TY - JOUR
AU1 - Aimo,, Alberto
AU2 - Ntritsos,, Georgios
AU3 - Masci,, Pier-Giorgio
AU4 - Figliozzi,, Stefano
AU5 - Klettas,, Dimitrios
AU6 - Stamatelopoulos,, Kimon
AU7 - Delialis,, Dimitrios
AU8 - Emdin,, Michele
AU9 - Georgiopoulos,, Georgios
AB - Abstract Aims Accurate and reproducible diagnostic techniques are essential to detect left-sided cardiac thrombi (either in the left ventricle [LV] or in the left atrial appendage [LAA]) and to guide the onset and duration of antithrombotic treatment while minimizing the risk for thromboembolic and hemorrhagic events. Methods and results We conducted a systematic review and meta-analysis aiming to compare the diagnostic performance of transthoracic echocardiography (TTE) vs. cardiac magnetic resonance (CMR) for the detection of LV thrombi, and transesophageal echocardiography (TEE) vs. computed tomography (CT) for the detection of LAA thrombi. Six studies were included in the first meta-analysis. Pooled sensitivity and specificity values were 62% (95% confidence interval [CI], 37-81%) and 97% (95% CI, 94-99%). The shape of the hierarchical summary receiver operating characteristic (HSROC) curve and the area under the curve (AUC) of 0.96 suggested a high accuracy. Ten studies were included in the meta-analysis of the diagnostic accuracy of CT vs. TEE. The pooled values of sensitivity and specificity were 97% (95% CI, 77-100%) and 94% (95% CI, 87-98%). The pooled DOR was 500 (95% CI, 52-4810), and the pooled LR+ and LR- values were 17% (95% CI, 7-40%) and 3% (95% CI, 0-28%). The shape of the HSROC curve and the 0.99 AUC suggested a high accuracy of CT vs. TEE. Conclusion TTE is a valid alternative to DE-CMR for the identification of LV thrombi, and CT has a good accuracy compared to TEE for the detection of LAA thrombosis.   110 Stress-rest myocardial perfusion scintigraphy for outcome prediction in patients with severe left ventricular dysfunction Alberto Aimo Alberto Aimo Scuola Superiore Sant’Anna Università di Pisa Alberto Clemente Alberto Clemente FTGM Michele Coceani Michele Coceani FTGM Michele Emdin Michele Emdin Scuola Superiore Sant’Anna FTGM Paolo Marzullo Paolo Marzullo FTGM Alessia Gimelli Alessia Gimelli FTGM Scuola Superiore Sant’Anna Università di Pisa FTGM Aims It is unclear if viability and ischaemia testing can predict the benefit from revascularization and long-term outcome in patients with coronary artery disease (CAD) and systolic dysfunction. We assessed the prognostic significance of the extent of perfusion deficits at baseline and the severity of inducible ischaemia. Methods and results Consecutive patients referred to stress-rest myocardial perfusion scintigraphy (MPS) from January 2010 and June 2019 (n = 1,576) were evaluated. They were stratified in the ≥50% (n = 1,213, 77%), 36-49% (n = 207, 13%) and ≤35% (n = 156, 10%) left ventricular ejection fraction (LVEF) categories, and revascularized according to current guidelines. Patients with LVEF ≤35% had the highest median age and percentage of males, the lowest frequency of typical angina, and were those most likely to have multivessel CAD. Median summed rest score (SRS) values, reflecting the extent of perfusion deficits at baseline, were 11, 6, and 1 in patients with LVEF ≤35%, 36-49% and ≥50%, respectively. Patients with LVEF ≤35% had more extensive inducible ischaemia, with higher summed stress score (SSS) than those with LVEF 36-49% and ≥50% (15, 12 and 6, respectively). SRS, SSS and summed difference score (SDS) were less predictive of significant CAD in patients with LVEF ≤35% than in the other patients. Furthermore, SRS, SSS and SDS were poor predictors of 3 endpoints (cardiovascular [CV] death or non-fatal myocardial infarction [MI], all-cause death, and CV death, non-fatal MI or late revascularization), as demonstrated by very low area under the curve values. The best SRS, SSS and SDS cut-offs identified extensive perfusion deficits at baseline or at peak stress, or severe inducible ischaemia. Moreover, patients with higher SRS or SSS values or SRS/SSS higher than or equal to the respective cut-offs had a worse outcome regardless of whether patients were revascularized or not and of the number of diseased vessels. Conclusion In patients with severe systolic dysfunction (LVEF ≤35%), the extent of perfusion deficits at baseline or at peak stress and the severity of inducible ischaemia are poor predictors of prognosis. The presence of high SRS, SSS or SDS values portend a worse outcome independent of revascularization and the extent of CAD. 175 Non invasive ventilation and right ventricle function in cardiogenic pulmonary oedema: the imager perspective to select the “right” ventilatory support Alessio Angelini Alessio Angelini Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Daniela Pedicino Daniela Pedicino Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Giulio Russo Giulio Russo Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Alessia D´Aiello Alessia D´Aiello Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Erica Rocco Erica Rocco Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Pellegrino Ciampi Pellegrino Ciampi Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Myriana Ponzo Myriana Ponzo Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Gabriella Locorotondo Gabriella Locorotondo Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Francesca Graziani Francesca Graziani Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Tommaso Sanna Tommaso Sanna Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Antonio Giuseppe Rebuzzi Antonio Giuseppe Rebuzzi Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Antonella Lombardo Antonella Lombardo Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Massimo Massetti Massimo Massetti Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Giovanna Liuzzo Giovanna Liuzzo Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Filippo Crea Filippo Crea Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli Irccs italy, Rome Istituto di Cardiologia, Università Cattolica del Sacro Cuore italy, Rome Aims High-flow nasal cannulae oxygen therapy (HFNCOT) represents a better tolerated alternative to non-invasive pressure support ventilation (NIPSV) for acute cardiogenic pulmonary oedema (ACPE) treatment. However, there are still few data on the effect of HFNCOT on cardiac function and hemodynamic. Our purpose was to assess and compare the effects of NIPSV and HFNCOT in ACPE setting on right ventricular (RV) systolic function and on indices of cardiac filling and output, as measured by echocardiography. Methods and results This is a cross-over controlled study, enrolling 15 consecutive patients admitted to our Cardiovascular Intensive Care Unit for ACPE and hypoxaemic, normo/hypocapnic acute respiratory failure, with P/F ratio < 200. Each patient received NIPSV, followed by HFNCOT. Full echocardiographic assessment and blood gas analysis (BGA) were performed 40 minutes from onset of each ventilation modality, respectively before NIPSV to HFNCOT switch and before HFNCOT interruption. In particular, RV function parameters, together with RV and atrial strain, were prospectively collected. In spite of not significant changes in BGA, RV function was significantly improved under HFNCOT, as compared to NIPSV, as assessed by the following parameters: tricuspid annular plane excursion (TAPSE) (P = 0.001), RV S’ wave (P = 0.007), RV fractional area change (RVFAC) (P = 0.006). Strain analysis confirmed the significant improvement in RV function, with free wall global longitudinal strain (GLS) and free wall and septum GLS significantly higher under HFNCOT, as compared to NIPSV (-21% vs -18% P < 0.001, and -15% vs -19% P = 0.008, respectively,), and a significant increase in right atrial positive longitudinal strain (P < 0.001). Conclusion NIPSV significantly affect RV function making more complex the management of patients presenting with ACPE. In this setting, HFNCOT represents a valuable alternative, providing similar respiratory outcomes while preserving good right ventricle performance. 