevalence of the preserved ejection fraction form (HFpEF) is high (about 50%). High blood pressure represents the most important risk factor for the development of HFpEF with a prevalence between 55 and 84%. In hypertensive patients left ventricular hypertrophy together with diastolic dysfunction is the main myocardial structural and functional alteration that leads to HFpEF. However, resting diastolic parameters may not exhaustively quantify the degree of functional limitation in such patients. The cardiopulmonary exercise test has been recognized by the American Thoracic Society as a fundamental tool for assessing functional capacity in subjects with cardiovascular and lung diseases. Materials and Methods physical examination, blood pressure measurement, basal ECG, blood chemistry, transthoracic echocardiogram and cardiopulmonary exercise test were performed. Results We examined a population of 20 hypertensive patients with or without diastolic dysfunction. The statistical analysis shows a significant correlation between VE / VCO2 slope value and all the echocardiographic indices of diastolic dysfunction, in detail: inverse correlation between VE / VCO2 slope and E / A ratio (p = 0.03), positive correlation between VE / VCO2 slope and left atrial volume (p = 0.04), negative correlation with Tissue Doppler parameters (septal e’ velocity and lateral e’ velocity; respectively, p = 0.08 and p = 0 , 01); correlations remain significant after correction with the main confounding factors (LV mass, sex, basal PAS). Discussion and Conclusions Our study has documented how VE / VCO2 slope is an independent predictor of increased ventricular filling pressures under stress attributable to increased stiffness of the left ventricle. This study aims to demonstrate how CPET can play a significant role in the diagnostic stratification of hypertension, allowing to indirectly predict asymptomatic diastolic dysfunction during exercise, an optimal evaluation of cardiovascular risk, a faster understanding of the pathophysiological mechanisms and an earlier and more appropriate drug treatment and a personalized exercise prescription. C94 MULTIDISCIPLINARY APPROACH TO INTERMEDIATE-HIGH RISK PULMONARY EMBOLISM: FROM BEDSIDE ASSESSMENT TO THE ANGIOGRAPHY ROOM L Occhi L Occhi ASST NIGUARDA, MILANO F Musca F Musca ASST NIGUARDA, MILANO A Sacco A Sacco ASST NIGUARDA, MILANO N Morici N Morici ASST NIGUARDA, MILANO B De Chiara B De Chiara ASST NIGUARDA, MILANO A Moreo A Moreo ASST NIGUARDA, MILANO I Bossi I Bossi ASST NIGUARDA, MILANO A Rampoldi A Rampoldi ASST NIGUARDA, MILANO ASST NIGUARDA, MILANO Background clinical management of intermediate-high risk pulmonary embolism (EP) is still a matter of debate and, with the advent of percutaneous reperfusion therapies, new therapeutic perspectives are emerging for this category of patients. Aim of the Work evaluate the efficacy and safety of treatment with ultrasound-facilitated loco-regional thrombolysis (USAT) in patients with intermediate-high risk EP (stratification according to ESC criteria). We collected and retrospectively analyzed clinical data, laboratories of patients admitted to our Hospital from 2014 to August 2019. Results 44 patients were enrolled, divided into two groups: USAT group (n = 24, treated with USAT) and UFH group (n = 20, treated with heparin). The two groups did not show significant differences in terms of comorbidities, symptoms and vital parameters on arrival. On blood chemistry tests, the USAT group presented higher D-dimer and lactate values, markers of high thrombotic burden and peripheral hypoperfusion. At echocardiographic evaluation, the USAT group had greater impairment of right ventricular function (TAPSE 14 ± 4; in the UFH TAPSE 18 ± 4 group). Both groups had increased PAPs (USAT: 48 ± 15; UFH 54 ± 17). The efficacy outcome was assessed in terms of improvement of TAPSE and PAPs at follow up (FU) and, for the USAT group, 24 hours after the procedure (T1). The USAT group presented a significant increase in TAPSE values both at 24h (19 ± 5mm, p 2 bleeds occurred. Mortality was identical in the two groups. Conclusions the USAT method is effective in improving VD dysfunction, with a significant improvement already visible 24 hours after the procedure. This method has a good safety profile and could represent a treatment option to be used for patients at greater risk of instability, in order to prevent short-term complications. C95 D-DIMERO AND ELDERLY: AN ADAPTION OF A BIOMARKER FINAL FOR BEST RULE-OUT AND PROCESS TIMES IN PULMONARY EMBOLISM G Savioli G Savioli POLICLINICO SAN MATTEO, PAVIA POLICLINICO SAN MATTEO, PAVIA Introduction D-dimer is an useful tool in diagnostic strategy of suspected pulmonary embolism (PE), in fact its negative predictive value is high, but it’s a little-specific parameter, in particulare in older patients with multiple comorbidity. The actually used cut-off is set at 500mcg/dl. In 2014, the study ADJUST-PE demonstrated the chance to fix the positivity cut-off of this parameter for older than 50 years patients, without losing specificity in the diagnosis. This cut-off was also reported in the European guidelines. Purpose of the Study to retrospectively evaluate the utility of standardizing the D-Dimer fixing by age of our ED, to avoid invasive radiodiagnostic invastigations in mostly old patients, and simultaneously shorten the duration of the hospitalization of these patients in our ED, but also conserving its negative predictot efficacy. Materials and Methods retrospective monocentric study, based on the management of all patients who accessed Policlinico San Matteo’s ED from 1st of january 2016 to 30th of may 2017 with suspected PE and D-dimer >500 mcg/dl, but less than the age-fixed cut-off (agex10 in older than 50 years patients). Results: in the period 2017-2018 173 patients accessed our ED, aging between 51 and 97 years, with PE suspect, whose D-Dimer fixed by the cut-off defined by the guidelines of PE management resulted negative. No one of these patients was dicharged with PE diagnosis. Between these, 26 patients (14,6% of the total) underwent chest CT angiography torace to rule out PE. All the CT-angiography resulted negative, further validating appropiatness of raising of threshold value for D-Dimer in older than 50 years patients. Mean waiting-time between D-Dimer validation and chest TC performance and report, and therefore the discharge is 5,26h. Conclusions a correct age-based D-dimer fixing in the patients with clinical suspect of PE would have spared, in the period between 1st of january 2016 and 30th of may 2017, to our ED and to the accessing patients, almost 14% of chest CT angiography performed and would have shorten the stay of these patients of almast 5.26h. C96 EARLY DIAGNOSIS OF PULMONARY ARTERIAL HYPERTENSION IN SYSTEMIC SCLEROSIS: A COMPARISON BETWEEN TWO SCREENING STRATEGIES IN THE REAL WORLD A Vincenzi A Vincenzi CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA M Pozzi M Pozzi CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA A Cirò A Cirò CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA A Frattola A Frattola CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA D D‘Amato D D‘Amato CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA P Cagnan P Cagnan CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA M Lettino M Lettino CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA CARDIOLOGIA OSP. SAN GERARDO, MONZA; REUMATOLOGIA, OSP., SAN GERARDO, MONZA; CARDIOLOGIA, OSP.. SAN GERARDO, MONZA; CARDIOLOGIA, OSP., SAN GERARDO, MONZA; UNIVERSITÀ MILANO BICOCCA, MONZA; CARDIOLOGIA, OSPEDALE SAN GERARDO, MONZA; CARDIOLOGIA, OSP. SAN GERARDO, MONZA Pulmonary arterial hypertension (PAH) is a rare disease (prevalence 15-25 cases per million) so that population screening is not appropriate; there is a greater prevalence (8 -12%) in patients (pts) with systemic sclerosis (SSC) for whom screening is therefore justifiable, especially since PAH is among the principal causes of death and carries a worse prognosis if diagnosis is delayed. For these pts ESC/ESR guidelines recommend an annual echocardiogram (ECHO) in order to select candidates for cardiac catheterisation (RHC). In 2013, a new two-level screening algorithm (DETECT) was proposed to identify pts for RHC: essentially the algorithm selects pts for ECHO and possible RHC on the basis of a predetermined score, calculated from ECG, blood tests and spirometry. Aim to evaluate whether the DETECT algorithm led to an early diagnosis of PAH in our patient group, thus minimising the number of missed diagnoses and optimising the use of ECHO and RHC. Method Between 2009 and 2019, 112 pts with SSC were assessed. 32 of these (28%) were put forward for RHC. From 2014, the DETECT algorithm was applied to 100 of these pts. A retrospective comparison based on mean pulmonary arterial pressure (MPAP), cardiac index (CI) and pulmonary resistance (PVR) was made between pts selected for RHC on the basis of annual ECHO between 2009 and 2013 (group 1) and those selected for RHC on the basis of the DETECT algorithm from 2014 to 2019 (group 2). Results A final diagnosis of PAH was reached in 20 (18%) of the 112 pts with SSC. Of the 100 pts then assessed by DETECT, 29 reached the threshold score for ECHO, 13 of these were eligible for RHC and 8 then received a subsequent diagnosis of PAH. False positives were 38%. A comparison of haemodynamic data (Table 3) shows a more severe form of PAH in Group 1 then in Group 2, both in terms of MPAP and PVR. The median CI was also lower in Group 1, indicating greater right ventricular impairment. Conclusion In our experience, the systematic use of the DETECT algorithm led to an effective selection of SSC pts at high risk of PAH who warranted RHC without the need for annual ECHO. Furthermore, DETECT pts received a diagnosis at an earlier stage of the disease as shown by the haemodynamic parameters described, thus raising the possibility of a better outcome for medical therapy in the long term. C97 EFFECTS OF CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION ON PULMONARY HAEMODYNAMICS IN PATIENTS AFFECTED BY GROUP II AND COMBINED PRE AND POST-CAPILLARY PULMONARY HYPERTENSION C Santolamazza C Santolamazza ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO A Giglio A Giglio ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO L D‘Angelo L D‘Angelo ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO E Ammirati E Ammirati ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO G Foti G Foti ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO G Masciocco G Masciocco ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO E Perna E Perna ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO M Varrenti M Varrenti ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO A Verde A Verde ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO M Cipriani M Cipriani ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO A Garascia A Garascia ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO M Frigerio M Frigerio ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; ASST FATEBENEFRATELLI – SACCO, MILANO Background Pulmonary hypertension (PH) due to left heart disease (LHD), or type II PH, is the most common form of PH, affecting up to 80% of patients with LHD. Patients with advanced heart failure developing PH have a worse prognosis and limited therapeutic opportunities; in fact non reversible PH represents a major contraindication to heart transplant. Continuous-flow left ventricular assist device (cf-LVAD) implantation can reduce pulmonary pressures in patients with advanced heart failure with reduced ejection fraction (HFrEF). Objectives To assess the effect of cf-LVAD implantation on type II and in combined post- and pre-capillary PH (Cpc-PH). Methods We retrospectively analyzed pulmonary haemodynamics of 60 patients undergoing cf-LVAD implantation between January 2007 and December 2016 at ASST Grande Ospedale Metropolitano Niguarda, Milan. A right heart catheterization (RHC) was performed before LVAD implant and 3, 8, 20 and 30 months after the operation. Pulmonary pressures, pulmonary gradients, pulmonary vascular resistance (PVR) and pulmonary arterial compliance (PAC) were measured or calculated in all patients. Results 48 patients (81%) had type II PH (mean pulmonary artery pressure, mPAP > 25 mmHg; Wedge pressure, WP > 15 mmHg) before LVAD implantation according to current guidelines. 66% of them had PVR > 3 Wood Unit (WU), identifying patients affected by cpc-PH. Baseline mean PAC value was very low (1.5 ml/mmHg). After LVAD, we observed a significant improvement in pulmonary haemodynamics (mPAP, PVR, WP, PAC) in all patients with evidence of effective left ventricle unloading. In some patients, unloading was limited by right ventricular dysfunction after LVAD, with subsequent PH persistence. Higher basal PVR or pre-implant PH irreversibility did not predict PH persistence after LVAD. Conclusions LV unloading by cf-LVAD is effective with subsequent normalization of PH in advanced HFrEF patients both with Group II PH and cpc-PH, until 30 months follow-up. This effect confirms the minor role of the pre-capillary component in cpc-PH. CLINICAL CARDIOLOGYC98 CARDIAC SARCOIDOSIS: INSIGHT FROM CARDIOVASCULAR MAGNETIC RESONANCE C Alderighi C Alderighi BRISTOL HEART INSTITUTE, BRISTOL; DIPARTIMENTO DI SCIENZE TORACICHE, CARDIOVASCOLARI E DI SANITA‘ PUBBLICA, UNIVERSITA‘ DI PADOVA, PADOVA; MEMORIAL BAHCELIEVLER HOSPITAL, ISTANBUL; BRISTOL HEART INSITUTE, BRISTOL A Baritussio A Baritussio BRISTOL HEART INSTITUTE, BRISTOL; DIPARTIMENTO DI SCIENZE TORACICHE, CARDIOVASCOLARI E DI SANITA‘ PUBBLICA, UNIVERSITA‘ DI PADOVA, PADOVA; MEMORIAL BAHCELIEVLER HOSPITAL, ISTANBUL; BRISTOL HEART INSITUTE, BRISTOL O Ozden Tok O Ozden Tok BRISTOL HEART INSTITUTE, BRISTOL; DIPARTIMENTO DI SCIENZE TORACICHE, CARDIOVASCOLARI E DI SANITA‘ PUBBLICA, UNIVERSITA‘ DI PADOVA, PADOVA; MEMORIAL BAHCELIEVLER HOSPITAL, ISTANBUL; BRISTOL HEART INSITUTE, BRISTOL M Perazzolo Marra M Perazzolo Marra BRISTOL HEART INSTITUTE, BRISTOL; DIPARTIMENTO DI SCIENZE TORACICHE, CARDIOVASCOLARI E DI SANITA‘ PUBBLICA, UNIVERSITA‘ DI PADOVA, PADOVA; MEMORIAL BAHCELIEVLER HOSPITAL, ISTANBUL; BRISTOL HEART INSITUTE, BRISTOL S Iliceto S Iliceto BRISTOL HEART INSTITUTE, BRISTOL; DIPARTIMENTO DI SCIENZE TORACICHE, CARDIOVASCOLARI E DI SANITA‘ PUBBLICA, UNIVERSITA‘ DI PADOVA, PADOVA; MEMORIAL BAHCELIEVLER HOSPITAL, ISTANBUL; BRISTOL HEART INSITUTE, BRISTOL C Bucciarelli–Ducci C Bucciarelli–Ducci BRISTOL HEART INSTITUTE, BRISTOL; DIPARTIMENTO DI SCIENZE TORACICHE, CARDIOVASCOLARI E DI SANITA‘ PUBBLICA, UNIVERSITA‘ DI PADOVA, PADOVA; MEMORIAL BAHCELIEVLER HOSPITAL, ISTANBUL; BRISTOL HEART INSITUTE, BRISTOL BRISTOL HEART INSTITUTE, BRISTOL; DIPARTIMENTO DI SCIENZE TORACICHE, CARDIOVASCOLARI E DI SANITA‘ PUBBLICA, UNIVERSITA‘ DI PADOVA, PADOVA; MEMORIAL BAHCELIEVLER HOSPITAL, ISTANBUL; BRISTOL HEART INSITUTE, BRISTOL Background Despite a higher prevalence in autoptic cases (25%), clinically manifest cardiac sarcoidosis (CS) has a prevalence of ? 5%, as it can be difficult to detect because of its focal nature. Diagnosis is multi-parametric and relies on clinical criteria and imaging findings, although a certain diagnosis,especially of isolated CS (ICS) can only be based on endomyocardial biopsy.Cardiovascular magnetic resonance (CMR)has an increasing role in supporting CS diagnosis in patients with histologically-proven extra-cardiac sarcoidosis. Aims To assess CS prevalence by CMR in a population with biopsy-proven extra-cardiac sarcoidosis and to analyse CMR characteristics of patients with extra-cardiac sarcoidos is found to have CS on CMR (CS-SS), those with only extra-cardiac sarcoidosis(SS) and those with ICS. Methods We retrospectively enrolled 84 patients(66% males, mean age 59 ± 13 years) referred to the CMR Unit of the Bristol Heart Institute for suspected CS (patients with biopsy-proven extra-cardiac sarcoidosis, n = 61; patients with >1symptom/sign suggestive of CS, n = 23). CMR was performed on a 1.5Tscanner (MAGNETOM Avanto, Siemens Healthcare), with a protocol comprehensive of biventricular functional assessment and post-contrast images. Results Based on CMR findings, 35 patients (42%) with extra-cardiac sarcoidosis, did not show cardiac involvement on CMR (SS), 26 (31%) had both cardiac and extra-cardiac sarcoidosis (CS-SS) and 23 (27%) had evidence of ICS.Patients with cardiac involvement were more likely to have a history of life-threatening tachyarrhythmias (p = 0.02); they had significantly lower LVEF (p < 0,01), larger LV volumes (p < 0,01) and greater LV mass (p < 0,01). GLS values were impaired in all 3 groups but were significantly more impaired in patients with CS (p < 0,01). With regards to late gadolinium enhancement (LGE) patients with ICS showed a higher number of myocardial segments involved by LGE, as compared to CSSS patients(p = 0,011) (Table 1). Oedema sequences were positive in 3 out of 30patients.T1 mapping, performed in 24 patients, mainly confirmed findings provided by LGE, and was abnormal in a patient, which could not receive gadolinium. Conclusions CMR findings consistent with CS were found in 49 patients referred for suspected CS.Patients with cardiac involvement had significantly lower LVEF, greater LV volumes and more impaired GLS. C99 DIAGNOSTIC AND THERAPEUTIC IMPACT OF CARDIAC MAGNETIC RESONANCE (CMR) IN PATIENTS WITH UNCLEAR CLINICAL PRESENTATION A Huqi A Huqi OSPEDALE VERSILIA, LIDO DI CAMAIORE J Del Meglio J Del Meglio OSPEDALE VERSILIA, LIDO DI CAMAIORE C Tessa C Tessa OSPEDALE VERSILIA, LIDO DI CAMAIORE L Salvatori L Salvatori OSPEDALE VERSILIA, LIDO DI CAMAIORE L Canale L Canale OSPEDALE VERSILIA, LIDO DI CAMAIORE E Ferrali E Ferrali OSPEDALE VERSILIA, LIDO DI CAMAIORE A Lilli A Lilli OSPEDALE VERSILIA, LIDO DI CAMAIORE G Solarino G Solarino OSPEDALE VERSILIA, LIDO DI CAMAIORE F De Caro F De Caro OSPEDALE VERSILIA, LIDO DI CAMAIORE G Casolo G Casolo OSPEDALE VERSILIA, LIDO DI CAMAIORE OSPEDALE VERSILIA, LIDO DI CAMAIORE Background Cardiac magnetic resonance (CMR) can help identify underlying etiologies and optimize therapy in patients presenting with confounding clinical patterns. For instance, patients admitted for suspected acute coronary syndrome with non obstructed coronary arteries, who are ultimately found to have perimyocarditis can be discharged with antiinflammatory rather than antiplatelet therapy. The impact of CMR in real world practice is unknown. We aimed to assess the diagnostic and decision-making implications of CMR in a non-University Cardiology Hospital setting. Methods and Results We retrospectively analysed data from patients undergoing CMR during hospitalization in the time period from 2017 to 2019. In our facility, patients referred for CMR are those with unclear diagnosis or needing further diagnostic support. Patients with suspected acute coronary syndrome (ACS) undergo coronary angiography in accordance with current clinical practice and guideline recommendations. Significant clinical impact was defined as identification of a new diagnosis and/or a change in management and length of stay. CMR (1.5-T) was performed using comprehensive protocols. Correlates of clinical and CMR indexes with a significant clinical impact were assessed with univariate and multivariate regression analysis. In the selected time period, 263 consecutive patients (54±17 years; 67% men) with no contraindications underwent CMR. At admission, 29% presented with unclear diagnosis, 28% with suspected acute coronary syndrome or takotsubo cardiomyopathy, 28% with suspected dilated cardiomyopathy and 15% with suspected myocardial inflammation. Following CMR, 47% of patients were excluded to have evidence of recent myocardial insult and 38% were finally diagnosed with dilated cardiomyopathy. Nineteen percent were diagnosed with acute coronary syndrome, 15% with takotsubo cardiomyopathy, 17% with myocardial inflammation, 9% with structurally normal heart and 2% with ARVC. Overall, CMR had a significant clinical impact in 121 (46%) patients (40% new diagnosis; 42% change in management; 11% change in hospital length of stay). At multivariate analysis, troponin values, edema and LGE remained significant predictors of clinical impact. Conclusions CMR significantly impacts diagnostic and therapeutic management of patients with unclear clinical presentation. Given the relevance of specific therapies, the use of CMR should be encouraged also in centers that currently lack this service. C100 THE ROLE OF CORONARY CT IN PREPARTICIPATION SCREENING OF MASTERS ALTHLETES A Roman Pognuz A Roman Pognuz OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI A Di Chiara A Di Chiara OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI L Mos L Mos OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI F Graniero F Graniero OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI E Bruschi E Bruschi OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI M Vergendo M Vergendo OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI M Valentino M Valentino OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI F Pelizzo F Pelizzo OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI OSPEDALE SAN ANTONIO, TOLMEZZO; OSPEDALE SAN ANTONIO, SAN DANIELE DEL FRIULI Preparticipation screening of athletes over the age of 35 (Masters athletes, MA) is one of the rising problems facing sports cardiologists. The incidence of sudden death within this group of patients is low and statistically correlated to the presence of coronary arteriosclerosis. In the light of this data, the evaluation of coronary circulation through coronary computed tomographic angiography (CCTA) is progressively changing the diagnostic and management approach regarding this patient population. Our experience with the use of CCTA began in 2017 in a spoke hospital, using a 64-layer CT. The trained medical team is composed of two cardiologists and three radiologists. Work activity is organized in one dedicated weekly session and the final medical report is compiled by both cardiologist and radiologist, and is always subject to a blind reading done by the second dedicated physician. We retrospectively examined 23 Masters athletes who underwent CCTA in our centre, analyzing symptoms, ergonometric test (ET) results, cardiovascular risk profile and elements that had emerged from CCTA. All of the patients (100%) underwent CCTA after a positive or inconclusive ET in terms of electrocardiographic alterations (ECG), but negative for angina or an anginal equivalent. CCTA showed the presence of coronary atherosclerosis with luminal stenosis less than 50% in 11 patients (47,8%) and coronary anomalies of course in 3 patients (13%). CCTA resulted negative in 9 patients. (39,2%). In our clinical records, positive or inconclusive ET in terms of electrocardiographic alterations (ECG) were not indicative of the presence of obstructive epicardial coronopathy (stenosis > 50 % lumen) on CCTA and this translated into a conservative attitude in the management of these patients, but also into an intensification of medical treatment in order to reach the objectives of primary prevention (modified in the light of evidence of atherosclerosis) as suggested by the CAD-RADS classification (Coronary Artery Disease reporting and Data System). Future studies will have to make use of second level imaging tests, which can clarify if there is a correlation between positivity in terms of ECG alterations during TE in MA and the presence of secondary ischaemia due to alterations of microcirculation. C101 CARDIOPULMONARY EXERCISE TEST TO ESTIMATE CHANGES IN FUNCTIONAL CAPACITY AFTER CARDIAC REHABILITATION IN ELDERLY MALE PATIENTS A Stuto A Stuto STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA B Armaro B Armaro STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA E Cosentino E Cosentino STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA G Canonico G Canonico STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA A Ambu A Ambu STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA F Raineri F Raineri STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA A Lo Giudice A Lo Giudice STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA G Cascone G Cascone STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA S Canonico S Canonico STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA S Cassarisi S Cassarisi STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA S Ierna S Ierna STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA G Basile G Basile STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA STAR FOR LIFE CENTRO DI RIABILITAZIONE CARDIACA, SIRACUSA; AMBULATORIO CARDIOLOGIA DR.BIAGIO ARMARO SRL, SIRACUSA; AMBULATORIO CARDIOLOGIA DR. BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRAC USA Objective The aim of this study was to evaluate the actual changes in functional capacity in elderly males after cardiac rehabilitation (CR). Material and Method The present study concerns 570 male patients, average age 72.9 +/- 6.4 years (range 65-86 years), enrolled in a three-month (twelve weeks) cardiac rehabilitation program with training sessions tri weekly lasting 60 minutes. All patients underwent an initial CPET at enrollment and a final CPET at the end of the rehabilitation cycle. The sustained workload (Watt) and the corresponding oxygen consumption (VO2) at the anaerobic threshold (AT) and at the peak (pk) were measured and the collected data were analyzed statistically using the statistical primer software. Results The table shows the average value and the standard deviation of the oxygen consumption (VO2) and of the work load (watts) sustained before and after the rehabilitation cycle at the anaerobic threshold (Watt AT, VO2 AT) and at the peak ( Watt pk and VO2 pk). Conclusions In elderly male patients functional capacity improves significantly after cardiac rehabilitation Table Measure Pre-CR vs Post-CR P value VO2 AT 11.76 +/- 4.01 vs 11.93 +/- 3.33 P = 0.456 Watt AT 57.73 +/- 17.74 vs 64.21 +/- 18.87 P = 0.000 VO2 pk 16.16 +/- 3.98 vs 16.47 +/- 4.04 P = 0.184 Watt pk 91.32 +/- 22.34 vs 100.03 +/- 21.2 P = 0.000 C102 DELIRIUM AND AGITATION IN THE INTENSIVE CARDIAC CARE UNIT. AN ITALIAN REGISTRY M Moltrasio M Moltrasio CENTRO CARDIOLOGICO, MILANO; OSPEDALE NIGUARDA CA‘ GRANDA, MILANO; HUMANITAS RESEARCH HOSPITAL, ROZZANO; OSPEDALE CIVILE DI LEGNANO, LEGNANO A Sacco A Sacco CENTRO CARDIOLOGICO, MILANO; OSPEDALE NIGUARDA CA‘ GRANDA, MILANO; HUMANITAS RESEARCH HOSPITAL, ROZZANO; OSPEDALE CIVILE DI LEGNANO, LEGNANO E Corrada E Corrada CENTRO CARDIOLOGICO, MILANO; OSPEDALE NIGUARDA CA‘ GRANDA, MILANO; HUMANITAS RESEARCH HOSPITAL, ROZZANO; OSPEDALE CIVILE DI LEGNANO, LEGNANO F Poletti F Poletti CENTRO CARDIOLOGICO, MILANO; OSPEDALE NIGUARDA CA‘ GRANDA, MILANO; HUMANITAS RESEARCH HOSPITAL, ROZZANO; OSPEDALE CIVILE DI LEGNANO, LEGNANO CENTRO CARDIOLOGICO, MILANO; OSPEDALE NIGUARDA CA‘ GRANDA, MILANO; HUMANITAS RESEARCH HOSPITAL, ROZZANO; OSPEDALE CIVILE DI LEGNANO, LEGNANO Introduction Patients admitted to Intensive Cardiac Care Unit for acute cardiovascular diseases frequently experience episodes of agitation and / or delirium. However, their epidemiological relevance and their clinical and prognostic impact in this specific clinical context have not yet been well defined. The purpose of this prospective and multicenter observational register was to evaluate the incidence of delirium and agitation in these patients, their prognostic impact and the therapies adopted. Materials and Methods 723 patients hospitalized in UTIC were enrolled. Agitation and sedation were classified by the Richmond Assessment Sedation Scale (RASS) and delirium was detected with the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit), performed bis in die or in the presence of changes in the state of consciousness. Primary endpoint was the incidence of delirium and agitation. Secondary endpoints the association between these complications, the in-hospital outcome and the therapies adopted. Results Among 723 patients, 16% had agitation and/or delirium. Patients with agitation/delirium had a higher ICCU mortality (10% vs. 2%) and a higher rate of major complications: ventricular arrhythmias (26% vs. 12%), atrial fibrillation (29% vs. 15%), sepsis (15% vs. 9%), and bleeding (17% vs. 7%;). Moreover, they were more frequently treated with mechanical procedures: invasive and non-invasive ventilation (58% vs. 18%), circulatory support (20% vs. 5%), continuous renal replacement therapy (6% vs. 1%). Finally, ICCU length of stay was longer (8 vs. 4 days; P<0.001). The drugs more likely used for agitation treatment were benzodiazepine (32%), dexmedetomidine (31%), opioids (10%), and antipsycotic drugs (1%). Delirium was mainly treated with dexmedetomidine (46%), benzodiazepine (23%), antipsycotic drugs (16%), and opioids (8%). Conclusions This registry confirm that delirium and agitation are frequent even in an acute cardiological setting and are associated with a worse prognosis. In this particular context, the choice of the most suitable treatment and its possible impact on the prognosis remain to be defined. C103 LENGTH OF STAY IN CARDIAC INTENSIVE CARE UNIT: WHAT FACTORS INFLUENCE IT? S Cignola S Cignola UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE D Nait D Nait UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE I Geromella I Geromella UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE P Nardini P Nardini UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE F Boneta F Boneta UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE G Ciarmatore G Ciarmatore UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE D Stolfo D Stolfo UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE A Sorrentino A Sorrentino UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE I Tavcar I Tavcar UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE M Milo M Milo UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE S Martino S Martino UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE S Liljana S Liljana UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE V Spinelli V Spinelli UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE A Nikolic A Nikolic UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE R Di Meola R Di Meola UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE G Sinagra G Sinagra UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE UNITÀ DI TERAPIA INTENSIVA CARDIOLOGICA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE; SC CARDIOLOGIA, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE, DAI CARDIOTORACOVASCOLARE, TRIESTE Background The intensive care units (ICU) have the role to manage critical patients, monitor them strictly using high technology systems and rapidly treat the acute fase of their illness. A prolonged stay in the ICU can affect patients mortality and increase costs. Factors most commonly associated with increased ICU length of stay (LOS) in patients undergoing cardiac surgery include increased age, atrial fibrillation/arrhythmia, chronic obstructive pulmonary disease (COPD), low ejection fraction, renal failure and non-elective surgery status. For what concern cardiac patients and their LOS in Cardiac Intensive Care Units (CICU) there is still lack of information. Methods Retrospective study. Setting. Cardiac Intensive Care Unit, Cardiovascular Department, Hospital of Trieste. Aim Describe characteristics of patients admitted to the CICU in the period between 2017 and 2018, and formulate some hypothesis on factors potentially affecting their LOS. Results A total of 2103 patients were included. Mean age was 68 (range 12-99; SD ± 13), 68.5% were male and 31.5% female, with a mean LOS of 2.3 days (range 0-15). 