350 Transient myocardial dysfunction in a patient treated with immune check-point inhibitor: insights from parametric cardiac magnetic resonance mapping Giovanni Camastra Giovanni Camastra Cardiologia, Ospedale Madre Giuseppina Vannini italia, Roma Luca Arcari Luca Arcari Cardiologia, Ospedale Madre Giuseppina Vannini italia, Roma Federica Ciolina Federica Ciolina Radiologia, Ospedale Madre Giuseppina Vannini italia, Roma Massimiliano Danti Massimiliano Danti Radiologia, Ospedale Madre Giuseppina Vannini italia, Roma Raffaella Semeraro Raffaella Semeraro Cardiologia, Ospedale Madre Giuseppina Vannini italia, Roma Stefano Sbarbati Stefano Sbarbati Radiologia, Ospedale Madre Giuseppina Vannini italia, Roma Salvatore Musarò Salvatore Musarò Cardiologia, Ospedale Madre Giuseppina Vannini italia, Roma Luca Cacciotti Luca Cacciotti Cardiologia, Ospedale Madre Giuseppina Vannini italia, Roma Gerardo Ansalone Gerardo Ansalone Cardiologia, Ospedale Madre Giuseppina Vannini italia, Roma Cardiologia, Ospedale Madre Giuseppina Vannini italia, Roma Radiologia, Ospedale Madre Giuseppina Vannini italia, Roma Aims a 70 year-old man presented to the emergency department because of sudden dyspnoea. Past medical history included lung cancer for which therapy with check-point inhibitor atezolizumab had been started a week earlier. At admission, ECG showed mild ST-segment elevation in antero-lateral leads, while focus echocardiography revealed extensive akinesia of left ventricular mid-apical segments, more evident at septum level. Urgent coronary angiography showed patent epicardial coronary arteries. In the following days, ECG showed inversion of T waves more evident in V2-V4 and QTc prolongation, peak hs-Troponin T was 3500 pg/ml. On day 3 from admission we performed cardiac magnetic resonance (CMR) imaging. Cine sequences confirmed echocardiographic findings of abnormal left ventricular kinesis. Native T1 was elevated on mid- (septum 1175 msec, lateral wall 1040 msec) as well as apical-short axis (septum 1284 msec, lateral wall 1143 msec), whereas we detected lower values at more basal segments (1006 msec at basal septum level). T2 mapping showed increased T2 values in areas of increased native T1 (mid-septum 54 msec, mid-lateral wall 47 msec, apical septum 65 msec, apical lateral wall 54 msec). Late gadolinium enhancement (LGE) images revealed no evident replacement fibrosis at septum level. In this case, the parallel increase of native T1 and T2 values at septum level, in the absence of any scar detected by LGE, would suggest myocardial water to be the main driver of their increase. Nearly complete recovery of wall motion abnormalities was detected by echocardiography at discharge on day 8. Methods and results in this patient, reversible circumferential wall motion abnormalities as well as ECG evolution and CMR findings were consistent with takotsubo syndrome (TTS). Notwithstanding, recent administration of atezolizumab poses differential diagnosis with immune check-point inhibitor myocarditis (ICI-M), an uncommon albeit severe complication of immunotherapy in cancer patients. CMR findings in ICI-M include wide areas of myocardial oedema often in the absence of any replacement fibrosis detectable at LGE imaging, though same results could be commonly found in TTS too. In this case, the relatively large cardiac troponin increase as compared to TTS, as well as the temporal link with ICI administration, would suggest a causative role of the drug in determining the myocardial dysfunction. Interestingly, and in accordance with our CMR mapping findings, interventricular septum appears the most common affected cardiac segment in ICI-M, however, reasons for this putative association have been poorly investigated to date. The relatively high native T1 and T2 values at septum level as well as the marked troponin release, could justify a repeated CMR at follow-up, currently planned, to exclude the late development of replacement fibrosis in areas with broader oedema/inflammation during the acute phase. Conclusion we reported a case of TTS like myocardial dysfunction following ICI treatment, in which CMR findings and clinical evolution largely overlapped those of more typical TTS. Further studies are needed in order to ascertain whether and to which extent ICI-M might be included in the enlarging spectrum of TTS. 444 Cardiac biomarkers in chronic kidney disease are independently associated with myocardial oedema and diffuse fibrosis by cardiovascular magnetic resonance Luca Arcari Luca Arcari Institute of Cardiovascular Imaging, Goethe University Hospital, Frankfurt am Main Germany Juergen Engel Juergen Engel Department of Nephrology, Goethe University Hospital, Frankfurt am Main Germany Tilo Freiwald Tilo Freiwald Department of Nephrology, Goethe University Hospital, Frankfurt am Main Germany Hui Zhou Hui Zhou Institute of Cardiovascular Imaging, Goethe University Hospital, Frankfurt am Main Germany Hafysiatul Zainal Hafysiatul Zainal Institute of Cardiovascular Imaging, Goethe University Hospital, Frankfurt am Main Germany Monika Gawor Monika Gawor Institute of Cardiovascular Imaging, Goethe University Hospital, Frankfurt am Main Germany Stefan Buettner Stefan Buettner Department of Nephrology, Goethe University Hospital, Frankfurt am Main Germany Helmut Geiger Helmut Geiger Department of Nephrology, Goethe University Hospital, Frankfurt am Main Germany Ingeborg Hauser Ingeborg Hauser Department of Nephrology, Goethe University Hospital, Frankfurt am Main Germany Eike Nagel Eike Nagel Institute of Cardiovascular Imaging, Goethe University Hospital, Frankfurt am Main Germany Valentina Puntmann Valentina Puntmann Institute of Cardiovascular Imaging, Goethe University Hospital, Frankfurt am Main Germany Department of Nephrology, Goethe University Hospital, Frankfurt am Main Germany Institute of Cardiovascular Imaging, Goethe University Hospital, Frankfurt am Main Germany Aims Cardiac biomarkers troponin T (hs-TropT) and NT-pro-brain nucleotide peptide (NTproBNP) are often elevated in chronic kidney disease (CKD) and associated with both cardiovascular remodelling and outcome. Relationship between biomarkers and quantitative imaging measures of myocardial fibrosis and oedema by T1 and T2 mapping remains unknown. Methods and results Consecutive patients with established CKD and estimated glomerular filtration rate (eGFR)≤59 ml/min/1.73m2 (n = 276, males 189, age: 58 ± 21 years) were compared to age/sex matched controls with eGFR > 60 (n = 242, males 145, age: 56 ± 19 years). Comprehensive cardiac magnetic resonance (CMR) with T1 and T2 mapping, myocardial ischemia and scar imaging was performed with venous sampling immediately prior to the CMR study. Hs-TropT was associated with imaging markers in the CKD group only (CKD vs. controls, hs-tropT(log-transformed, lg10): native T1 r = 0.40 vs. 0.07, native T2 r = 0.52 vs 0.10). NTproBNP was associated with native T1 in both groups, but native T2 in the CKD group only (NTproBNP(lg10): native T1 r = 0.49 vs. 0.27, native T2 r = 0.42 vs.0.12). Multivariable analyses (CMR volume, function, mass and scar) revealed independent associations between hs-TropT and native T2 (B = 0.516, p < 0.001), and NTproBNP with native T1 (B = 0.429, p < 0.001) in CKD group. In controls both biomarkers were associated with native T1 only (B = 0.304 and 0.407, p < 0.001). A subgroup of patients, re-imaged immediately after hemodialysis, showed reduction of native T2, proportional to the removed volume (n = 10, mean difference±standard deviation = 2.40 ± 1.53 ms, r = 0.71, p < 0.001). Conclusion We demonstrate independent associations between cardiac biomarkers with imaging marker of myocardial oedema and diffuse fibrosis, which are CKD-group specific. 71 Resources and outcome impact of routine availability of computed tomography perfusion Andrea Baggiano Andrea Baggiano Centro Cardiologico Monzino IRCCS Alberico Del Torto Alberico Del Torto Centro Cardiologico Monzino IRCCS Laura Fusini Laura Fusini Centro Cardiologico Monzino IRCCS Marco Guglielmo Marco Guglielmo Centro Cardiologico Monzino IRCCS Giuseppe Muscogiuri Giuseppe Muscogiuri Centro Cardiologico Monzino IRCCS Daniele Andreini Daniele Andreini Università Degli Studi di Milano Saima Mushtaq Saima Mushtaq Centro Cardiologico Monzino IRCCS Edoardo Conte Edoardo Conte Centro Cardiologico Monzino IRCCS Andrea D Annoni Andrea D Annoni Centro Cardiologico Monzino IRCCS Alberto Formenti Alberto Formenti Centro Cardiologico Monzino IRCCS Maria E Mancini Maria E Mancini Centro Cardiologico Monzino IRCCS Andrea I Guaricci Andrea I Guaricci Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari Antonio L Bartorelli Antonio L Bartorelli Università Degli Studi di Milano Mauro Pepi Mauro Pepi Centro Cardiologico Monzino IRCCS Gianluca Pontone Gianluca Pontone Centro Cardiologico Monzino IRCCS Centro Cardiologico Monzino IRCCS Università Degli Studi di Milano Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari Aims Stress computed tomography perfusion (Stress-CTP) is a functional technique that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). To determine the impact of routine availability of Stress-CTP added to cCTA in terms of downstream testing, radiation exposure and outcome in patients with high risk or known CAD. Methods and results Patients symptomatic for chest pain, known for CAD, with previous revascularization or with increased pre-test likelihood of CAD, referred for clinically indicated cCTA with Stress-CTP were prospectively enrolled. Data regarding evaluability, overall radiation exposure, invasive and non-invasive downstream testing, hospitalizations, revascularizations, major adverse cardiac events (MACE) as unstable angina, non-fatal myocardial infarction and cardiovascular death after index test were collected at follow-up. 263 consecutive patients were prospectively enrolled (mean age: 65 ± 9 years; male: 79%), of which 162 (62%) had previous revascularization. The mean follow-up was 323 ± 175 days. cCTA and Stress-CTP were fully evaluable in 95% and 99%, respectively. Obstructive CAD and inducible ischaemia were found in 170 (65%) and 129 (49%) subjects, respectively. No significant difference was found between patients with presence or absence of perfusion defects in terms of downstream non-invasive testing (p: 0.229), while patients with inducible ischaemia had more downstream invasive testing, increased overall radiation exposure, more hospitalizations for cardiovascular reasons and revascularization (all endpoints with p: < 0.001). No differences were detected between patients with inducible ischaemia treated with revascularization after index test and patients without inducible ischaemia, even if with obstructive CAD, treated medically in terms of MACE. Conclusion Routine implementation of cCTA with Stress-CTP is associated with subsequent low rate of other non-invasive testing, low overall radiation exposure in case of negative Stress-CTP and good prognosis if clinical management is based on combined anatomical and functional information. 