31% of patients had LOS ≥ 3 days; mean LOS for those patients was 5.3 days, while it was 1 day for the others (p<0.0001). Patients with a prolonged LOS (≥3 days) suffered in higher percentages for: diabetes (33.7% vs 19.8%, p<0.0001), chronic renal failure (17.4% vs 7.8%, p<0.0001), COPD (10% vs 7%, p=0.032) and cardiac failure as hospitalization diagnosis (20.6% vs 7%, p<0.0001). Those patients incurred more in delirium (11.7% vs 5%, p<0.0001), acute cardiac failure (8.7% vs 2.2%, p<0.0001), non invasive ventilation (11% vs 3%, p<0.0001), therapy with inotropic drugs (15.7% vs 6%, p<0.0001), dialysis (3.3% vs 1%, p=0.0006) or ultrafiltration (1% vs 0.1%, p=0.0059). Other factors associated with a LOS ≥3 were male gender (RR 1.33, IC 95% 1.15-1.55, p=0.0001) and age > 65 years (RR 2.49, IC 9% 2.16-2.87, p<0.0001). Otherwise patients with LOS <3 days were admitted to the CICU for monitorization following trans aortic valve implantation (TAVI), Mitraclip and ablations (12.2% vs 1.5%, p<0.0001). Conclusions 31% of patients admitted to the CICU had a LOS ≥3 days. Diabetes, chronic renal failure, COPD, cardiac failure, complications that occurred during hospitalization, the need for advanced mechanical/pharmacological supports, male gender and age >65 years can affects patients LOS in CICU. Relevance for Clinical Practice The knowledge of factors potentially affecting LOS allows to elaborate preventive strategies or manage problems affecting hospitalized patients who are staying for a medium-long period in CICU and avoid complications. Key words Length of stay; cardiology; intensive care. References 1 Toptas M, Sengul Samanci N, Akkoc İ, Yucetas E, Cebeci E, Sen O, et al. Factors Affecting the Length of Stay in the Intensive Care Unit: Our Clinical Experience. Biomed Res Int. 2018;20(2018):9438046. 2 Almashrafin A, Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Serv Res.2016;29(16):318. C104 PERCUTANEOUS DRUG ELUTING BALLOON TREATMENT OF PATIENTS WITH DYSFUNCTION VASCULOGENIC ERECTILE R Iorio R Iorio CLINICA SAN GAUDENZIO, NOVARA G Celano G Celano CLINICA SAN GAUDENZIO, NOVARA A Cereda A Cereda CLINICA SAN GAUDENZIO, NOVARA S Bongo S Bongo CLINICA SAN GAUDENZIO, NOVARA G Sangiorgi G Sangiorgi CLINICA SAN GAUDENZIO, NOVARA CLINICA SAN GAUDENZIO, NOVARA Introduction Erectile dysfunction (ED) is defined as "persistent inability to have and maintain an erection sufficient to ensure a satisfactory sexual activity. Seventy percent of ED recognize a vasculogenic cause for the presence of significant atherosclerotic plaques at level of pudendal and dorsal arteries of the penis. A Sirolimus eluting balloon (SEB) has recently been introduced into clinical practice, characterized by a 1.27 microg / mm2 Sirolimus drug dosage encapsulated in a base excipient of phospholipids which acts as a carrier for drug transport within the vascular wall through a diffusion coefficient. The purpose of this work was the evaluation of procedural and clinical success rate with the use of SEB in patients with arteriogenic ED. Method From Sep 2018 to Dec 2019, 194 consecutive patients affected by DE were enrolled (IEF-5 <21 associated with Penile Doppler selected Dynamic with PSV <25 cm s - 1, EDV <5 cm s - 1, RI > 0.8). Of these, 138 were treated with paclitaxel eluting balloon (PEB) and 56 with SEB. Results The characteristics of the population are reported in Table 1. 238 lesions were treated, of which 6 (16%) at the level of the internal iliac artery, 155 (65%) of the internal pudenda, 57 (30%) of the common penile artery and 10 (4%) of the dorsal artery of the penis. 93 patients showed involvement of the left side pudendal district (47%), 82 (43%) of right side and 19 (10%) bilateral, respectively. The length of the affected segment was 11.9 ± 6.6 mm, the total length treated 17.6 ± 13.3 mm. The reference diameter of the vessel was 2.2 ± 0.5 mm with a minimum lumen diameter of 1.2 ± 0.6 mm. Relative stenosis was 73 ± 6.5%. A PEB was used in 141 lesions (59%); SEB in 56 (24%). Procedural success (defined as residual stenosis <10% without signs of dissection) was 98%. Clinical success (defined by delta IEF-5 baseline score vs. 3/6/8 months > 5 points) occurred in 74.1% of patients treated with SEB and in 78.2% of patients treated with PEB (p = NS). Clinical success at 8 months was 68.9% in the SEB group and in the 63.1% in the PEB group (Figure 1). Conclusions The clinical success of DEB treatment (PEB o SEB) of patients with vasculogenic DE in the mid-term 8 mos follow up is maintained in approximately 70% of cases treated with these devices and should be considered as a second line of treatment at the moment that first-line PDEF5-i drug therapy has failed. Treatment Success Referred to Minimal Clinical Improvement of the IEF-5 Score between Sirolimus Eluting Balloon (SEB - N = 56) and Paclitaxel Eluting Baloon (PEB - n = 138) in a consecutive series of Patients with Arteriogenic DE Table 1 Clinical Characteristics of the Study Group (n = 194) Tabella 1. Caratteristiche Cliniche del Gruppo di Studio (n = 194) Età 59.8+10.8 BMI (kg/m2) 25.1+2.8 Fumatori (n,%) 115 (59) Diabete NID (n,%) 97 (50) Diabete ID (n,%) 36 (18) Ipertensione (n,%) 132 (68) Ipercolesterolemia (n,%) 125 (64) Familiarità per CAD (n,%) 45 (23) Cardiopatia Ischemica Cronica (n,%) 62 (32) Arteriopatia Obliterante Arti Inferiori (n,%) 33 (7) Storia di Chirurgia Prostatica (n,%) 28 (14) Storia di Prostatiti Croniche (n,%) 11 (6) Dialisi 0 Punteggio IIEF-5 basale 9.7+6.6 Q3: Capacità di penetrazione 1.69+1.27 Q4: Capacità a mantenere l’erezione 1.18+1.23 Endoleak Venoso Associato 10 (5) Farmaci Provati Prima della Procedura Inibitori delle Fosfodiesterasi – 5 (n,%) Prostaglandine Intracavernose (n,%) Testosterone (n,%) 144 (74) Farmaci con impatto su DE 48 (24) 5 (2) β-bloccanti (n,%) Farmaci Psicotropi (n,%) Diuretici Tiazidici (n,%) 58 (30) 8 (4) 32 (16) Età 59.8+10.8 BMI (kg/m2) 25.1+2.8 Fumatori (n,%) 115 (59) Diabete NID (n,%) 97 (50) Diabete ID (n,%) 36 (18) Ipertensione (n,%) 132 (68) Ipercolesterolemia (n,%) 125 (64) Familiarità per CAD (n,%) 45 (23) Cardiopatia Ischemica Cronica (n,%) 62 (32) Arteriopatia Obliterante Arti Inferiori (n,%) 33 (7) Storia di Chirurgia Prostatica (n,%) 28 (14) Storia di Prostatiti Croniche (n,%) 11 (6) Dialisi 0 Punteggio IIEF-5 basale 9.7+6.6 Q3: Capacità di penetrazione 1.69+1.27 Q4: Capacità a mantenere l’erezione 1.18+1.23 Endoleak Venoso Associato 10 (5) Farmaci Provati Prima della Procedura Inibitori delle Fosfodiesterasi – 5 (n,%) Prostaglandine Intracavernose (n,%) Testosterone (n,%) 144 (74) Farmaci con impatto su DE 48 (24) 5 (2) β-bloccanti (n,%) Farmaci Psicotropi (n,%) Diuretici Tiazidici (n,%) 58 (30) 8 (4) 32 (16) Open in new tab Table 1 Clinical Characteristics of the Study Group (n = 194) Tabella 1. Caratteristiche Cliniche del Gruppo di Studio (n = 194) Età 59.8+10.8 BMI (kg/m2) 25.1+2.8 Fumatori (n,%) 115 (59) Diabete NID (n,%) 97 (50) Diabete ID (n,%) 36 (18) Ipertensione (n,%) 132 (68) Ipercolesterolemia (n,%) 125 (64) Familiarità per CAD (n,%) 45 (23) Cardiopatia Ischemica Cronica (n,%) 62 (32) Arteriopatia Obliterante Arti Inferiori (n,%) 33 (7) Storia di Chirurgia Prostatica (n,%) 28 (14) Storia di Prostatiti Croniche (n,%) 11 (6) Dialisi 0 Punteggio IIEF-5 basale 9.7+6.6 Q3: Capacità di penetrazione 1.69+1.27 Q4: Capacità a mantenere l’erezione 1.18+1.23 Endoleak Venoso Associato 10 (5) Farmaci Provati Prima della Procedura Inibitori delle Fosfodiesterasi – 5 (n,%) Prostaglandine Intracavernose (n,%) Testosterone (n,%) 144 (74) Farmaci con impatto su DE 48 (24) 5 (2) β-bloccanti (n,%) Farmaci Psicotropi (n,%) Diuretici Tiazidici (n,%) 58 (30) 8 (4) 32 (16) Età 59.8+10.8 BMI (kg/m2) 25.1+2.8 Fumatori (n,%) 115 (59) Diabete NID (n,%) 97 (50) Diabete ID (n,%) 36 (18) Ipertensione (n,%) 132 (68) Ipercolesterolemia (n,%) 125 (64) Familiarità per CAD (n,%) 45 (23) Cardiopatia Ischemica Cronica (n,%) 62 (32) Arteriopatia Obliterante Arti Inferiori (n,%) 33 (7) Storia di Chirurgia Prostatica (n,%) 28 (14) Storia di Prostatiti Croniche (n,%) 11 (6) Dialisi 0 Punteggio IIEF-5 basale 9.7+6.6 Q3: Capacità di penetrazione 1.69+1.27 Q4: Capacità a mantenere l’erezione 1.18+1.23 Endoleak Venoso Associato 10 (5) Farmaci Provati Prima della Procedura Inibitori delle Fosfodiesterasi – 5 (n,%) Prostaglandine Intracavernose (n,%) Testosterone (n,%) 144 (74) Farmaci con impatto su DE 48 (24) 5 (2) β-bloccanti (n,%) Farmaci Psicotropi (n,%) Diuretici Tiazidici (n,%) 58 (30) 8 (4) 32 (16) Open in new tab C105 THE USE OF TWO DIFFERENT TYPES OF CARDIOPLEGIA, WARM BLOOD AND COLD ST. THOMAS CRYSTALLOID, FOR MYOCARDIAL PROTECTION DURING ISOLATED CORONARY ARTERY BYPASS GRAFT: OPERATIVE RESULTS P Nardi P Nardi CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA C Pisano C Pisano CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA F Bertoldo F Bertoldo CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA M Ferrante M Ferrante CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA C Bassano C Bassano CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA A Scafuri A Scafuri CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA D Buioni D Buioni CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA D Colella D Colella CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA G Ruvolo G Ruvolo CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA CARDIOCHIRURGIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA; CARDIO–ANESTESIA, POLICLINICO UNIVERSITÀ DI ROMA TOR VERGATA, ROMA Aim of the Study We retrospectively analyzed early results of coronary artery bypass grafting (CABG) surgery using antegrade intermittent warm blood or St.Thomas cold crystalloid cardioplegia. Methods From January 2015 to May 2018, in 556 patients undergoing isolated CABG, cardiac arrest was obtained with use of warm blood (WB-group, n = 402) or St.Thomas (ST-group, n = 154) cardioplegia. Myocardial enzymes’ release was calculated at the end of CABG (time 0), 24, 48 hours postoperatively. The study is still ongoing prospectively. Results In-hospital, mortality was 1.74% in WB-group, 0.65% in ST-group(P=NS). As compared with WB-group, in ST-group the number of distal coronary artery anastomoses per-patient was significantly higher (2.9±0.9 vs 2.6±0.8, P10% was similar. As compared with WB-group, in ST-group the rate of patients with CK-MB/CK ratio>5% was lower during each time points of evaluation, with a significant difference at time 0 (30.5% vs 48%, P = 0.0005) (Figure 1), but need for blood transfusion per-patient was higher (1.3±2.0 versus 0.54±1.3; P5% was significantly reduced when dose administration was repeated within 18 minutes compared to 20-25 minutes (36% vs 59%, P10% and >5%. Conclusions Based on a single-center experience, both types of cardioplegia were associated with equivalent clinical results. St.Thomas cardioplegia, despite the greater mean number of grafts and longer extracorporeal circulation time appeared to be associated with lower rate of CK-MB ratio>5%. Warm blood cardioplegia allows better protection when administered in a 18-minute re-dosing interval and required less blood transfusion. C106 PROMOTING APPROPRIATE PATIENT ACCESS TO PCSK9 INHIBITORS IN THE ITALIAN NATIONAL HEALTH SERVICE: THE ACCESS AND PRESCRIPTION PROCEDURE OF THE INTEGRATED CARDIOLOGY NETWORK OF THE ASL ROMA 1 F Colivicchi F Colivicchi P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA A Aiello A Aiello P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA M Leggio M Leggio P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA A Chiera A Chiera P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA A Totteri A Totteri P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA G Greco G Greco P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA L Capaldo L Capaldo P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA S Festinese S Festinese P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA R Ricci R Ricci P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA P.O. SAN FILIPPO NERI – ASL ROMA 1, ROMA; OSPEDALE SANTO SPIRITO, ROMA `Four years after EMA approval of PCSK9 inhibitors (PCSK9i) for hypercholesterolemia, patient access to monoclonal antibodies remains low, possibly leading to a significant undertreatment. Implementing specific clinical pathways may help provide optimal patient management, favoring appropriate access to innovative care. The Italian National Health Service (INHS) is publicly financed and regionally based. Italian Regions organize health services through Local Health Units. The “ASL ROMA 1” is a local health unit of the Lazio Region and it is based in the city of Rome, providing health services to more than 1.100.000 residents. Recently, the “ASL ROMA 1” has developed an Integrated Cardiology Network (ICN). In the last 12 months, this professional Network has implemented an access and prescription procedure (APP) for appropriate prescription of PCSK9i. The ICN presently includes two hospitals, namely S. Filippo Neri and S. Spirito, and 14 outpatient clinics. In the INHS, PCSK9i are reimbursed only when prescribed by public institutions in the following cases: Primary prevention – age <80 years, Familial Hypercholesterolemia (FH) and LDL cholesterol (LDL-C) ≥130 mg/dL, despite 6 months of treatment with the maximum tolerated dose of a statin and ezetimibe or with ascertained statin intolerance. Secondary prevention – age <80 years, any prior cardiovascular event (stroke, ACS, PCI, etc.) LDL-C ≥100 mg/dL, despite 6 months of treatment with the maximum tolerated dose of a statin and ezetimibe or with ascertained statin intolerance. According to the recently designed APP, patients eligible for PCSK9i therapy can be referred for prescription at one of the two hospitals belonging to the ICN by all outpatient cardiologists from the 14 clinics of the ICN. Actually, outpatient cardiologists should: Check eligibility , LDL-C, and ongoing therapy. Refer eligible patients to the nearest hospital center. Provide clinical follow up after prescription. Primary care physicians can refer any potentially eligible patients to the nearest outpatient clinic for evaluation. The APP suggests referral for any statin-naïve patient with a LDL-C >190 mg/dL or any patient with a LDL-C >160 mg/dL on any statin treatment. At present, such APP has favored the access to PCSKi therapy to more than 130 patients in about 12 months. To date, this specific program represents the largest institutional experience of a systemic approach for appropriate access to PCSK9i in the INHS. ECHOCARDIOGRAPHYC107 IMPLEMENTING THE PACING OF THE CONDUCTION SYSTEM AS FIRST LINE APPROACH L Marcantoni L Marcantoni OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO G Pastore G Pastore OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO E Baracca E Baracca OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO M Carraro M Carraro OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO L Conte L Conte OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO C Picariello C Picariello OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO S Aggio S Aggio OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO S Giatti S Giatti OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO A Maddalozzo A Maddalozzo OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO D Lanza D Lanza OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO M Galasso M Galasso OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO L Roncon L Roncon OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO F Zanon F Zanon OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO OSPEDALE S. MARIA DELLA MISERICORDIA, ROVIGO Background His Bundle Pacing (HBP) and Left Bundle Branch Pacing (LBBP) ensure a physiologic ventricular activation and can prevent detrimental effects of apical pacing. The evidences both clinical and technical supporting these new pacing modalities are rapidly increasing. Physicians are currently adopting the pacing of the conduction system (CSP) in selected patients. Objective To analyze short-term results of the conduction system pacing (HBP and LBBP) implemented as first line therapy in all patients referred for PM implant. Methods We analyzed 164 consecutive patients (78±9 years; 124 males) coming from a single operator experience who has adopted CSP as the first line approach in all the patients. Selective HBP (37%), non selective HBP (47%) or LBBP pacing (16%) were obtained by the 3830 lead Medtronic, from 2018 to 2019 July. The pacing indications were AV block in 62%, sinus node disease in 12%, slow atrial fibrillation in 12% and heart failure in 14%. Ischemic cardiopathy was present in 28%; hypertension in 83%, diabetes in 25%. Average baseline QRS duration was 136±36 ms and 60% of pts had bundle branch block. The basal mean EF 56±12%. 75% of the pts were in sinus rhythm at implant. The back-up lead was implanted in apex or septum in 18 (11%) patients. A lead in the coronary sinus was placed in 18 (11%) as part of CRT implant. Results The devices were checked 48 hours and 1 month after implant, as usual in our centre. At the 1 month follow-up 158 (96,4 %) patients showed good performance of the 3830 lead with morphology and duration of QRS like the post implant one (115 ±21 ms). Mean VP% was 64% and mean AP% 40%. VP ≥ 90% was detected in 65% of patients. Chronic AF (AT/AF 100%) in 22% of patients. Mean threshold was 1,5V@0,6 ms, mean sensing 5,6 mV and mean impedance 469 ohm. The device’s check revealed 3830 lead malfunction in 6 patients (3,6%) due high threshold (zero macroscopic dislodgement). In 2 (1,6%) of these cases the operator decided to re-operate with 3830 lead extraction and new standard lead implant on RV septum. Conclusion The pacing of the conduction system, both HBP and LBBP is safe and feasible in the clinical practice as first line therapy in all patients referred for PM implant. The system ensures a physiologic ventricular contraction thus allowing a better clinical outcome. 1,6% of re-intervention due to 3830 lead malfunction were required during 1 month follow up. C108 SPECKLE TRACKING-ASSESSED MECHANICAL DISPERSION AND PREDICTION OF VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION: THE INFLUENCE OF LEFT BUNDLE BRACH BLOCK A Mengoni A Mengoni CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA E Carluccio E Carluccio CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA P Biagioli P Biagioli CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA R Lauciello R Lauciello CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA G Bardelli G Bardelli CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA M De Rosa M De Rosa CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA V Oliva V Oliva CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA G Zingarini G Zingarini CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA R Azzunziata R Azzunziata CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA CARDIOLOGIA E FISIOPATOLOGIA CARDIOVASCOLARE, PERUGIA; CARDIOLOGIA, PERUGIA Background Mechanical dispersion (MD), the standard deviation of time-to-peak longitudinal strain by 2D-speckle tracking echocardiography (STE), has been recently proposed as an important predictor for ventricular arrhythmias (VAs) in different clinical contexts, independent of ejection fraction (EF).However, other than myocardial fibrosis and disarray, MD can also be related to conduction disturbances such as left bundle branch block (LBBB). Objectives To investigate whether LBBB could affect the ability of MD to predict VAs in patients with heart failure and reduced EF (HFrEF). Methods We prospectively studied 295 HFrEF patients meeting primary (n = 251) or secondary (n = 44) ICD prevention criteria. 2D-STE ?was used to compute global longitudinal strain (GLS; average strain in a 16-segment LV model), and MD. Results After a median follow-up of 43.2 months (range 21.1 – 71.0 months), 74 patients experienced 1 or more VAs requiring appropriate ICD therapy. Compared to those without VAs, ICD patients with VAs during follow-up showed similar EF (27.1±7.9% vs. 27.4±7.3%, P = 0.729), and GLS (-7.02±2.7% vs -7.47±2.7%, P = 0.223), but greater MD (119.2±47.7 ms vs. 97.4±48.9 ms, P < 0.001). By multivariable Cox regression, MD was a strong and independent predictor of VAs (hazard ratio: 1.14 per 20-ms increase, 95% confidence interval: 1.06-1.23, P = 0.001). This effect was seen in the whole population as well as in the subgroup with normal QRS but not in those with LBBB (HR: 1.08; 95%Cis: 0.96-1.21, P = 0.205). there was a significant interaction between QRS duration and morphology and MD (P < 0.05): presence of LBBB was associated with a 50% reduction in the risk of VAs that was even greater for increasing values of MD > 100 ms. Conclusions Mechanical dispersion is greater in HFrEF patients with arrhythmias. Presence of LBBB blunted the predictive power of MD against VAs suggesting possible different underlying mechanisms other than myocardial disarray. C109 ASSOCIATION OF LOSS-OF-FUNCTION SCN5A INTRAGENIC DUPLICATION WITH EPILEPSY, VENTRICULAR TACHYCARDIA AND FIBRILLATION AND BRUGADA-LIKE SYNDROME D Fiscella D Fiscella STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO N Marziliano N Marziliano STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO A Medoro A Medoro STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO A Fiscella A Fiscella STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO M Longo M Longo STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO G Francese G Francese STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO S Folzani S Folzani STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO C Reverberi C Reverberi STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO M Gulizia M Gulizia STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO M Intrieri M Intrieri STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO STRUTTURA COMPLESSA DI CARDIOLOGIA– OSPEDALE ARNAS GARIBALDI–NESIMA–CATANIA, CATANIA; CLINICAL PATHOLOGY LABORATORY, ASL TARANTO, GROTTAGLIE, GROTTAGLIE; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO, CAMPOBASSO; FONDAZIONE FLORESTA LONGO, CATANIA–, CATANIA; IMAGING DEPARTMENT, POLIAMBULATORIO CITTÀ DI COLLECCHIO, COLLECCHIO; CARDIOLOGY DEPARTMENT, POLIAMBULATRIO GEMINI, PARMA; DEPARTMENT OF MEDICINE AND HEALTH SCIENCES “V. TIBERIO”, UNIVERSITY OF MOLISE, CAMPOBASSO In the last years, the increasing evidences about the co-existence of genetically based cardiac arrhythmias and epilepsy brings out the emerging concept of cardio-cerebral channelopathy. The SCN5A gene encodes for the α-subunit of the Nav1.5 channel and mutations in this gene are mainly involved in electrical channelopathies that lead to life-threatening arrhythmias (Brugada syndrome, Long-QT syndrome, Sudden Infant Death syndrome, etc.) or structural changes in the myocardium, such as in the dilated cardiomyopathy (DCM). Additionally, the SCN5A is associated with drug-resistant epilepsy both early onset and in the adulthood. In this view, we describe two unrelated cases presenting with cardiac and epileptic phenotypes in which two novel intragenic duplications in the SCN5A gene (c.1627_1653dup, p.Phe543_Ala551dup and c.1846_1863dup, p.Ser616_Pro621dup respectively) were identified. In particular, the family of the proband harboring the SCN5A: c.1627_1653dup both phenotypes are consistently present. With the aim of characterizing the biological effects of such genetic defects, we studied the biophysical properties of the Nav1.5 channels revealing that duplication might prompt for a loss-of-function of the Nav1.5-mediated current in a zebrafish model (Danio rerio) without alterations in the heart structure and function (at least for the first mutation). Taking together, clinical and biochemical data support the idea that the intragenic in-frame duplications within the SCN5A gene could be responsible for both cardiac and brain phenotypes thus providing the molecular basis for a more appropriate management in patients with epilepsy and ventricular malignant arrhythmias. C110 ELECTROCARDIOGRAPHIC SIGNS RELATED TO WORST PROGNOSIS IN BRUGADA SYNDROME F Vitali F Vitali AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA C Balla C Balla AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA A Brieda A Brieda AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA A Antonucci A Antonucci AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA M De Raffele M De Raffele AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA M Malagù M Malagù AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA M Bertini M Bertini AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA AZIENDA OSPEDALIERO–UNIVERSITARIA DI FERRARA, CENTRO CARDIOLOGICO, FERRARA Background The 12-lead electrocardiogram (ECG) has played an essential role for the diagnosis of Brugada Syndrome (BrS) since its first description. Different ECG signs other than spontaneous type 1 ECG pattern were linked to arrhythmic risk with conflicting results. Purpose: to evaluate the prognostic value of different ECG signs in BrS patients. Methods We retrospectively analyzed 46 patients with Brs and spontaneous type 1 ECG pattern. Patients were categorized in three groups: asymptomatic, with previous syncope and with previous cardiac arrest (CA) / documented ventricular arrhythmias (VTA) / appropriate ICD interventions. Sings collected from each ECG were: presentation rhythm, heart rate, atrial depolarization duration and axis, PR interval (ms), QRS complex morphology, QRS duration in V2 and DII (ms), QRS fragmentation, Tzou criteria (V1R>0.15 mV, V6S>0.15 mV, V6S/R>0.2 mV), duration and voltage of S wave in lateral leads (≥40 ms and ≥ 0,1 mV), aVR sign (R’≥ 0,3 mV), QT and QTc (Bazett) duration in DII and repolarization dispersion (T peak - T end in V2 and V6). Results In our BrS patients with spontaneous type 1 ECG pattern PR interval > 200 ms (p = 0,017), QRS duration > 120 ms in DII (p = 0,001) and > 140 ms in V2 (p = 0,02), presence of aVR sign (p = 0,006), wide and or large S wave in DI-aVL (p = 0,02), fQRS (p = 0,012) and Tzou Criteria (p = 0,039) were associated with CA and VTA. Conclusions In our population, prolonged PR interval, wide QRS in DII and V2, fragment QRS, wide and large S wave in lateral leads, wide R' wave in aVR and presence of Tzou Criteria were associated with worst clinical outcome. C111 A CASE OF BRUGADA PATTERN "BIGEMINY" G Mugnai G Mugnai OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO S Cavedon S Cavedon OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO A Cima A Cima OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO C Dalla Valle C Dalla Valle OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO A Mecenero A Mecenero OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO C Perrone C Perrone OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO C Bilato C Bilato OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO OSPEDALE PUBBLICO DI ARZIGNANO, ARZIGNANO Introduction Brugada syndrome is an important hereditary ion channel disorder characterized by a coved-type ST-segment elevation in leads V1to V3 of the ECG associated with sudden cardiac death in structurally normal hearts. This case reports for the first time an usual presentation of Brugada type 1 pattern occurring in a “bigeminy way” without no drug challenges or any apparent causes in a family member of a proband with type 1 pattern. Case Summary A 46 year-old male, brother of a proband with Brugada type 1 pattern, presented to our outpatient clinic for a routinary ECG. His ECG curiously showed an intermittent Brugada type 1 pattern with a “bigeminy” trend P-Q and R-R intervals were stable and did not significantly change during the ECG. This particular “bigeminy” trend of Brugada type 1 pattern persisted during the whole ECG tracing. No family history of sudden cardiac death was reported. The genetical test demonstrated the mutation of SCN5A gene, as the brother also had. As the programmed electrical stimulation did not induce any malignant arrhythmias and the patients was asymptomatic for syncope, no further measures were indicated. Discussion The present case shows a dynamic alternans of Brugada type 1 pattern with a curious “bigeminy” trend in a patient with a documented mutation of SCN5A and with a brother affected by Brugada type 1. Repolarization changes have been reported to fluctuate occasionally in patients with Brugada syndrome, probably because some factors, such as autonomic imbalance, might affect ventricular depolarization or repolarization. Decreased Na+channel function has been suggested to be involved in the genesis of ST elevation, together with prominent development of the transient outward K+current Ito in epicardial cells of the right ventricular outflow tract with little development of current in endocardial cells resulting in augmented notch and loss of dome in epicardial action potential and increased disparity of repolarization. We might hypothesize that a marked dominance of Ito or an inhibition of ICa, INa occurred in a 1:1 fashion resulting in a “bigeminy-like” Brugada type 1 pattern. This phenomenon might hypothetically indicate a marked impairment of currents in the epicardial cells of the right ventricular outflow tract; however, the clinical meaning of this phenomenon is unknown and it is important to state that this is not necessarily related to an increased risk of ventricular arrhythmias. ATHEROSCLEROSISC112 COMPARATIVE STUDY OF VASCULAR FUNCTION IN NORMAL AND HYPERTENSIVE PREGNANT G Chiarello G Chiarello POLICLINICO DI BARI, BARI; UNIVERSITÀ DI FOGGIA, FOGGIA R Carbonara R Carbonara POLICLINICO DI BARI, BARI; UNIVERSITÀ DI FOGGIA, FOGGIA C Girasoli C Girasoli POLICLINICO DI BARI, BARI; UNIVERSITÀ DI FOGGIA, FOGGIA I Panettieri I Panettieri POLICLINICO DI BARI, BARI; UNIVERSITÀ DI FOGGIA, FOGGIA M Ciccone M Ciccone POLICLINICO DI BARI, BARI; UNIVERSITÀ DI FOGGIA, FOGGIA V Vulpis V Vulpis POLICLINICO DI BARI, BARI; UNIVERSITÀ DI FOGGIA, FOGGIA POLICLINICO DI BARI, BARI; UNIVERSITÀ DI FOGGIA, FOGGIA Aim Compare the temporal changes in vascular function and arterial pressure during pregnancy in healthy and hypertensive women (PIH). Vascular function was assessed at 4time (11-13 + 6 weeks+days, 20-22 + 6 weeks+days , 30-32 + 6 weeks+days and first trimester after delivery) by brachial flow-mediated dilatation (b-FMD), uterine resistance index (u-IR) carotid-intima media tickness (c-IMT) and 24h ABPM in women with singleton pregnancies. Methods 48 normal pregnant females and 45 hypertensive pregnant females were included in this study. Detailed history, clinical examination, ABPM, FMD, c-IMT Doppler ultrasound, u-IR and relevant biochemical parameters (high sensitivity C-reactive protein : hs-PCR) were assessed at each visit. The study groups were found to be age matched (p = 0,78). FMD level in the pregnancy-induced hypertensive group (average = 6,34±1,23%) was significantly lower in the third trimester than the normal pregnant (average: 12,65±2,74% ) and the difference between these 2 groups was significant (p < 0,01 ). Results Significantly lower levels of FMD during the third trimester were assessed in PIH subjects compared to normal pregnant, and after the delivery the FMD values in PIH were better than the third trimester (average: 8,56±1,71%) but lower than the baseline (10,5±2,36%; p = 0,036). The lower values of FMD are probably caused by a state of inflammation because FMD correlated with hs-CRP that directly increases in the third trimester of pregnancy in hypertensive women. IMT does not statistically change in two study group. U-RI is reduced in the third pregnancy quarter and correlates with FMD (r: 0.798). Conclusions Values of FMD in the first quarter pp improve compared to the third trimester of pregnancy, but are still lower compared to baseline in hypertensive pregnant as opposed to the healthy pregnant group in which FMD values remain consistently high. This predisposes that gestational hypertension increases cardiovascular risk although seriated monitoring to more long time are needed. C113 CLINICAL OUTCOME OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION AND ANGIOGRAPHIC EVIDENCE OF CORONARY ARTERY ECTASIA L Esposito L Esposito AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO G Fierro G Fierro AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO M Di Maio M Di Maio AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO A Silverio A Silverio AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO F Di Feo F Di Feo AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO A Iannicelli A Iannicelli AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO M Varone M Varone AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO M Ciccarelli M Ciccarelli AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO C Vecchione C Vecchione AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO G Galasso G Galasso AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO C Baldi C Baldi AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA, SALERNO Background Coronary artery ectasia (CAE) is a relatively frequent finding in patient with ST-elevation myocardial infarction (STEMI) who undergo emergent coronary angiography. However, the long-term outcome of STEMI patients with CAE as compared to Non-CAE has been poorly investigated. Purpose To compare the baseline features and outcome of patients with and without CAE in the clinical setting of STEMI. Methods All patients with STEMI who underwent emergent coronary angiography from January 2012 to December 2017 at our Institution were retrospectively enrolled. Baseline demographic, clinical, instrumental, angiographic and percutaneous coronary intervention (PCI) findings were collected for patients with and without CAE. The study outcome measures were recurrent myocardial infarction (MI) and all-cause death. The propensity score weighting (PSW) technique was used to take into account for potential selection bias in treatment assignment between CAE and Non-CAE groups. Results The study population included 560 patients (mean age = 60.6 ± 13.7 years; 79.5% males). Hypertension was observed in 351 patients (62.7%), diabetes in 134 (23.9%), dyslipidemia in 266 (47.5%), smoking status in 316 (56.4%), history of coronary artery disease (CAD) in 76 (13.6%), prior MI in 69 (12.3%), prior PCI in 62 (11.1%). Multivessel disease (MVD) was reported in 211 (37.7%) cases. The infarct-related artery was the left anterior descending in 310 patients (55.4%), the right coronary artery in 179 (32.0%), the left circumflex 60 (10.7%) and the left main in 11 (2.0%). Total cholesterol mean value was 187.7 ± 48.8 mg/dl; LDL cholesterol was 112.2 ± 41.3 mg/dl and Lp(a) was 26.5 ± 27.2 mg/dl. At three-year follow-up, MI occurred in 58 (10.4%) patients. At multivariable analysis, Lp(a) (HR 1.015 95%CI: 1.008-1.022 p<0.001) and MVD (HR 1.994; 95%CI 1.179-3.372 p=0.010) emerged as the only two independent predictors of MI recurrence up to three years. The Kaplan-Meier analysis showed a significantly lower survival free from MI in patients with Lp(a) ≥50 mg/dl as compared to the subgroups with levels ≥30 and <50 mg/dL, or <30 mg/dL (Log-Rank=0.001). Also, MVD was able to identify patients with significantly lower survival free from MI for up to three years (Log-Rank=0.004). The Kaplan-Meier analysis combining these two parameters identified patients with both MVD and Lp(a)≥50 mg/dl as the highest risk cohort for MI recurrence up to three years (MI incidence rate=22.2%; Log-Rank=0.002). Conclusions Among patients with STEMI who underwent pPCI, high Lp(a) level and MVD predict the recurrence of MI at long-term follow-up. C114 SUSTAINABLE TELE-CARDIOLOGY SYSTEM WITH THE USE OF DIGITAL - THE TREC CARDIO STUDY IN TRENTINO M Maines M Maines OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO M Moz M Moz OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO S Forti S Forti OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO E Gabardi E Gabardi OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO C Dario C Dario OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO D Conforti D Conforti OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO G Tomasi G Tomasi OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO R Bonmassari R Bonmassari OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO M Marini M Marini OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO M Del Greco M Del Greco OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO OSPEDALE SANTA MARIA DEL CARMINE, ROVERETO; APSS TRENTO, TRENTO; FONDAZIONE BRUNO KESSLER, TRENTO; PAT UFFICIO INNOVAZIONE E RICERCA, TRENTO; OSPEDALE S. CHIARA, TRENTO; OSPEDALE S. MARIA DEL CARMINE, ROVERETO The use of telemedicine associated with artificial intelligence systems represents an innovative system for managing patients with arrhythmic problems and device. Our Tele-cardiology clinic presents a model focused on the nurse and mainly manages patients with loop recorders (407), pacemakers (1078) and defibrillators/biventricular (402). Methods the TreC_cardio study was designed to automate at least part of this process. Thanks to the partnership agreement with the biomedical device supplier companies, it was possible to start creating a first software that allows the direct and open download of the data coming from the various devices. Subsequently, a dashboard was created that allows the doctor to have a general view of the patient's medical history. A patient interface has also been created in the form of an APP for smart phones where messages will automatically arrive from the health care worker, a messaging system with the doctor and information about the lifestyles that can be obtained from the different wearables will then be loaded. Furthermore, through a virtual coach, a questionnaire will be administered to the patient for the evaluation of the degree of cardiac compensation. Educational modules are also provided. Results Thanks to the construction of this new telecardiology system, it is possible to 1) reduce patient movements for visit, 2) carry out an early diagnostic-therapeutic intervention in case of arrhythmic events or device malfunctions compared to the traditional control system (in our experience with LoopRecorder monitoring there was an advance of 3.8 months for medical intervention, 3) breaking down the waiting lists for device checkups (in our experience of about 90%) 4) saving 80% about medical time (from 880 medical hours / year to 200 medical hours per year for a thousand patients) counterbalanced by the use of 1 full-time nurse every approximately 1000 patients, 5) all with a high degree of patient satisfaction. Conclusions Telecardiology has already demonstrated a series of benefits in patient management, the integration with new technologies and artificial intelligence models could give further advantages and make the management of the generated big data more sustainable. C115 OUTCOME TO ONE YEAR OF THE PATIENTS OF THE START REGISTER (STABLE CORONARY ARTERY DISEASES REGISTRY) BASED ON THE PRESENCE OF THE COMPASS CRITERIA D Formigli D Formigli AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO L De Luca L De Luca AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO M Gulizia M Gulizia AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO S Urbinati S Urbinati AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO F Colivicchi F Colivicchi AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO D Gabrielli D Gabrielli AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO M Scherillo M Scherillo AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO AO SAN PIO, BENEVENTO; OSPEDALE SAN GIOVANNI EVENGELISTA, TIVOLI; AO GARIBALDI, CATANIA; OSPEDALE BELLARIA, BOLOGNA; PO SAN FILIPPO NERI, ROMA; OSPEDALE CIVILE AUGUSTO MURRI, FERMO Background The proposal of this analysis is to evaluate the cardio-vascular outcomes of the patients of the START study based on the presence or absence of the inclusion criteria of the COMPASS trial. Method The START registry is a prospective, observational, national registry conducted by ANMCO with the aim of evaluating the presentation, management, treatment and quality of life of patients with chronic coronary syndrome (SCAD) enrolled or on an outpatient or to hospital discharge. A 12-month follow-up was performed for each patient. Between March 2016 and February 2017, a total of 5070 patients were enrolled for three centers for each center of the 183 participating centers. The population was divided according to the inclusion and exclusion criteria of the COMPASS study. Major cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction or stroke, and net adverse clinical events (NACE) defined as MACE with the addition of major bleeding were assessed. Results 4068 patients had a definition of SCAD and / or peripheral arterial disease (PAD) according to the definition of the COMPASS trial. Of these, 1811 (44.5%) were classified as COMPASS-Like (presence of inclusion criteria but without exclusion criteria), 841 (20.7%) as COMPASS-Excluded (presence of at least one exclusion criterion) and 1416 (34.8 %) as Non-COMPASS (without neither inclusion nor exclusion criteria). At one year follow-up the MACE and NACE were significantly higher in COMPASS-Like patients than in Non-COMPASS patients (2% vs. 0.9%; P = 0.013 for MACE; 2.1% vs. 0.9%; P = 0.007 for NACE); (Figure 1) as well as in COMPASS-Excluded patients compared to COMPASS-Like patients (5% vs. 2%; P<0.001 for MACE and 5.1% vs. 2.1%; P<0.001 fori NACE). (Figure 2). Conclusions It is confirmed that in a contemporary Italian population of patients with SCAD represented by patients enrolled in the START register conducted by ANMCO, the identification of a clinical phenotype based on the criteria used by the COMPASS trial allows to select a population with a higher cardiovascular risk already one year of follow-up. This population could therefore benefit from a more aggressive drug treatment. C116 DIFFERENTIAL ASSOCIATION OF LIPID FRACTIONS WITH STAGE 2 CHRONIC KIDNEY DYSFUNCTION IN HEALTHY BLOOD DONORS C Pavanello C Pavanello UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA M Parolini M Parolini UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA A Alberti A Alberti UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA D Impellizzeri D Impellizzeri UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA G Mombelli G Mombelli UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA F Pazzucconi F Pazzucconi UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA F Orsi F Orsi UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA M Carenini M Carenini UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA G Origgi G Origgi UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA M Trivella M Trivella UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA L Calabresi L Calabresi UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA R De Maria R De Maria UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA UNIVERSITÀ DEGLI STUDI, MILANO; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, MILANO; ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SICILIA SISTEMI TECNOLOGIE, CATANIA; UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO; DEDALUS SPA, BOLOGNA; ISTITUTO DI FISIOLOGIA CLINICA DEL CNR, PISA Aims Chronic kidney disease (CKD) defined as a glomerular filtration rate (GFR) <60 ml/min/1.73 m2 (or stage ≥3) confers a 2 to 4-fold higher risk of cardiovascular disease (CVD) than that in individuals with normal kidney function. Dyslipidemia plays an important role both in the progression and the development of CKD. Studies in the community have reported that a lower GFR threshold may be useful to predict CVD. Stage 2 CKD (GFR 60–89 ml/min/1.73 m2) can suggest the start of the disease process. We studied the association between lipid profile and renal function as depicted by estimated GFR in healthy blood donors. Methods We assessed laboratory findings in 4411 blood donors, 2909 (66%) males, aged 18-65 (42±11) years. We calculated eGFR from serum creatinine using the CKD-EPI equation and LDL cholesterol by the Friedewald equation. Thresholds used to classify dyslipidemia were LDL-C>115 mg/dl, HDl-C<40 mg/dl, Triglycerides (TG) ≥ 150 mg/dl, non-HDL-C >140 mg/dl. Results In the overall study cohort 23.8% (25.3% of F vs 23% of M, p=.089) had an eGFR <90 ml/min/1.73 m2. eGFR was inversely correlated with age (rho -0.524, p<.0001), total cholesterol (TC) (rho -0.259, p<.0001), LDL-C (rho -0.223, p<.0001), non-HDL-C (rho -0.247, p<.0001), TG (rho -0.215, p<.0001). The mean GFR of the 2335 subjects (53%) with normal values for all lipid parameters was 102±14 ml/min/1.73 m2. When compared to donors with lipid values within normal thresholds, mean GFR levels (Fig.1) were significantly lower for each lipid abnormality i.e. in subjects with LDL-C>115 mg/dl (n = 1802, 40.9%) or non-HDL-C >140 mg/dl (n = 1487, 33.7%) or TG ≥ 150 mg/dl (n = 441, 10%), except for those with HDL-C <40 mg (n = 304, 6.9%). The age and sex-adjusted relative risks (RR) of stage 2 CKD are summarized in Table 1. The RR of stage 2 CKD increased significantly with each quartile of TG, in the highest quartile of non-HDL-C and in the third quartile of HDL-C. No risk differences were observed among LDL quartiles. Conclusions Stage 2 CKD is common among healthy donors. Increasing lipid levels for TC, LDL-C, non-HDL-C and TG correlate with lower eGFR values. In age and sex-adjusted logistic regression models, the risk of prevalent stage 2 CKD shows graded associations with TG levels, whereas it is significantly increased only in the highest non-HDL-C quartile. Our findings confirm the role of TG levels in impaired GFR and support the notion of a U-shaped association between HDL-C and stage 2-CKD. HEART FAILURE, PROGNOSISC117 OXYGEN UPTAKE DURING DAILY LIFE DOMESTIC ACTIVITIES IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION M Mapelli M Mapelli CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO E Salvioni E Salvioni CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO P Gugliandolo P Gugliandolo CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO F De Martino F De Martino CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO C Vignati C Vignati CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO P Palermo P Palermo CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO I Mattavelli I Mattavelli CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO A Magini A Magini CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO B Pezzuto B Pezzuto CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO M Contini M Contini CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO A Apostolo A Apostolo CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO P Agostoni P Agostoni CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO Background Dyspnea is a pivotal symptom of chronic heart failure with reduced EF (HFrEF). It compromises exercise performance, capability to perform activities of daily living (ADLs) and quality of life. Cardiopulmonary exercise test (CPET) is the gold standard in assessing functional capacity. However, exercise protocols don’t fully represent patients’ daily-life, with most of the symptoms arising with different activities like fastening the shoes (i.e. bendopnea). The aim of the present study is to assess differences in task-related oxygen uptake (maxVO2), both as absolute value and as % of the peakVO2 obtained at CPET (%peakVO2), ventilation (VE), and Borg symptom scores between pre-selected HFrEF sub-groups of patients (stratified according to their peakVO2) and healthy subjects during a standardized protocol of ADLs. Materials and Methods Subjects underwent a basal CPET and the following exercises (Fig. 1) wearing a full wearable device (Cosmed® K5): ADL1: getting dressed-ADL2: folding 8 towels-ADL3: putting away 6 bottles-ADL4: making a bed-ADL5: sweeping the floor for 4-min ADL6: climbing 1 flight of stair carrying a load-6 minutes walking test-4-min 2Km/h treadmill -4-min 3Km/h treadmill Results 60 stable HFrEF patients with optimized medical treatment (age 65.2±12.1y; EF 30.4±6.7%), and 40 healthy volunteers (58.9±8.2y) were enrolled. As expected, at CPET, HFrEF patients showed significantly lower peak VO2 (14.2±4.0 vs. 28.1±7.4ml/min/kg, respectively) and higher VE/VCO2slope (36.8±9.1 vs. 27.2±4.0). For each exercise, patients showed higher VE/CO2 and %peakVO2 values compared to controls, while maxVO2 was higher in all the exercises except treadmill (the only ones in which both execution time and velocity are fixed). As expected, patients experienced more dyspnea (Borg), lower heart rate and higher exercises duration. Tab1 shows differences in the main metabolic values recorded in HFrEF sub-groups for each exercise: in exercises with non-fixed execution velocity, patients with more severe HFrEF have lower maxVO2, higher %peakVO2 and higher VE/VCO2. In exercises with fixed execution time and velocity maxVO2 did not changed among groups. Conclusions Oxygen consumption during ADLs worsens according to heart failure, with progressively increasing ventilatory inefficiency and erosion of the patients’ VO2 “reserve”. Our data suggest that HFrEF patients limit themselves during the exercise, whenever possible, by decreasing velocity and/or intensity. C118 EARLY CARDIAC REVERSE REMODELING IN A LARGE COHORT OF PATIENTS WITH HFREF TREATED WITH SACUBITRIL/VALSARTAN M Mapelli M Mapelli CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI E Salvioni E Salvioni CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI I Mattavelli I Mattavelli CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI V Sassi V Sassi CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI V Mantegazza V Mantegazza CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI V Volpato V Volpato CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI C Vignati C Vignati CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI F De Martino F De Martino CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI S Paolillo S Paolillo CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI L Fusini L Fusini CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI M Muratori M Muratori CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI M Pepi M Pepi CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI P Agostoni P Agostoni CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO; UNIVERSITÀ FEDERICO II, NAPOLI, NAPOLI Background Despite the widespread use of Sacubitril/valsartan (Sac/Val) in patients with reduced ejection fraction (HFrEF), definite data on cardiac remodeling under treatment are still lacking. Methods and Aim of the Study We conducted a retrospective analysis on a large cohort of 201 consecutive HFrEF ambulatory patients who started Sac/Val in our HF unit between Sept. 2016 and Dec. 2018 on top of optimal medical treatment. Patients with both basal and follow up (at least 3 months) echocardiographic assessment (TTE) were included. Results A follow up TTE was performed in 100 patients (male 76%; mean age 67.4±11.1 years; medium follow-up 309±182 days). Baseline characteristics are shown in Tab.1. 34% of the patients reached the maximal dose (97/103 b.i.d.) while 18 interrupted the treatment. We observed an overall significant improvement in ejection fraction (EF), end-diastolic and end-systolic ventricular volumes (EDV/ESV), while just a trend in pulmonary pressures (PAPs) and mitral regurgitation (MR) reduction was noted (p = 0.06 and 0.09 respectively). Non ischemic etiology and high dose of Sac/Val were predictors of better remodeling (Fig.1). Conclusion Sac/Val led to an early favorable ventricular remodeling assessed by echocardiography. The benefit was greater in patients on higher Sac/Val dose and non ischemic etiology. C119 OUTCOMES OF CHRONIC HEART FAILURE: TEMPORAL TRENDS FROM ANMCO IN-HF REGISTRY M Iacoviello M Iacoviello UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Gori M Gori UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Marini M Marini UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO L Gonzini L Gonzini UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO A Municinò A Municinò UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO L Cassaniti L Cassaniti UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Benvenuto M Benvenuto UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO A Navazio A Navazio UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO E Ammirati E Ammirati UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO G Leonardi G Leonardi UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO N Pagnoni N Pagnoni UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO L Montagna L Montagna UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO M Floresta M Floresta UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO P Midi P Midi UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO R De Maria R De Maria UO CARDIOLOGIA UNIVERSITARIA, OSPEDALE POLICLINICO, BARI; CARDIOLOGIA 1, ASST PAPA GIOVANNI XXIII, BERGAMO; SOD CARDIOLOGIA OSPEDALIERA EMODINAMICA E UTIC, OSPEDALI RIUNITI, ANCONA; CENTRO STUDI ANMCO, FONDAZIONE PER IL TUO CUORE, FIRENZE; SC CARDIOLOGIA – UTIC, OSPEDALE PADRE ANTERO MICONE, GENOVA; UO CARDIOLOGIA – UTIC, OSPEDALE E. MUSCATELLO, AUGUSTA; CARDIOLOGIA UTIC ED EMODINAMICA, OSPEDALE CIVILE G. MAZZINI, TERAMO; SOC CARDIOLOGIA, ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA; CARDIOLOGIA 2 –INSUFFICIENZA CARDIACA E TRAPIANTO, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; SSD SCOMPENSO CARDIACO GRAVE, POLICLINICO CATANIA PO G. RODOLICO, CATANIA; CARDIOLOGIA E RIABILITAZIONE CARDIOLOGICA, AO SAN GIOVANNI ADDOLORATA, ROMA; SCDO CARDIOLOGIA, OSPEDALE SAN LUIGI GONZAGA, ORBASSANO; UO CARDIOLOGIA – CERVELLO, AOR VILLA SOFIA–CERVELLO P.O. CERVELLO, PALERMO; UOC CARDIOLOGIA E UTIC, OSPEDALE DEI CASTELLI, ARICCIA; CNR – ISTITUTO DI FISIOLOGIA CLINICA, ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO D.on behalf of the Researchers D.on behalf of the Researchers Background Since the end of the XX century, the implementation of evidence-based therapies appears to have improved outcomes of patients with chronic heart failure (CHF). We describe the temporal trends in mortality and morbidity of CHF patients enrolled in a nationwide registry during the last 2 decades. Methods According to the recruitment epoch, patients enrolled in the registry since January 1999 through May 2018 were divided into 3 cohorts: 1999-2005 (N = 5404); 2006-2011 (N = 3971); 2012-2018 (N = 5448). We analysed temporal changes among the 3 cohorts in one-year outcomes across 3 age groups: < 65 (n = 5465); 65-79 (n = 6838); 80 + (n = 2520) year old. Results In the overall population of 14823 CHF patients (72.9% men, age 67+13 years, LV ejection fraction (LVEF) 37+12%), reduced LVEF (<40%) phenotype 60%), comparisons among the 3 age groups showed with increasing age (<65 vs 65-79 vs 80+), an increase in all-cause mortality (3.3; 7.0; 12.2%, p<.0001) and in the proportion of patients admitted to hospital for non cardiovascular (CV) causes (4.7; 7.1; 8.6%, p<.0001) and for acute HF decompensation (5.4; 7.7; 8.3%, p<.0001). Conversely, the proportion of patients hospitalized for CV causes did not differ significantly (16.3; 16.2; 14.3%, p=0.06). Conclusions During 20 years, mid-term prognosis of CHF patient enrolled in our nationwide registry has overall improved. Among younger patients, all-cause mortality decreased, while the proportion of hospitalized patients remained stable. Conversely, among octogenarians no changes in mortality were observed, but the proportion of patients admitted to hospital for CV causes, and specifically for HF decompensation, declined. These data suggest that cardiologist input may contribute to decrease the socioeconomic burden of CHF in the elderly. C120 EFFICACY AND SAFETY OF SACUBITRIL VALSARTAN IN REAL WORLD OLDER PATIENTS WITH HFrEF. RESULTS FROM THE MAP-HF STUDY G Pulignano G Pulignano OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE G Di Pasquale Mazzilli G Di Pasquale Mazzilli OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE S Tolone S Tolone OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE M Tinti M Tinti OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE G Palombaro G Palombaro OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE D Del Sindaco D Del Sindaco OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE P Pino P Pino OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE M Uguccioni M Uguccioni OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE M Iacoviello M Iacoviello OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE A Di Lenarda A Di Lenarda OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVO REGINA MARGHERITA, ROMA; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE ED UNIVERSITÀ DI TRIESTE, TRIESTE Background The PARADIGM-HF trial established the safety and the efficacy of Sacubitril/Valsartan (Sac/Val) in pts with Heart Failure with reduced ejection fraction (HFrEF). We compared the outcomes and safety of Sac/Val in older pts (> 75 yrs) and younger pts (<75 years) followed in our HF Clinic and enrolled in the prospective registry Multidimensional Assessment of Prognosis in HF (MAP-HF). Methods We enrolled consecutive ambulatory HF pts starting Sac/Val according to ESC /AIFA recommendations. Pts underwent at baseline and at f-up a clinical, instrumental (EKG and echocardiogram) and laboratory evaluation (creatinine, electrolytes, NT-ProBNP). Outcomes were: cardiovascular (CV) death, CV death and first HF hospitalization, first HF hospitalization or worsening HF, death for all causes, worsening renal function, non CV hospitalization. We also analysed the modality of uptitration and safety of Sac/Val. Results 120 consecutive pts, aged > 30 years (mean age 66,9 ± 12), were enrolled. Older patient (mean age 80,8 ± 4 yrs) were 34 (28,4%). The mean duration of f-up was 503 days (SD ± 228). Pts in the older group had higher levels of NT-ProBNP, higher baseline NYHA class and lower blood pressure levels. At f-up 58,8% of older pts vs 47,7% were on lower dose (24/26 mg BID). Both groups showed at f-up a similar improvement of NYHA Class (older group: baseline 2.44±0.5 vs f-up 1.94±0.6 p < 0.0001; younger group: baseline 2.36±0.5 vs f-up 1.88±0.5 p < 0.0001) and an increase of EF (older group: baseline 32,03 ±4,5 vs f-up 39,7 ±5,8 p = 0.0001; younger group: baseline 32,3 ±3,4 vs f-up 40,7 ±6 p < 0.0001), while a significant improvement of NTproBNP was observed only in the younger group. All cause and CV deaths were more frequent in the older group, while hospitalizations for all causes and HF rates were similar. The incidence of symptomatic hypotension (SBP< 90 mmHg) was similar (11,7% vs 12,8%, p=ns), while older pts experienced more worsening kidney failure with serum creatinine >3mg/dl (8.8% vs 0, p = 0.02). The incidence of permanent discontinuation was similar (5,9% vs 2.3%, p=ns). Conclusions In a real world HF clinic, Sac/Val showed a similar profile of efficacy and safety in older vs younger HFrEF pts. The higher mortality in older pts may be explained by the increased age-related risk profile. Further studies are warranted to evaluate the influence of geriatric variables, such frailty and cognitive impairment, on efficacy and safety of Sac/Val. C121 SACUBITRIL VALSARTAN IN HFrEF: A COMPARISON