236 Multimodality cardiac imaging for evaluation of a young man with chest pain: expect the unexpected Sara Baggio Sara Baggio IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano Milan Italy Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele Milan Italy Gianluigi Condorelli Gianluigi Condorelli IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano Milan Italy Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele Milan Italy Paolo Pagnotta Paolo Pagnotta IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano Milan Italy Lorenzo Monti Lorenzo Monti IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano Milan Italy Renato Maria Bragato Renato Maria Bragato IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano Milan Italy IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano Milan Italy Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele Milan Italy Aims coronary embolism is an under-diagnosed cause of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). In this context, multimodality imaging is the cornerstone for differential diagnosis. Methods and results a 21-year-old male presented to the Emergency Department complaining ongoing typical chest pain, started 2 hours earlier at rest. He had no history of previous cardiac problems, but he suffered from migraines and flu-like symptoms one month ago. At presentation, the electrocardiogram showed mild ST-elevation in the inferior leads. Therefore, the patient underwent urgent percutaneous coronary angiography, which demonstrated normal coronary arteries. Lab test revealed elevated troponin I levels (11800 ng/l). In order to confirm the working diagnosis of MINOCA, we excluded missed obstructions and performed a transthoracic echocardiogram, which showed inferior wall hypokinesia, normal left ventricle ejection fraction, and an atrial septal aneurysm with left-to-right shunt. Transesophageal echocardiogram confirmed the presence of multiple jets of left-to-right inter-atrial shunt, associated with moderate right-to-left shunt after Valsalva maneuver, due to the presence of an atrial septal aneurysm with multiple fenestrations and a patent foramen ovale (PFO); there was no evidence of thrombosis or embolic sources. The patient started anticoagulation. Two main differential diagnosis were left: coronary embolism vs. myocarditis. Therefore, we performed a cardiac magnetic resonance imaging (MRI) which established the presence of inferior wall myocardial infarction in a subacute phase, with right ventricle involvement and no-reflow. Considering the anatomy, we made a diagnosis of MINOCA due to coronary embolism. The Heart Team recommended PFO closure because the probability of a causal link and the risk of recurrence were both high. Although percutaneous closure was challenging, due to the presence of an aneurysmal atrial septum, with excursion of 11 mm and multiple fenestrations, we decided to perform a transcatheter procedure with the new device Flex II UNI Occluder 28.5/28.5 mm, specifically designed as an alternative to surgical approach to close complex cases of atrial septal defects. No complications occurred during the procedure. However, the echocardiogram demonstrated a mild residual shunt, with unknown prognostic significance. The patient was discharged with a program of follow-up, which include thrombophilia testing at 1 month and echocardiogram at 6 months. Conclusion paradoxical embolism in a rare cause of MINOCA. However, the PFO is frequent in the general population and it may only coexist by chance. Closure of the defect should be indicated after understanding the individual probability of a causal link and the risk of recurrence, considering multimodality imaging and case-by-case interdisciplinary discussion. 236 Figure Open in new tabDownload slide 236 Figure Open in new tabDownload slide 172 The conundrum of classifying diastolic function in pre-clinical heart failure. A large primary-care Italian study Martina Setti Martina Setti Cardiology Unit, University of Verona Giovanni Benfari Giovanni Benfari Cardiology Unit, University of Verona Donato Mele Donato Mele Cardiology Unit, University of Ferrara Andrea Rossi Andrea Rossi Cardiology Unit, University of Verona Piercarlo Ballo Piercarlo Ballo Cardiology Unit, Santa Maria Annunziata Hospital , Florence Maurizio Galderisi Maurizio Galderisi Department of Advanced Biomedical Sciences, Federico II University , Naples Michael Henein Michael Henein Institute of Public Health and Clinical Medicine Umea University Stefano Nistri Stefano Nistri CMSR Veneto Medica-Cardiology Service, Altavilla Vicentina (VI) Cardiology Unit, University of Verona Cardiology Unit, University of Ferrara Cardiology Unit, Santa Maria Annunziata Hospital , Florence Department of Advanced Biomedical Sciences, Federico II University , Naples Institute of Public Health and Clinical Medicine Umea University CMSR Veneto Medica-Cardiology Service, Altavilla Vicentina (VI) Aims Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two independent algorithms have been proposed by Johansen et al and Oh et al. We sought 1 to assess the concordance of ASE/EACVI guidelines on DF, with newly proposed alternative approaches; 2 to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring procedures to reduce the number of indeterminate DD. Methods and results We retrospective analyzed the echocardiographic reports of 1,158 outpatients including subjects at risk of heart failure (HF) without (SAHF, n = 644) or with (SBHF, n = 241) structural heart disease, and 273 healthy individuals (S0HF). Concordance was calculated using the k coefficient and overall proportion of agreement. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons), as shown in the figure. DF could not be graded in 9% and 11% patients by ASE/EACVI and OH, respective-ly. The majority of patients (62% and 60%, respectively) could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter for this aim. Conclusion Inconsistencies between updated guidelines and independent, alternative approaches to assess and grade DF impede their interchangeable utilization. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients and LAVi/a’ emerges as a new and effective approach to this aim. 173 Clinical impact of left ventricular measurements in patients with aortic valve regurgitation. A multicenter Italian study Luca Maritan Luca Maritan Sezione di Cardiologia, Universita’ di Verona Andrea Barbieri Andrea Barbieri Sezione di Cardiologia, Universita’ di Modena Giovanni Benfari Giovanni Benfari Sezione di Cardiologia, Universita’ di Verona Elisa Giubertoni Elisa Giubertoni Sezione di Cardiologia, Universita’ di Modena Marcella Manicardi Marcella Manicardi Sezione di Cardiologia, Universita’ di Modena Francesca Bursi Francesca Bursi Sezione di Cardiologia, Universita’ di Modena Dipartimento di Cardiologia, Asst Santi Paolo e Carlo, Ospedale San Paolo , Milano Andrea Rossi Andrea Rossi Sezione di Cardiologia, Universita’ di Verona Giuseppe Boriani Giuseppe Boriani Sezione di Cardiologia, Universita’ di Modena Sezione di Cardiologia, Universita’ di Verona Sezione di Cardiologia, Universita’ di Modena Dipartimento di Cardiologia, Asst Santi Paolo e Carlo, Ospedale San Paolo , Milano Aims Guidelines for the management of aortic valve regurgitation (AR) have been traditionally focused on linear left ventricular dimensions to define the timing for intervention in asymptomatic patients. However, the clinical usefulness of linear dimensions vs. 2 D volumes has not been clarified. Methods and results We retrospectively analysed consecutive asymptomatic patients diagnosed with pure chronic moderate or severe AR in two tertiary Italian centres between 2008 and 2019. We assessed 2 D-echocardiography quantitative LV remodelling parameters indexed LV end-diastolic volume (LVEDVi), indexed LV end-diastolic diameter (LVEDDi) as per ASE/EACVI recommendations. The endpoint was the combination of cardiac death, hospitalization for acute heart failure, or AVR. A total of 192 included patients formed the study cohort; mean age 66 ± 17 years 63% women. Overall, there was a poor correlation between LV end-diastolic diameter and volume (r2=0.52, p < 0.0001); furthermore, linearity was lost for larger LV diameters. After a median medical follow-up of 4.5 ± 3.6 years, 44 (22.4%) patients died, 20 (10.4%) were hospitalized and 58 (30.2%) underwent aortic valve replacement. Both linear and volumetric end-diastolic measurements were significantly associated with survival after adjusting for age and LV ejection fraction (HR 1.16 [95%CI 1.07-1.26] p < 0.001 and HR 1.01 [95%CI 1.0–1.01] p < 0.01, respectively). Patients’ prognosis was poorer when both diameter and volumes indicated the presence of severe LV enlargement (concordant group) vs. discordant categorization (p = 0.001). These findings where confirmed in patients with preserved or reduced LV ejection fraction (p < 0.0001), and even after performing a landmark analysis to exclude a possible referral bias (p = 0.02). Conclusion In large cohort of asymptomatic AR patients, the diagnosis of severe LV dilatation is challenging and there is frequently discordance between linear and volumetric dimensions, especially for enlarged ventricles. The concordance in linear and volumetric measurements helps the identification of patients at higher risk of events during the medical follow-up. 306 Clinical phenotype of patients with progressive-tricuspid regurgitation in an Italian Tertiary Center Valentina Siviero Valentina Siviero Cardiology Unit, University of Verona Valentina Battisti Valentina Battisti Cardiology Unit, University of Verona Luca Felice Cerrito Luca Felice Cerrito Elvin Tafciu Elvin Tafciu Cardiology Unit, University of Verona Martina Setti Martina Setti Cardiology Unit, University of Verona Michele Pighi Michele Pighi Cardiology Unit, University of Verona Andrea Rossi Andrea Rossi Cardiology Unit, University of Verona Flavio Luciano Ribichini Flavio Luciano Ribichini Cardiology Unit, University of Verona Giovanni Benfari Giovanni Benfari Cardiology Unit, University of Verona Cardiology Unit, University of Verona Aims Significant tricuspid regurgitation (TR) is a frequent finding among outpatients assessed by echocardiography, and it is associated with poor prognosis. TR may progress over time, but there are few data on the rate of progression and associated clinical characteristics. The aim of the study is to investigate clinical and echocardiographic features associated with progression to severe TR. Methods and results The study retrospectively analyzed the echocardiography and clinical database of patients with a first diagnosis of moderate TR in an Italian tertiary centre. We selected patients with at least two consecutive echocardiographic examinations and complete clinical details. TR severity was graded based on multiparametric evaluation as recommended, and progression was defined as a worsening to severe TR. Eligible patients with moderate TR were 115 (age 73 ± 9, 60% women), and median time between the two echocardiograms was 20 [95%CI 10-37] months. The majority of patients (N = 95, 83%) remained stable, 4 (3%) improved to mild TR, and 16 (14%) progressed to severe TR. At baseline, left ventricular ejection fraction (55 ± 14% vs 51 ± 13%, p = 0.4), pulmonary pressure level (47 ± 15% vs 43 ± 7%, p = 0.2), ischaemic heart disease (26% vs 33%, p = 0.6), rate of atrial fibrillation (63% vs 73%, p = 0.4), hospitalization for heart failure (19% vs 20%, p = 0.7) were similar for progressive-TR vs. stable-TR patients. The distinctive features of patients with progressive-TR (vs. stable-TR) were: frequent concomitant left-side valvular disease (88% vs 62%, p 0.04), particularly of rheumatic etiology (44% vs 18%, p = 0.01), previous mitral valve surgery (50% vs 18%, p = 0.001) or any cardiac surgery (56% vs 27%, p = 0.02), and more cardiac surgical reintervention (19% vs 7%, p = 0.01). Conclusion TR progression is predominant, or may occur faster, in patients with previous left heart valve surgery or rheumatic heart disease. Specific studies on the natural history of TR in this clinical context are warranted. 361 Multimodality imaging in ICD implantation decision making in heart failure patients: LGE by cardiac magnetic resonance is superior to 123I-mIBG to predict ventricular arrhythmias Lucia Ilaria Birtolo Lucia Ilaria Birtolo Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Viviana Maestrini Viviana Maestrini Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Paola Scarparo Paola Scarparo Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Sara Cimino Sara Cimino Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Nicolò Salvi Nicolò Salvi Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Viviana Frantellizzi Viviana Frantellizzi Department of Radiological Science, Oncology and Anatomo-Pathology, Sapienza University of Rome Paolo Severino Paolo Severino Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Carlo Lavalle Carlo Lavalle Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Marco Francone Marco Francone Department of Radiological Science, Oncology and Anatomo-Pathology, Sapienza University of Rome Carlo Catalano Carlo Catalano Department of Radiological Science, Oncology and Anatomo-Pathology, Sapienza University of Rome Giuseppe De Vincentis Giuseppe De Vincentis Department of Radiological Science, Oncology and Anatomo-Pathology, Sapienza University of Rome Massimo Mancone Massimo Mancone Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Francesco Fedele Francesco Fedele Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Department of Clinical, Internal, Anesthesiogy and Cardiovascular Sciences, Sapienza Universirty of Rome Department of Radiological Science, Oncology and Anatomo-Pathology, Sapienza University of Rome Aims ICD implant in heart failure (HF) patients is currently mainly based on left ventricular ejection fraction (LVEF), despite its well-known limitations. The aim of this study is to determine the impact of the combination of 123-iodine metaiodobenzylguanidine (123I-mIBG) and cardiac magnetic resonance (CMR) for risk stratification in HF patients with reduced LVEF candidates to ICD implant, as these have been tested individually in the past to improve patients selection with not conclusive Results. Methods and results 81 patients scheduled for ICD in primary prevention were enrolled. Before ICD implantation, all patients underwent 123I-mIBG scan and CMR. At 48 months follow-up cardiac events (CE, cardiac death and rehospitalization for HF) and major arrhythmic events (ventricular tachycardia, VT and ventricular fibrillation, VF) were evaluated. Patients were divided into two groups according with CE or VT/VF. CE patients (37%) had higher values of LLS (respectively 42 ± 10 vs 36 ± 10%, p = 0.033) and higher rate of LSS > 26 (60% vs 43%, p = 0.018). Event-free survival rate was lower in LSS > 26 patients (p = 0.029). CE patients showed a higher rate of LGE (77% vs 60% p = 0.048). Event-free survival rate was lower in LGE patients (p = 0.048). Event-free survival rate was lower in LSS > 26 + LGE patients (p = 0.015). Only the presence of LGE resulted to be independently associated with CE [HR 2.1 (CI 95% 1.03-4.4, p = 0.037)]. VT/VF patients (41%) had higher values of LSS (46 ± 9vs 37 ± 10%, p = 0.003). VT/VF patients showed a higher rate of LGE presence (92% vs 50% p = 0.048). Event-free survival rate was lower in LGE patients (p = 0.037). LGE was a predictor of VT/VA over 123I-mIBG parameters with HR 2.2 (CI 95% 1.02-4.5), p = 0.03. Conclusion The present study failed to demonstrate the incremental value of the combination of 123I-mIBG and LGE for risk stratification in patients implanted with ICD for primary prevention. LGE provided added value to select HF patients that will benefit from ICD. 361 Figure 1. Open in new tabDownload slide MIBG and CMR cases. Top row shows the case of a patient with negative 123I-MIBG, positive LGE and ventricular fibrillation treated by appropriate ICD shock. MIBG scan showing planar 1, three planes 2 and Bull's eye 3 images; long 4 and short axis 5 LGE images showing transmural LGE in the inferior wall; ICD interrogation showing appropriate ICD shock for VF 6. Bottom row shows the case of a patient with positive 123I-MIBG, negative LGE and no event at ICD interrogation. MIBG scan showing: planar 1, three planes 2 and Bull's eye 3 images; long 4 and short axis 5 LGE images showing no LGE; ICD interrogation showing no arrhythmic event 6. 361 Figure 1. Open in new tabDownload slide MIBG and CMR cases. Top row shows the case of a patient with negative 123I-MIBG, positive LGE and ventricular fibrillation treated by appropriate ICD shock. MIBG scan showing planar 1, three planes 2 and Bull's eye 3 images; long 4 and short axis 5 LGE images showing transmural LGE in the inferior wall; ICD interrogation showing appropriate ICD shock for VF 6. Bottom row shows the case of a patient with positive 123I-MIBG, negative LGE and no event at ICD interrogation. MIBG scan showing: planar 1, three planes 2 and Bull's eye 3 images; long 4 and short axis 5 LGE images showing no LGE; ICD interrogation showing no arrhythmic event 6. 