BETWEEN PARADIGM-HF AND REAL WORLD PATIENTS. RESULTS FROM THE MAP-HF STUDY G Pulignano G Pulignano OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE S Tolone S Tolone OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE G Di Pasquale Mazzilli G Di Pasquale Mazzilli OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE M Tinti M Tinti OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE G Palombaro G Palombaro OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE D Del Sindaco D Del Sindaco OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE P Pino P Pino OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE M Uguccioni M Uguccioni OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE M Iacoviello M Iacoviello OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE A Di Lenarda A Di Lenarda OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA; OSPEDALE SAN CAMILLO, ROMA ; OSPEDALE NUOVA REGINA MARGHERITA, ROMA ; AOU POLICLINICO CONSORZIALE DI BARI, BARI; CENTRO CARDIOVASCOLARE E UNIVERSITÀ DI TRIESTE, TRIESTE Background The PARADIGM-HF trial established the safety and the efficacy of Sacubitril/Valsartan (Sac/Val) in pts with Heart Failure with reduced ejection fraction (HFrEF). We compared the outcomes and safety of Sac/Val on pts followed in a Heart Failure (HF) Cardiology Clinic and enrolled in the prospective registry Multidimensional Assessment of Prognosis in HF (MAP-HF), with those of the Sac/Val arm of PARADIGM-HF. Methods We prospectively enrolled consecutive ambulatory HF pts starting Sac/Val according to ESC/AIFA recommendations. Pts underwent at baseline and at f-up a clinical, instrumental (EKG and echocardiogram) and laboratory evaluation (serum creatinine, electrolytes, NT-ProBNP). Outcomes were: cardiovascular (CV) death, CV death and first HF hospitalization, first HF hospitalization or worsening HF, death for all causes. We also analysed the modality of titration and safety of Sac/Val. Results 120 consecutive pts, aged >30 years (mean age 66,9 ± 12, 20% women), were enrolled. The mean f-up was 503 days (SD ± 228). Pts were older (66,9 +12,5 vs 63,8 +11,5 yrs; p = 0.014) than those of the PARADIGM-HF trial, had higher EF (32.2% vs 29.6% p < 0.001), lower NTproBNP levels (793.5 pg/mL vs 1631 pg/mL p < 0.001) and worse NYHA class (NYHA III-IV 23,1% vs 39,2% ; p < 0.0001). Moreover, in MAP-HF vs PARADIGM-HF pts showed: a greater use of diuretics (91.7% vs 80.3% p = 0,0019), a higher rate of ICD (63% vs 14.9% p < 0,0001) and CRT (21.7% vs 7% p < 0,0001). At F-up, 61 pts (50,8%) were on 24/26mg BID, 43 pts (35,8%) on 49/51mg BID, and only 16 pts (13,3%) achieved and maintained the dose of 97/103 mg BID. CV death/first HF hospitalization:12,5% vs 21,8; p = 0,014, CV death: 3,3% vs 13,3%; p = 0,0013, all-cause death:9,2% vs 17%; p = 0,023 were reduced in our pts. The incidence of HF hospitalization or worsening HF was similar. An increased incidence of symptomatic hypotension with SBP< 90 mmHg (7.3% vs 2.7% p = 0.0016) was observed, but the rate of permanent discontinuation for adverse effects (2,5% vs 10.6%; p = 0.0013) were significantly lower. Conclusions In a real world HF Clinic, Sac/Val showed a similar profile of efficacy and safety when compared with the different setting and population enrolled in the pivotal trial. Nevertheless, only few pts reached the target dose of 97/103 mg. Further larger studies are warranted to identify clinical variables, disease severity markers and strategies associated with successful titration to target dose. C122 ONE YEAR TSH INCREASE IS INDEPENDENTLY ASSOCIATED WITH A WORSE PROGNOSIS IN CHRONIC HEART FAILURE OUTPATIENTS M Albanese M Albanese POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI D Grande D Grande POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI P Terlizzese P Terlizzese POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI G Angelini G Angelini POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI R Ursi R Ursi POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI M Bellino M Bellino POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI F Lisi F Lisi POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI L Amato L Amato POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI M Gioia M Gioia POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI G Parisi G Parisi POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI M Iacoviello M Iacoviello POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI POLICLINICO DI BARI, CARDIOLOGIA UNIVERSITARIA, BARI; OSPEDALE M. SARCONE, TERLIZZI; OSPEDALE BOLOGNINI, SERIATE ASST BERGAMO EST; OSPEDALE A. PERRINO, BRINDISI Background Hypothyroidism is a common comorbidity associated with adverse events in chronic heart failure(CHF)patients.The aim of the study is to evaluate the impact of changes in the Thyroid-stimulating hormone(TSH)on the prognosis of CHF outpatients. Materials and Methods At baseline 285 patients were evaluated(79% males, 63±13 years,NYHA class 2.3±0.6,Left Ventricular Ejection Fraction-LVEF-33±9%,NT-pro-BNP 1747±2512 pg/mL,glomerular filtration rate-GFR-72±26 mL/min*1.73m2).All underwent medical visit,12-lead electrocardiogram,transthoracic echocardiography and blood chemistry tests,including fT3,fT4 and TSH.Thyroid function was reassessed at 1 year. After excluding 33 because affected by hyperhyroidism or low T3 syndrome, in 81 of the the remaining 252, hypothyroidism was diagnosed at baseline or one-year evaluation. According to the TSH values at the enrollment and at one-year, they were classified in three different groups. Group 1: patients with improved thyroid function (n.21), i.e. high baseline TSH values, which had been normalized or markedly decreased (>40%) at one year; Group 2: patients with stable mildly high TSH values(n.31): i.e. persistently elevated baseline and one–year TSH values (<10 mUI/ml); Group 3: patients with worsening thyroid function (n.29), i.e. those with normal baseline TSH values and high values at one year or high baseline values (<10 mUI/ml) and markedly elevated one–year TSH values (>10 mUI/ml). During follow-up, the primary endpoint was represented by all-cause mortality. As secondary end-point hospitalization due to acute decompensated heart failure(ADHF) was considered. Results During follow-up(54±18 months)60 patients died and 99 patients were hospitalized for exacerbation of heart failure. As shown in the Table, Group 3 was associated with an increased risk of death for all causes and ADHF at univariate regression analysis as well as at multivariate analysis after correction for ischaemic aetiology, age,NYHA class III, systolic arterial pressure below or equal to 90 mmHg,GFR<60 ml/min*1.73m2,NT-proBNP>1000 pg/mL and LVEF<30%. Figure shows the Kaplan Meyer curves relating to the primary and secondary end points in euthyroid and hypothyroid patients. Conclusion Our research demonstrates the clinical relevance not only of diagnosis of hypothyroidism,but also of the changes of TSH serum levels among patients affected by CHF,thus strengthening the possible role of thyroid hormone replacement to reduce the risk of heart failure progression. C123 THE PHASE ANGLE IN HEART FAILURE: THE ROLE OF CONGESTION AND NUTRITION R Nitti R Nitti UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI F Massari F Massari UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI P Scicchitano P Scicchitano UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI M Milo M Milo UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI R Ruggieri R Ruggieri UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI M Bellino M Bellino UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI A Agea A Agea UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI A Passantino A Passantino UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI R Valle R Valle UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI M De Palo M De Palo UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI P Sasanelli P Sasanelli UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI M Sanasi M Sanasi UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI A Piscopo A Piscopo UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI P Guida P Guida UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI P Caldarola P Caldarola UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI M Ciccone M Ciccone UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI UNIVERSITÀ DEGLI STUDI DI BARI, BARI; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA, ALTAMURA; UO CARDIOLOGIA P.O. "F PERINEI" ALTAMURA (BA), ALTAMURA; IRCCS MAUGERI – BARI, BARI; UO CARDIOLOGIA P.O. DI CHIOGGIA, CHIOGGIA; UO CARDIOCHIRURGIA POLICLINICO DI BARI, BARI; UO CARDIOLOGIA P.O. "SAN PAOLO" BARI, BARI Objective the whole-body bioelectrical phase angle (PhA) is emerging as a new tool in stratifying prognosis in patients with both acute (AHF) and chronic heart failure (CHF). The aim of the study was to evaluate the determinants of PhA in HF patients. Methods We analyzed data from 900 patients with AHF or CHF (mean age: 76±10 years, 54% AHF). Clinical, serum biochemical, echocardiographic and bioelectrical measurements were collected from all of patients. PhA was quantified in degrees. Congestion was assessed by a multiparametric approach, including the presence of peripheral edema, brain natriuretic peptides (BNP) plasma levels, blood urea nitrogen to creatinine ratio (BUN/Cr), and relative plasma volume status (PVS) calculated by Kaplan-Hakim's formula. Geriatric Nutritional Risk Index (GNRI) was adopted as indicator for nutritional status. Results At univariate analysis, PhA was significantly lower in females, in patients with peripheral edema, and AHF. PhA significantly correlates age, BNP, PVS, BUN/Cr, and GNRI. At multivariate analysis, congestion biomarkers emerged as the major determinant of PhA as they explained the 34% of data variability, while age, GNRI, and gender only explained 6%, 0.5%, and 0.5%, respectively (adjusted R2 = 0.41). In particular, PVS (regression of coefficient B=-0.17) explained the 20% of PhA variability, while peripheral congestion (B=-0.27) and BNP (B=-0.15) contributed to 10% and 2%, respectively. Conclusions The main determinant of bioelectrical PhA in patients with HF is congestion and PVS in particular, while nutritional status has marginal impact. This will ameliorate strategies for the management and prognostic evaluation of patients with HF. C124 CARDIAC MAGNETIC RESONANCE IMAGING FOR THE SELECTION OF PATIENTS THAT CAN BE SAFELY DISCHARGED WITH A WEARABLE DEFIBRILLATOR (LIFEVEST): A SINGLE EXPERIENCE CENTER G Solarino G Solarino OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE J Del Meglio J Del Meglio OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE A Lilli A Lilli OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE M Canale M Canale OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE A Huqi A Huqi OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE E Ferrali E Ferrali OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE F De Caro F De Caro OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE A Comella A Comella OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE R Poddighe R Poddighe OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE F Vivaldi F Vivaldi OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE L Robiglio L Robiglio OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE M Baratto M Baratto OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE G Casolo G Casolo OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE OSPEDALE VERSILIA – UOC CARDIOLOGIA, LIDO DI CAMAIORE; OSPEDALE VERSILIA, LIDO DI CAMAIORE Introduction Patients with impaired left ventricular (LV) function and "midwall" or "limited" scar distribution at Cardiac Magnetic Resonance (CMR) have been shown to have a low arrhythmogenic risk and a high probability of LV functional recovery. We aimed to document the arrhytmogenic burden and LV functional recovery in patients with severe LV dysfunction, who were discharged home with a wearable device (LifeVest). Methods and Results From May 2016 to November 2019, 35 consecutive patients (30 males; average age 65.7aa ± 9.6aa) were discharged home with a wearable device from our cardiology ward. At discharge, mean Ejection Fraction (EF) was 26.4% (± 7.9%), all patients received guideline directed medical therapy (beta-blockers 85%, ace-inhibitors 68%, ANRI 22%, diuretics 100%, sartans 10%, ivabradine 25%, K savers 85%; amiodarone 15%). At 3 months from discharge, 24 patients (68%) showed significant functional recovery (EF 43,1±10.7%), and dropped-out from indication for permanent defibrilator implantation (ICD). The remaining patients did not show functional improvement, and thereby were implanted with ICD. LifeVest device was well-tolerated and was weared continuously from all patients in 94.05% of time. During the observation time (range 2.97 months, ±1.7), only a non-sustained ventricular tachycardia was observed and this was correctly identifyed and monitored from the device. No other arrhythmias o events were registered. Conclusions CMR can be helpful for identifying patients with a low arrhythmogenic risk, who can be safely discharged home with Life Vest. This allows the myocardium to recover in absolute safety under optimal medical therapy. Such a strategy can help reduce the use of definitive ICD in patients with unclear indications and, therefore contain healthcare costs. Further studies are needed to validate this method. HEART VALVE DISEASEC125 PROPORTIONAL GEOMETRY FOR MITRAL RECONSTRUCTION: ECHOCARDIOGRAPHIC AND SURGICAL ASPECTS L Deorsola L Deorsola CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO A Bellone A Bellone CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO E Aidala E Aidala CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO M Cascarano M Cascarano CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO A Valori A Valori CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO R Bordese R Bordese CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO A Villar A Villar CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO G Agnoletti G Agnoletti CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO C Pace Napoleone C Pace Napoleone CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOCHIRURGIA PEDIATRICA, TORINO; OSPEDALE SAN GIOVANNI BOSCO – CARDIOLOGIA, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA – P.O. OIRM – CARDIOLOGIA PEDIATRICA, TORINO Mitral Conservative Surgery is highly complex, it requires a careful evaluation of valve anatomy and an accurate operative planning. This is impossible without a pre- intra- and post-operative echocardiographic evaluation, which has become unavoidable and provides us with a huge amount of information about valve geometry and function. Particularly, these data are essential to investigate and quantify valve damages and surgical results. Proportional Geometry is an analysis method developed in our center and based on literature and echocardiographic data: a geometrical model considering Mitral Valve as made of components related each other by precise proportions and dependent on body size. These proportions