363 Reduced 123I-mIBG uptake is associated with cardiac death and rehospitalization in HFrEF implanted ICD patients Lucia Ilaria Birtolo Lucia Ilaria Birtolo Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Paola Scarparo Paola Scarparo Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Sara Cimino Sara Cimino Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Viviana Maestrini Viviana Maestrini Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Nicolò Salvi Nicolò Salvi Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Viviana Frantellizzi Viviana Frantellizzi Department of Radiolofical Science, Oncology and Anathomo-Pathology, Sapienza University of Rome Pucci Mariateresa Pucci Mariateresa Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Paolo Severino Paolo Severino Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Carlo Lavalle Carlo Lavalle Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Giuseppe De Vincentis Giuseppe De Vincentis Department of Radiolofical Science, Oncology and Anathomo-Pathology, Sapienza University of Rome Massimo Mancone Massimo Mancone Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Francesco Fedele Francesco Fedele Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome Department of Radiolofical Science, Oncology and Anathomo-Pathology, Sapienza University of Rome Aims Although cardiac sympathetic activity is associated with ventricular arrhythmias (VA), limited data are currently available on the predictive value of 123-iodine metaiodobenzylguanidine (123I-mIBG) imaging on VA occurrence. Aim of the study was to evaluate whether 123I-mIBG scan predicts the occurrence of malignant VA in heart failure (HF) patients with reduced ejection fraction (HFrEF) scheduled for ICD therapy (primary endpoint), and the cumulated occurrence of cardiac death and rehospitalization for HF, summarized as cardiac events (CE) (secondary endpoint). Methods and results 221 HFrEF (EF: 28 ± 5%) patients underwent both echocardiography and 123I-mIBG scan. Early and late 123I-mIBG imaging (Summed Score, SS and heart-to-mediastinum ratio H/M) was performed to assess cardiac innervation. Appropriate ICD therapy or VA occurrence and CE were documented at 48 months. 221 HFrEF patients were enrolled. VA rate was of 37% and CE was of 34%. Patients were divided into two groups according with CE or VA occurrence. CE group showed a significantly higher rate of SS > 26% (60% vs 44%, p < 0.001, SE 60%). Survival analysis showed lower event-free rate in SS > 26 patients (p log-rank< 0.001). No differences in H/M were recorded. Regarding VA occurrence, neither SS and H/M indexes seemed to be related with the endpoint. EF was lower in patients who experienced VA (28 ± 5 vs 26 ± 7%, p = 0.048). Conclusion Cardiac sympathetic activity failed to demonstrate predictive value for VA occurrence in HFrEF patients. 123I-mIBG scan was still useful in risk stratification for cardiac death and rehospitalization for HF. 583 Left atrial strain highly correlates with left ventricular end-diastolic pressure in paediatric patients with heart transplant Nunzia Borrelli Nunzia Borrelli Aorn dei Colli, Monaldi Hospital, Naples (IT) Mario Panebianco Mario Panebianco Bambino Gesù Paediatric Hospital, Rome (IT ) Giovanni Di Salvo Giovanni Di Salvo University of Padua, Padua (IT) Sara Alfieri Sara Alfieri Bambino Gesù Paediatric Hospital, Rome (IT ) Daniela De Angelis Daniela De Angelis Bambino Gesù Paediatric Hospital, Rome (IT ) Marcello Chinali Marcello Chinali Bambino Gesù Paediatric Hospital, Rome (IT ) Antonio Amodeo Antonio Amodeo Bambino Gesù Paediatric Hospital, Rome (IT ) Francesco Parisi Francesco Parisi Bambino Gesù Paediatric Hospital, Rome (IT ) Paolo Guccione Paolo Guccione Bambino Gesù Paediatric Hospital, Rome (IT ) Aorn dei Colli, Monaldi Hospital, Naples (IT) Bambino Gesù Paediatric Hospital, Rome (IT ) University of Padua, Padua (IT) Aims Episodes of rejection and graft dysfunction of heart transplant (HT) may occur at different times after surgery. Left-ventricular end-diastolic pressure (LVEDP) is generally invasively obtained through a cardiac catheterization and used to catch early signs of rejection. This study sought to correlate transthoracic echocardiographic parameters to LVEDP at cardiac catheterization in paediatric transplant recipients. Methods and results This is a retrospective study of 50 patients (54% male) with HT who underwent heart transplantation in paediatric age (0-18 years old). The echocardiographic evaluation was performed within three weeks from the left heart cardiac catheterization. From the echocardiographic apical window, we measured: left atrial strain (LAS) indices [atrial contraction (εac), LA filling (reservoir phase, εres), and LA passive emptying (conduit phase, εcon)], mitral Doppler E/A, E/e’, global longitudinal strain (LVGLS) and strain rate. Median LVEDP was 10 mmHg (IQR 8.25-12 mmHg) and had the best correlation with decreased εres (r= -0.56, p < 0.0001). The other LAS indices and mitral E/e’ correlated less strongly with LVEDP (εac: r= -0.42, p = 0.004; εcon: r= -0.55, p = 0.0001; E/e’: r = 0.28, p = 0.04). E/A, LVGLS, and LVGLS rate did not correlate with LVEDP. By ROC analysis, εres ≤ 16.3% was predictive of elevated LVEDP with good sensitivity (86%) and moderate specificity (57%). A multivariate analysis produced εres as the best predictor (p = 0.0001) for high LVEDP. Conclusion The echocardiographic parameter εres may be used to monitor non-invasively the value of LVEDP. εres may be of value in patients with HT to survey for rejection and graft dysfunction. 72 Global longitudinal strain at rest predicts significant coronary artery stenosis in patients with peripheral arterial disease Ludovica Fiorillo Ludovica Fiorillo Departement of Clinical Medicine and Surgery, Federico II University italy, Naples Valentina Capone Valentina Capone Departement of Advanced Biomedical Sciences, Federico II University italy, Naples Ofelia Casciano Ofelia Casciano Departement of Advanced Biomedical Sciences, Federico II University italy, Naples Federica Luciano Federica Luciano Departement of Advanced Biomedical Sciences, Federico II University italy, Naples Mario Enrico Canonico Mario Enrico Canonico Departement of Advanced Biomedical Sciences, Federico II University italy, Naples Silvia Orefice Silvia Orefice Departement of Clinical Medicine and Surgery, Federico II University italy, Naples Teresa Fedele Teresa Fedele Departement of Clinical Medicine and Surgery, Federico II University italy, Naples Vittoria Cuomo Vittoria Cuomo Departement of Clinical Medicine and Surgery, Federico II University italy, Naples Roberta Esposito Roberta Esposito Departement of Clinical Medicine and Surgery, Federico II University italy, Naples Ciro Santoro Ciro Santoro Departement of Advanced Biomedical Sciences, Federico II University italy, Naples Departement of Clinical Medicine and Surgery, Federico II University italy, Naples Departement of Advanced Biomedical Sciences, Federico II University italy, Naples Aims Critical peripheral artery disease (PAD) is expression of systemic chronic atherosclerosis, it being often associated with cardiovascular events. The assessment of global longitudinal strain (GLS) at rest by speckle tracking echocardiography could be useful to unmask significant coronary artery disease (CAD) in asymptomatic PAD patients. To determine whether resting GLS is able to predict significant coronary artery stenosis in PAD patients selected for peripheral or carotid angiography. Methods and results One-hundred three clinically relevant PAD patients (M/F = 76/27, age = 66.8 ± 10,2 years, 72 with significant lower limb artery stenosis and 31 with carotid artery stenosis ≥50%), asymptomatic for CAD, underwent standard echo-Doppler exam at rest, comprehensive of GLS analysis, prior peripheral and coronary angiography. Information on cardiovascular (CV) risk factors and comorbidities were collected. Patients with know CAD and previous myocardial infarction, left ventricular (LV) ejection fraction < 50% and inadequate echocardiographic imaging were excluded. According to the results of coronary angiography, patients were divided in two groups: with significant coronary artery stenosis (>50% of obstruction. n = 73) and without significant coronary artery lesions (n = 30). No intergroup difference in the prevalence of CV risk factors and comorbidities was found. Age, body mass index and blood pressure were comparable between the two groups. LV ejection fraction (59.9 ± 4.2% in patients with significant coronary stenosis vs. 60.2 ± 4.7% in those without coronary stenosis, p = 0.75) and wall motion score index (1.02 ± 0.09 vs 1.03 ± 0.09 respectively, p = 0.67) did not differ significantly. Conversely, GLS was lower in patients with significant coronary artery stenosis than in those without (21.6 ± 2.7% vs. 22.8 ± 2%, p < 0.02) (Figure 1). This difference remained significant comparing the carotid subgroup with coronary stenosis vs. those without (p < 0.05) whereas it did not achieve the statistical significance in patients with lower limb artery lesions (p = 0.42). Conclusion In PAD patients, GLS at rest shoes the capability in identifying patients at higher probability of significant coronary artery stenosis. This involves in particular patients with carotid artery stenosis. GLS might be helpful to select patients who need to extend the peripheral angiographic evaluation to the coronary tree. 74 Tadalafil treatment improves left ventricle diastolic parameters Silvia Orefice Silvia Orefice Department of Clinical Medicine and Surgery, Federico II University italy, Naples Ofelia Casciano Ofelia Casciano Department of Advanced Biomedical Sciences, Federico II University italy, Naples Teresa Fedele Teresa Fedele Department of Clinical Medicine and Surgery, Federico II University italy, Naples Vittoria Cuomo Vittoria Cuomo Department of Clinical Medicine and Surgery, Federico II University italy, Naples Ludovica Fiorillo Ludovica Fiorillo Department of Clinical Medicine and Surgery, Federico II University italy, Naples Valentina Capone Valentina Capone Department of Advanced Biomedical Sciences, Federico II University italy, Naples Mario Enrico Canonico Mario Enrico Canonico Department of Advanced Biomedical Sciences, Federico II University italy, Naples Federica Luciano Federica Luciano Department of Advanced Biomedical Sciences, Federico II University italy, Naples Roberta Esposito Roberta Esposito Department of Clinical Medicine and Surgery, Federico II University italy, Naples Ciro Santoro Ciro Santoro Department of Advanced Biomedical Sciences, Federico II University italy, Naples Department of Advanced Biomedical Sciences, Federico II University italy, Naples Department of Clinical Medicine and Surgery, Federico II University italy, Naples Aims Phosphodiesterase type 5 inhibitors (PDE5i) are first-line treatment for erectile dysfunction (ED). Tadalafil, a prolonged half-life PDE5i, has been considered one of the first-line treatment options for ED after nerve-sparing robotic radical prostatectomy (NS-RARP) for prostate cancer. PDE5-inhibitors prevent the breakdown of nitric oxide (NO)-driven cGMP, in vascular smooth muscle cells, and act as potent vasodilators. Since phosphodiesterase 5 inhibitors restore NO signaling, chronic treatment with Tadalafil may enhance plasma NO levels and reduce endothelial and cardiac dysfunction. to determine whether the use of Tadalafil for erectile dysfunction may cause cardiac changes detectable by echocardiogram. Methods and results we enrolled twenty-three patients (age = 64.0 ± 7,6 years) who underwent NS-RARP and who were treated with Tadalafil 20 mg on alternate days to promote recovery of sexual function. All patients have been taking Tadalafil for at least 6 months. Participants underwent standard echo-Doppler exam with evaluation of ejection fraction, global longitudinal strain, LA maximum volume index and Doppler-derived LV diastolic parameters (including mitral flow velocities, mitral annular e’ velocity, E/e’ ratio, peak velocity of Tricuspid regurgitation (TR) jet) at the start of therapy, and after three and six month follow-up. Informations about cardiovascular (CV) risk factors were collected. Patients with known coronary artery disease, left ventricular (LV) ejection fraction <53% and inadequate echocardiographic imaging were excluded. no difference was found at three months. At six month Follow-up patients were comparable for body mass index, blood pressure and heart rate. Among echo parameters, LV mass index, relative wall thickness, left atrial volume index, LV ejection fraction and global longitudinal strain were not different between basal and after six months echocardiograms. Of interest E/e’ ratio (7.4 ± 2.7 vs. 6.2 ± 1.3, p < 0.03) peak velocity of TR jet (2.4 ± 0.2 vs. 2.1 ± 0.2, p < 0.001) and PAPs (27.3 ± 3.5 vs. 22.9 ± 5.7, p < 0.005) were significantly lower after six months of therapy. Conclusion Tadalafil treatment reduced left ventricular end-diastolic pressure and increased left ventricular developed pressure. Our preliminary data, according to what is present in the literature, would show an improvement of diastolic function in the absence of cardiovascular complications detectable by the echocardiogram. Therefore we conclude that the use of Tadalafil for erectile dysfunction is safe and it also brings benefits to cardiac function. 225 Peripartum cardiomyopathy in a patient with situs viscerum inversus and dextrocardia Valentina Capone Valentina Capone Department of Advanced Biomedical Sciences, Federico II University italy, Naples Alessandra Scatteia Alessandra Scatteia Division of Cardiology” Villa dei Fiori” Hospital ,Italy Acerra, Naples Salvatore Chianese Salvatore Chianese Department of Advanced Biomedical Sciences, Federico II University italy, Naples Carlo Di Nardo Carlo Di Nardo Department of Advanced Biomedical Sciences, Federico II University italy, Naples Raffaella America Raffaella America Division of Cardiology” Villa dei Fiori” Hospital ,Italy Acerra, Naples Carmine Emanuele Pascale Carmine Emanuele Pascale Division of Cardiology” Villa dei Fiori” Hospital ,Italy Acerra, Naples Giovanni Esposito Giovanni Esposito Department of Advanced Biomedical Sciences, Federico II University italy, Naples Santo Dellegrottaglie Santo Dellegrottaglie Division of Cardiology” Villa dei Fiori” Hospital ,Italy Acerra, Naples Zena and Michael A. Wiener Cardiovascular Institute Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, ICAHN School of Medicine at Mount Sinai, New York us, NY Department of Advanced Biomedical Sciences, Federico II University italy, Naples Division of Cardiology” Villa dei Fiori” Hospital ,Italy Acerra, Naples Zena and Michael A. Wiener Cardiovascular Institute Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, ICAHN School of Medicine at Mount Sinai, New York us, NY A 37-years-old woman, with known situs viscerum inversus and dextrocardia, was admitted to the emergency department for shortness of breath one month after the delivery of her first son. Standard cardiac screening as performed during pregnancy was unremarkable. Repeated transthoracic echocardiography showed a dilated left ventricle (LV) with severely reduced ejection fraction (EF). To investigate the aetiology of the LV dysfunction, she was then referred to have a cardiovascular magnetic resonance (CMR) scan. CMR confirmed the situs viscerum inversus with dextrocardia, but no other congenital cardiovascular anomalies were detected. LV was dilated, with diffuse wall thinning and moderate reduction of LV EF. A well-defined pattern of left ventricular non-compaction (LVNC) in the apex was detected. Right ventricular dimensions and function were normal. There were no signs of myocardial oedema on STIR T2-weighted images nor evidence of LV late gadolinium enhancement on post-contrast LGE images. The patient was, therefore, diagnosed with peripartum cardiomyopathy (PPCM) and referred to the physicians for the appropriate treatment. PPCM is a potentially severe pregnancy-associated disease consisting in LV dysfunction and heart failure occurring over peripartum period. It is widely known that pregnancy could contribute to significant haemodynamic changes and could precipitate pre-existing congenital heart disease (CHD). Situs viscerum inversus with dextrocardia is an uncommon CHD, with the apex of the heart being located on the right side of the chest and with mirror image of major visceral organs. Nevertheless, no cases of PPCM in subjects with this specific congenital condition have been reported so far. Alterations in the process of embryogenesis may constitute a common link between the situs inversus and LVNC, both observed in these patients. PPCM occurrence with LV dysfunction may be favored by LVNC itself. We report a unique case of dextrocardia with situs viscerum inversus and PPCM. Being their potential link still unknown, pregnant women with this congenital anomaly, even in absence of overt cardiovascular consequences, should receive careful cardiological checks over the entire peripartum period, as in other form of CHD during pregnancy. 309 Diastolic dysfunction is associated with reduced physical performance and poor prognosis in older patients with myocardial infarction Laura Sofia Cardelli Laura Sofia Cardelli Azienda Ospedaliero-Universitaria di Ferrara Anna Piredda Anna Piredda Azienda Ospedaliero-Universitaria di Ferrara Rita Pavasini Rita Pavasini Azienda Ospedaliero-Universitaria di Ferrara Azienda Ospedaliero-Universitaria di Ferrara Aims In 2016 a new algorithm for the assessment of diastolic dysfunction has been released. No studies investigated the relationship between diastolic dysfunction (DD), physical performance and/or frailty and outcome. The present analysis is carried out to fill this gap in evidence. Methods and results Older (age ≥70 years) patients admitted to hospital for acute coronary syndromes (ACS) were included. Before the discharge a complete transthoracic echocardiogram (baseline TTE) was performed with assessment of DD following the 2016 algorithm. TTE was repeated after 1 year. Clinical follow-up was performed at 1-year. Seven scales of frailty and physical performance were assessed. First, the relationship between DD and tests of frailty and physical performance was investigated. Second, the association with 1-year occurrence of all-cause death and re-hospitalization was valuated. Overall 329 patients were included in the analysis. Patients were stratified in two groups: DD grade 0-1 vs. 2-3. The mean age of the group was 77 ± 5 vs 79 ± 6 years, respectively. Physical performance and frailty resulted significantly lower in patients with DD grade 2-3 compare to the others. After multivariate Cox logistic regression, DD (degree 2-3 vs. 0-1) remained an independent predictor of the composite endpoint (HR 1.46, 95% CI 1.06-2.02, p = 0.02) even if it was not an independent predictor of all-cause mortality, but of one-year re-hospitalization (HR 1.75, 95% CI 1.26-2.44, p < 0.001). Conclusion In older ACS patients the assessment of diastolic dysfunction with the 2016 algorithm is related to parameters of frailty and physical performance and it is a predictor of one- year re-hospitalization. 