rely on three elements widely diffused in Nature: the Golden Section, the Fibonacci Sequence and Fractal Geometry. Far less complex than it can sound, this model provides a set of easy calculations to predict ideal valve geometry, helping to quantify the disease aspects and plan surgical strategy. From January 2015, in our center, 14 patients underwent Mitral Repair. All subjects had congenital or acquired isolated Mitral disease. Five were males and 9 females, aged between 5 months and 14 years. All showed severe Mitral regurgitation and NYHA 3-4. Surgical technique, basically the same used for adult patients, was sometimes slightly modified to comply with the disease or with patient’s age. Both echocardiographic evaluation and surgical planning were made using Proportional Geometry. Immediate surgical results were highly satisfying. Valve anatomy looked regular, regurgitation was absent in 12 cases and mild in 2, transvalvular gradient was mild in 1 case and absent in 13. Mean hospital stay was 14 days, 3 of which in ICU. At Follow-Up, 100% complete and 2 years long, no deaths and only 2 early complications occurred. All patients show NYHA 1. Valve morphology appears regular. In 11 cases there is no regurgitation, while in 3 it appears only mild. In 8 patients no transvalvular gradient is present, while in 6 it ranges between 1 and 4 mmHg. Proportional Geometry appears a simple method for both echocardiographic analysis and surgical planning of Mitral Repair. Its easy calculations allow a precise analysis of valve geometry and echocardiographic data. They seem to help the surgeon to evaluate the necessary anatomical modification, guiding him towards a surgical result which gives the valve a configuration as close as possible to the natural healthy one. C126 PROCALCITONIN, WHITE BLOOD CELL COUNT AND C-REACTIVE PROTEIN AS PREDICTORS OF S. AUREUS INFECTION AND MORTALITY IN INFECTIVE ENDOCARDITIS C Arzilli C Arzilli EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA A Aimo A Aimo EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA C Tascini C Tascini EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA F Sbrana F Sbrana EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA A Ripoli A Ripoli EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA L Ghiadoni L Ghiadoni EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA C Bertone C Bertone EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA C Passino C Passino EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA V Attanasio V Attanasio EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA E Sozio E Sozio EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA E Taddei E Taddei EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA R Murri R Murri EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA M Fantoni M Fantoni EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA F Paciosi F Paciosi EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA D Francisci D Francisci EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA M Pasticci M Pasticci EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA C Pallotto C Pallotto EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA G Di Caprio G Di Caprio EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA A Carrozza A Carrozza EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA S Maffei S Maffei EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA EMERGENCY MEDICINE DEPARTMENT, UNIVERSITY HOSPITAL OF PISA, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, PISA; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; FONDAZIONE TOSCANA GABRIELE MONASTERIO; INSTITUTE OF LIFE SCIENCES, SCUOLA SUPERIORE SANT‘ANNA, PISA; EMERGENCY MEDICINE DEPARTMENT, LIVORNO HOSPITAL, LIVORNO; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE, ROMA; INSTITUTE OF INFECTIOUS DISEASES, UNIVERSITÀ CATTOLICA DEL SACRO CUORE; FONDAZIONE POLICLINICO UNIVERSATARIO A. GEMELLI IRCSS, UOC INFECTIOUS DISEASES, ROMA; SECTION OF INFECTIOUS DISEASES, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA–TERNI; SECTION OF INFECTIOUS DISEASES, DEPARTMENT OF MEDICINE, UNIVERSITY OF PERUGIA, PERUGIA; DEPARTMENT OF INFECTIOUS DISEASES, AZIENDA OSPEDALIERA DEI COLLI, NAPLES, ITALY; INFECTIOUS AND TROPICAL DISEASES UNIT, AORN S. ANNA E S. SEBASTIANO, CASERTA, NAPOLI–CASERTA; UOSD ADVANCED TECHNIQUES IN CARDIOSURGERY, MONALDI HOSPITAL, AORN DEI COLLI, NAPOLI; FONDAZIONE TOSCANA GABRIELE MONASTERIO, MASSA Background Infective endocarditis (IE) is characterized by high rates of in-hospital death, and Staphylococcus aureus infection predicts a worse prognosis. We aimed to assess if admission inflammatory biomarkers (white blood cell - WBC - count, C-reactive protein - CRP, and procalcitonin) are informative on microbiological etiology and short-term outcomes. Methods Data from 236 patients admitted for IE from January 2013 to June 2018 were retrieved from a multicenter registry. Results Fifty-two patients (22%) were infected by S. aureus. WBC, CRP and procalcitonin had area under the curve (AUC) values for S. aureus infection of 0.595, 0.675, and 0.727, respectively (figure 1). Adding procalcitonin to WBC improved discrimination over WBC alone (p?=?0.045), and procalcitonin predicted S. aureus infection independently from the other inflammatory biomarkers and patient characteristics. Patients with WBC?≥?12,800/mm3, CRP?≥?130?mg/L, and procalcitonin?≥?1.7?ng/mL had an almost 20-fold higher risk of S. aureus infection than patients with all biomarkers?<?cut-offs (figure 2). AUC values for in-hospital death were 0.702, 0.725 and 0.727 for the WBC, CRP, and procalcitonin, respectively. Among inflammatory biomarkers, WBC and procalcitonin independently predicted in-hospital death. Procalcitonin refined risk stratification when added to WBC, and to the combination of WBC and CRP. Patients with WBC?≥?10,535/mm3, CRP?≥?85?mg/dL, and procalcitonin?≥?0.4?ng/mL had a 27-fold higher risk of in-hospital death than patients with all biomarkers?<?cut-offs (figure 2). Conclusions Among patients with IE, high levels of inflammatory biomarkers on admission, particularly procalcitonin, are associated with a higher likelihood of S. aureus infection, and a higher risk of in-hospital mortality. C127 A CASE OF SEVERE AORTIC INSUFFICIENCY IN A QUADRICUSPID VALVE C Condello C Condello AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA C Marcelli C Marcelli AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA A Fiocco A Fiocco AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA C Fraccaro C Fraccaro AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA S Rizzo S Rizzo AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA M Micciolo M Micciolo AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA D Mancuso D Mancuso AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA G Brunello G Brunello AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA AOPD– CARDIOLOGIA, PADOVA; AOPD– CARDIOCHIRURGIA, PADOVA; AOPD– ANATOMIA PATOLOGICA, PADOVA; AOPD–CARDIOLOGIA, PADOVA Background Quadricuspid aortic valve (QAV) represents 0.003% –0.043% of all congenital cardiac defects. Although frequently isolated, it has been described with coronary abnormal origin, septal defects and rarely with dilatation of ascending aorta. The most common associated dysfunction is aortic insufficiency (AI) which usually occurs in adulthood (49 years as mean age at diagnosis), more likely in males. Hurwitz and Roberts classification recognizes 7 subtypes of QAV based on the morphology of the cusps but does not predict the extent of dysfunction. Trans-esophageal echocardiography (TEE) is the method of choice for the morpho-functional evaluation of QAV, angioCT and MRI can provide further anatomical information. Case Report Male, 38-year-old, hypertensive, dyslipidemic, obese, symptomatic for exertional dyspnea. In view of bariatric surgery he underwent clinical investigations including trans-thoracic echocardiography (TTE) with detection of severe AI on quadricuspid aortic valve and ectasia of the ascending aorta, findings confirmed at a subsequent CT angiography. The patient was then admitted to our centre where repeated TTE showing quadricuspid aortic valve, with normal systolic-diastolic excursion of the cusps and central coaptation defect resulting in severe valve insufficiency, holodiastolic reflux in the ascending and abdominal aorta; moderate dilatation of left ventricle with normal pump function; dilation of the aortic root and ascending aorta. Coronary angiography showed absence of angiographically significant stenosis and aortography confirmed a moderate dilation of the ascending aorta. The patient was referred for surgical correction of the valve defect and, with intraoperative TEE monitoring, he underwent valve replacement with bioprosthesis and ascending aorta replacement with vascular prosthesis. At surgical exploration aortic valve was confirmed to be quadricuspid. The histological examination showed fibromixoid degeneration of a dysplastic quadricuspid aortic valve in degenerative pathology of the aortic root. Conclusions QAV is a rare congenital anomaly that can cause severe AI around the fifth to sixth decade of life. Echocardiography is crucial in its recognition and classification. In surgical correction, valve repair should be considered, although replacement is often necessary, especially if aortic dilatation coexists. C128 PREDICTORS OF LONG-TERM OUTCOME IN LEFT-SIDED INFECTIVE ENDOCARDITIS: A COHORT STUDY IN 414 PATIENTS E Durante Mangoni E Durante Mangoni OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA G Giuffrè G Giuffrè OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA M Ursi M Ursi OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA D Iossa D Iossa OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA L Bertolino L Bertolino OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA A Senese A Senese OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA P Pafundi P Pafundi OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA F D‘Amico F D‘Amico OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA R Albisinni R Albisinni OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA R Zampino R Zampino OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA OSPEDALE MONALDI, NAPOLI; OSPEDALE SANTA MARIA DELLA MISERICORDIA PERUGIA, PERUGIA Background Very little data are available on the long-term outcome of infective endocarditis (IE) and its determinants. The aim of this study was to identify the predictors of long-term outcome in patients affected by left sided IE (LSIE). Methods This was a retrospective study on prospectively collected data of patients with LSIE hospitalized in the Monaldi Hospital, Naples, Italy (January 2000-December 2017). Multiple variables relevant to history, physical examination, laboratory tests, echocardiography, comorbidies, complications and outcome were analyses in order to identify predictors of in-hospital, one-year and long-term mortality. Results 414 patients were included, and followed up for a median of 39 months [IQR 11-74]. Median age was 59 years [range 3-89], and most patients were male. Over 50% showed at least one comorbidity. Hyperglycaemia, increased creatinine and an indication for surgery predicted in-hospital mortality, while a prior myocardial infarction, chronic kidney disease (CKD) on hemodialysis and a larger vegetation were independent predictors of 1-year mortality. At multivariable Cox proportional hazard regression, peripheral arterial disease (p = 0.002), hyperglycemia (p = 0.041) and CKD on hemodialysis (p = 0.025) were found to be independently associated with an increased risk of long-term mortality. Conclusions Cardiovascular and metabolic risk signals, specifically peripheral arterial disease, hyperglycaemia and CKD on hemodialysis affect long-term mortality of LSIE. An active follow up could be indicated in IE survivors showing these conditions at outset. C129 SUCCESSFUL TRANSCATHETER AORTIC VALVE-IN-VALVE IMPLANTATION DURING ECMO E Manzan E Manzan AOR SAN CARLO, POTENZA F Prestipino F Prestipino AOR SAN CARLO, POTENZA R D‘Ascoli R D‘Ascoli AOR SAN CARLO, POTENZA G Paternoster G Paternoster AOR SAN CARLO, POTENZA G Luzi G Luzi AOR SAN CARLO, POTENZA AOR SAN CARLO, POTENZA Case Report A 34-year-old male was admitted to our Institution with heart failure after aortic bioprosthesis degeneration and left ventricular dysfunction. Medical history included aortic valve endocarditis followed by aortic valve replacement with biological 21mm Edwards Magna Ease prosthesis in 2010. Enterococcus faecalis infective endocarditis on the aortic bioprosthesis occurred in 2014. In 2018 the patient was admitted to the Cardiac Intensive Care because of pulmonitis, with negative blood cultures. Then clinical conditions worsened due to heart failure, pulmonary edema and fever. Transesophageal Echocardiogram showed left ventricle dilation (EDD 59mm), increased wall thickness (IVS 12mm), reduced ejection fraction (20%) and severe calcific degeneration of aortic prosthesis (mean gradient 45mmHg, associated moderate intra-prosthesis aortic regurgitation). High inotropic support and mechanical ventilation were started. Blood culture, PCT, endotoxin and IL-6 tests were performed when body temperature rose to 39 °C. After 6-hours-long maximum drug therapy and mechanical ventilation, hemodynamic instability persisted, worsened gas exchange and oliguria occurred. EGA confirmed clinical deterioration, therefore VA ECMO was implanted with percutaneous right femoral vein cannulation and surgical right axillary artery cannulation (dacron graft interposition). Markers of inflammation were high, CytoSorb cartridge was installed in ECMO circuit, in order to modulate inflammatory response in view of transfemoral TAVI. After the first 24 hours of CytoSorb treatment, the patient underwent transfemoral aortic valve-in-valve implantation with 23mm Edwards SapienXT valve. CytoSorb therapy lasted 72 hours and was combined with IGM administration (Pentaglobin 250 mg/kg for 5 days). The patient was weaned from ECMO after 4 days. Subsequently, weaning from mechanical ventilation and inotropic support were performed. The patient was discharged 21 days after procedure. At 18-month follow up, the patient is in good clinical conditions, echocardiogram shows good hemodynamic performance of the new Valve-in-valve prosthesis (mean gradient 15mmHg, no PVL). Conclusions This case report proved the efficacy of CytoSorb hemoadsorption combined with ECMO in a patient with heart failure, to overcome inflammatory response and positive blood culture. Sepsis-like syndrome contributed, in our opinion, to the worsening of hemodynamic conditions according to septic myocardial failure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2020. For permissions please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - ARRHYTHMIAS, PACING, ABLATIONC1 A DEPENDENT SYNCOPE
JF - European Heart Journal Supplements
DO - 10.1093/eurheartj/suaa105
DA - 2020-08-01
UR - https://www.deepdyve.com/lp/oxford-university-press/arrhythmias-pacing-ablationc1-a-dependent-syncope-0npFYuijBE
SP - G1
EP - G56
VL - 22
IS - Supplement_G
DP - DeepDyve
ER -