266 Exploring the grey zone of E/E' ratio: does left atrial strain help? Luca Felice Luca Felice Università Degli Studi di Verona CerritoRiccardo M Inciardi CerritoRiccardo M Inciardi Università Degli Studi di Verona Giovanni Benfari Giovanni Benfari Università Degli Studi di Verona Corinna Bergamini Corinna Bergamini Università Degli Studi di Verona Flavio L Ribichini Flavio L Ribichini Università Degli Studi di Verona Andrea Rossi Andrea Rossi Università Degli Studi di Verona Università Degli Studi di Verona Aims The combination of early trans-mitral inflow and mitral annular tissue Doppler velocities (E/e’ ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However E/e’ ratio has a significant grey zone that restrict its accuracy and left atrial (LA) deformation analysis by speckle tracking echocardiography (STE) was recently proposed as an alternative approach to estimate LV filling pressures, but the clinical application of LA strain in the subgroup of patients with E/E’ between 8 and 14 has been under-investigated. This study aimed to analyze the role of LA longitudinal function by STE (PALS) to estimate intra-cardiac pressures as assessed by systolic pulmonary artery pressure (sPAP), measured by Doppler, specifically in patients with an E/e’ ratio > 8 and ≤ 14. Methods and results We enrolled 142 consecutive, non-selected patients, referred to our echocardiography laboratory for a comprehensive transthoracic echocardiography. Exclusion criteria were: organic mitral valve disease or prosthesis and presence of disease possibly associated with pre-capillary pulmonary hypertension. Particular care was used for accurate measurement of maximal tricuspid regurgitation velocity and of right atrial pressure and consequently sPAP estimation. PALS values were obtained by averaging all segments, and by separately averaging segments measured in the 4-chamber and 2-chamber views. Seventy-four patients (52% of total) showed an E/e’ ratio > 8 and ≤ 14, with the following characteristics: mean age 65.5 ± 11.9 years, LVEF 54.5 ± 11.2, E/e’ 11.2 ± 1.9, sPAP 33 ± 7 mmHg, PALS 31.6 ± 11.7%. A negative correlation between PALS and sPAP was found (r = -0.55, p < 0.0001). From receiver operating characteristic (ROC) curves, PALS demonstrated a high diagnostic accuracy (AUC 0.78 (95% CI: 66%–90%)); the cutoff value of 23% showed an excellent specificity of 90% with a sensibility of 60%, to predict sPAP higher than 35 mmHg. Conclusion LA function measured by STE is a simple parameter able to predict increased intra-cardiac pressure even in the intermediate E/E’ group. This parameters might help in improving the diagnostic algorithm of diastolic function. 331 Left atrial strain in patients with severe organic mitral regurgitation undergoing mitral valve surgery: association with pre and post-surgical functional capacity Luca Felice Cerrito Luca Felice Cerrito Section of Cardiology, University of Verona italy, Verona Martina Milani Martina Milani Cardiovascular Department, Niguarda Great Metropolitan Hospital italy, Milan Andrea Rossi Andrea Rossi Section of Cardiology, University of Verona italy, Verona Antonella Moreo Antonella Moreo Cardiovascular Department, Niguarda Great Metropolitan Hospital italy, Milan Section of Cardiology, University of Verona italy, Verona Cardiovascular Department, Niguarda Great Metropolitan Hospital italy, Milan Aims Left atrial (LA) enlargement in patients with chronic mitral regurgitation (MR) occurs as a part of cardiac remodelling due to volume overload. LA functional impairment evaluated by 2-D Speckle Tracking Echocardiography (STE) has been observed in patients with severe MR, however its role in determining pre and post-surgery heart failure symptoms remain un-explored. Aim of this study was to evaluated the role of LA strain in the occurrence of heart failure symptoms in patients with severe organic MR before and after surgery. Methods and results Patients with severe organic MR underwent to mitral valve surgery were retrospectively enrolled. All patients had a transthoracic echocardiography and a clinical evaluation including New York Heart Association (NYHA) functional classification at baseline and a clinical evaluation after surgery. Peak atrial longitudinal, contraction (PALS, PACS), conduit and global LV longitudinal strain (GLS), were obtained at baseline. One hundred-twenty patients were enrolled, age 66 ± 11 years, 39% female. Baseline parameters: PALS 29 ± 12%, PACS 12 ± 7%, conduit 19 ± 7%, GLS -21 ± 4%. At baseline there were 30 patients (255) NYHA I, 40 patients (33%) NYHA II, and 50 patients (42%) NYHA III. At follow-up, excluding patients that were asymptomatic (NYHA I) at baseline, 73 patients (81%) showed an improvement of NYHA class. At univariate analysis, the following parameters were correlated to baseline NYHA: PALS (R = 0.43, p < 0.001), GLS (R = 0.37, p < 0.001), PACS (R = 0.31, p = 0.009), conduict (R = 0.30, p = 0.01), LV end-diastolic volume (R = 0.22, p = 0.01). At multivariate analysis baseline PALS was the only parameter (β= -0.30, p = 0.02) independently associated to baseline NYHA classification. At univariate analysis the following parameters showed to be predictors of NYHA class at Follow-up: PALS (R = 0.43, p < 0.001), PACS (R = 0.35, p = 0.004), GLS (R = 0.24, p = 0.002), TAPSE (R = 0.21, p = 0.02), LVEF (R = 0.19, p = 0.04). At multivariate analysis, PALS (β= -0.45, p = 0.02) was the independent predictor of NYHA class at Follow-up. Conclusion Our study demonstrates that LA strain was independently associated with heart failure symptoms, even after surgery. Also, LA was found to predict AF in this patients. These finding suggest that LA strain is valuable in chronic severe primary MR. 224 Unveiling a complex congenital disorder with cardiovascular magnetic resonance in an adult woman with shortness of breath Salvatore Chianese Salvatore Chianese Department of Advanced Biomedical Sciences, Federico II University italy, Naples Alessandra Scatteia Alessandra Scatteia Division of Cardiology” Villa dei Fiori”Hospital italy, Acerra, Naples Valentina Capone Valentina Capone Department of Advanced Biomedical Sciences, Federico II University italy, Naples Carlo Di Nardo Carlo Di Nardo Department of Advanced Biomedical Sciences, Federico II University italy, Naples Raffaella America Raffaella America Division of Cardiology” Villa dei Fiori”Hospital italy, Acerra, Naples Carmine Emanuele Pascale Carmine Emanuele Pascale Division of Cardiology” Villa dei Fiori”Hospital italy, Acerra, Naples Eugenio Stabile Eugenio Stabile Department of Advanced Biomedical Sciences, Federico II University italy, Naples Giovanni Esposito Giovanni Esposito Department of Advanced Biomedical Sciences, Federico II University italy, Naples Santo Dellegrottaglie Santo Dellegrottaglie Division of Cardiology” Villa dei Fiori”Hospital italy, Acerra, Naples Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, ICAHN School of Medicine at Mount Sinai USA, NEW YORK, NY Department of Advanced Biomedical Sciences, Federico II University italy, Naples Division of Cardiology” Villa dei Fiori”Hospital italy, Acerra, Naples Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, ICAHN School of Medicine at Mount Sinai USA, NEW YORK, NY A 55-year-old woman was admitted to our emergency department for dyspnoea. She had been diagnosed with situs viscerum inversus and dextrocardia with interatrial defect 4 years before during an episode of acute cardiac failure and atrial fibrillation. ECG showed sinus tachycardia with right axial deviation. Transthoracic echocardiography (TEE) revealed atrial dilation with evident bidirectional shunt through an interatrial septum defect. Moreover, the left and right ventricular systolic function was moderately reduced. She was then referred to have a cardiovascular magnetic resonance (CMR) scan to better characterize the congenital abnormalities. CMR findings included: double superior vena cava (SVC) circulation (Figure 1; A-B); completely unroofed coronary sinus (Figure 2: A-B), with interatrial defect leading to a significant left-to-right shunt (Qp/Qs = 2,6); severely dilated right heart chambers (Figure 3); mildly reduced right ventricular ejection fraction, with preserved left ventricular systolic function. Coronary sinus atrial septal defects are characterized by the absence of at least a portion of the common wall that separates the coronary sinus from the left atrium, ultimately resulting in left-to-right shunt, and constitute the less common type of atrial septal defect. The combination of abnormal systemic venous drainage from double SVC circulation (usually as a persistent left SVC draining into the left atrium) and unroofed coronary sinus is referred to as Raghib syndrome (or Raghib complex), which is an extremely rare cardiac anomaly, in some cases associated with ventricular septal defects, enlargement of tricuspid annulus and pulmonary stenosis, with potential clinical presentation as heart failure or ischaemic stroke. This case is the first CMR report of a Raghib syndrome in situs viscerum inversus and dextrocardia. CMR, with its high contrast and spatial resolution combined with large field-of-view capability, provided accurate definition of systemic venous return as well as cardiac anatomy and function allowing the full non-invasive depiction of this rare combination of congenital abnormalities. Physicians should always consider performing CMR when handling patients, specially adults, with complex congenital heart disease. Figure. 2-chamber cine image 1 and right ventricular outflow tract cine image 2 showing unroofed coronary sinus (black arrows). LA: left atrium, RA: right atrium, LV: left ventricle, MPA: main pulmonary artery. 438 Clinical significance of intraventricular stasis detected at cardiac magnetic resonance in patients with acute myocardial infarction: a restrospective cohort study Mauro Massussi Mauro Massussi Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua Italy Alberto Cipriani Alberto Cipriani Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua Italy Nicola De La Cruz Nicola De La Cruz Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua Italy Raffaella Motta Raffaella Motta Department of Medicine, Radiology Unit, University of Padua Italy Giorgio De Conti Giorgio De Conti Department of Medicine, Radiology Unit, University of Padua Italy Iliceto Sabino Iliceto Sabino Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua Italy Martina Perazzolo Marra Martina Perazzolo Marra Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua Italy Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua Italy Department of Medicine, Radiology Unit, University of Padua Italy Aims the relationship between acute myocardial infarction (AMI) and acute cerebrovascular events (CVE) has been widely studied in literature. Sinus rhythm AMI patients, particularly those with left ventricular (LV) systolic dysfunction, carry a 2% risk of CVE in the first 12 months after the cardiac event. Intraventricular stasis (IS) detected at cardiac magnetic resonance (CMR) might have a role in the risk stratification of CVE. to establish the clinical significance of IS in a cohort of AMI patients and to investigate IS as a risk factor for CVE. Methods and results all patients admitted to the Cardiac Intensive Care Unit of Padua University Hospital for AMI between 2013 and 2017, who underwent CMR within 7 days from the event, were included in this retrospective analysis. Patients on treatment with oral anticoagulation therapy at admission or showing ventricular thrombosis at CMR were excluded. IS was defined by the presence of intraventricular signal hyperintensity on T2-weighted images. Patients were followed-up for a median duration of 54 months and predictors of CVE, non-fatal Re-infarction and cardiovascular death were determined. the final population included 214 patients (153 males [71.5%], mean age 61 years), of which 56 (26.2%) showed IS at CMR. Patients with IS had more frequently a transmural AMI (94.4% vs 75.7%, p = 0.003), and a lower LV ejection fraction (40.5 ± 8,9 vs 50.9 ± 11,3, p < 0.001). During follow-up, 8 CVE, 6 cardiovascular deaths and 9 non-fatal Re-infarction occurred. IS carried a odds ratio (OR) for CVE of 9.36 (95% confidence interval [CI] 1.8-47.9, p = 0.007), and for cardiovascular death of 6.0 (95% CI 1.1-33.7, p = 0,042). Conclusion IS detected at CMR is associated with an increased risk of CVE and cardiovascular death in patients with AMI. Further prospective studies with larger populations are needed to confirm these results, and to explore the possibility of prophylactic low-dose anticoagulation therapy for preventing CVE. 199 Pac-man heart and mitral valve prolapse: an unreported Lyason Angela Pamela Peluso Angela Pamela Peluso A.O.U. San Giovanni di Dio e Ruggi D’aragona Ivana Iesu Ivana Iesu A.O.U. San Giovanni di Dio e Ruggi D’aragona Gennaro Provenza Gennaro Provenza A.O.U. San Giovanni di Dio e Ruggi D’aragona Rossella Benvenga Rossella Benvenga A.O.U. San Giovanni di Dio e Ruggi D’aragona Michele Bellino Michele Bellino A.O.U. San Giovanni di Dio e Ruggi D’aragona Maria Vincenza Polito Maria Vincenza Polito A.O.U. San Giovanni di Dio e Ruggi D’aragona Michele Ciccarelli Michele Ciccarelli A.O.U. San Giovanni di Dio e Ruggi D’aragona Gennaro Galasso Gennaro Galasso A.O.U. San Giovanni di Dio e Ruggi D’aragona Carmine Vecchione Carmine Vecchione A.O.U. San Giovanni di Dio e Ruggi D’aragona Rodolfo Citro Rodolfo Citro A.O.U. San Giovanni di Dio e Ruggi D’aragona A.O.U. San Giovanni di Dio e Ruggi D’aragona Aims Pac-man heart is an extremely rare anomaly consisting with a partial ventricular septal defect. It may be of congenital origin or acquired as a complication of myocardial infarction. Few cases have been already reported in literature including one in patient with parachute mitral valve. Methods and results A 50 yy old man accessed the echolab for dyspnoea. His past medical history was unremarkable. Transthoracic two-dimensional echocardiogram showed a posterior leaflet of the mitral valve prolapse associated with eccentric regurgitant jet anteriorly directed. Due to the detection of vena contracta witdh 8 mm; effective regurgitant orifice area 42 mm2; regurgitant volume 65 ml/beat mitral valve regurgitation was considered severe. Mild dilatation of the left atrium and ventricle with ejection fraction 57% were identified. Pulmonary artery systolic pressure derived from a mild tricuspid regurgitation was estimated 42 mmHg. In addition an excavation of the medium interventricular septum with a closure of its mouth during systole and opening during diastole was observed. Of note no evidence of left-right interventricular shunt was observed. Owing to the absence of myocardial infarction in the past medical history, in this case partial ventricular septum defect was considered “Pac-man heart” of congenital origin. After ruling out coronary artery disease by coronary angiography, patient underwent surgical repair of the severe mitral regurgitation by quadrangular resection and posterior leaflet sliding plus annuloplasty. The abnormal cavity of ventricular septum was confirmed by intraoperative evaluation but, taking into account the absence of shunt at colour flow mapping, surgical treatment of Pac-man heart was not indicated. At 3 months follow-up patient was asymptomatic and echocardiography revealed mild residual mitral regurgitation. Conclusion We described a case of Pac-man heart, detected as an incidental finding, in a patient with organic mitral valve regurgitation. A common embryological disorder involving the mesenchymal cells of the cardiac cushions could be hypothesized to explain this previously unreported association of Pac-man heart and mitral valve prolapse. 578 Atrial myxoma: what is the best management in pregnancy? Alvise Del Monte Alvise Del Monte Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Alice Benedetti Alice Benedetti Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Maurizio Rubino Maurizio Rubino Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Alessandra Zambon Alessandra Zambon Obstetrics and Gynecology Clinic, Department of Women and Children’s Health, University of Padua italy, Padua Benedetta Giorgi Benedetta Giorgi Institute of Radiology, Department of Medicine, University f Padua italy, Padua Martina Perazzolo Marra Martina Perazzolo Marra Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Stefania Rizzo Stefania Rizzo Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Sabino Iliceto Sabino Iliceto Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Daniela Mancuso Daniela Mancuso Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Obstetrics and Gynecology Clinic, Department of Women and Children’s Health, University of Padua italy, Padua Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Padua Institute of Radiology, Department of Medicine, University f Padua italy, Padua Cardiac myxoma during pregnancy is a rare condition with only a few cases described in the literature. Its management is complicated by the absence of specific recommendations and information about the risks related to both mother and fetus. We describe a case of a 37-year-old woman at 22 weeks’ gestation presenting with a cardiac mass in the left atrial posterior wall diagnosed by transthoracic echocardiogram (A, B). A cardiac magnetic resonance confirmed the presence of a sessile atrial mass isointense to myocardium on T1-weighted sequences and hyperintense to myocardium on T2-weighted sequences, compatible with a myxoid lesion or a high cellularity tissue (C, D). After multidisciplinary consultation, the decision was to postpone surgery and follow the pregnant woman with serial transthoracic echocardiograms in an outpatient setting until Foetal maturity. No changes were registered in the atrial mass characteristics during the follow-up. At 35 weeks’ gestation, an elective cesarean delivery was performed without complications. Six weeks later the woman underwent cardiac surgery on cardiopulmonary bypass and the whole tumor was excised. The postoperative course was uneventful, and the patient was discharged on day 5. Histological examination confirmed the diagnosis of a smooth sessile pseudo vascular myxoma of the left atrium (E, F). Short- and long-term follow-up did not show any recurrences of the cardiac mass. 127 A rare case of tricuspid valve Libman-Sacks endocarditis in a pregnant woman with primary antiphospholipid syndrome Vittoria Cuomo Vittoria Cuomo Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Silvia Orefice Silvia Orefice Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Ludovica Fiorillo Ludovica Fiorillo Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Teresa Fedele Teresa Fedele Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Valentina Capone Valentina Capone Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Ofelia Casciano Ofelia Casciano Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Federica Luciano Federica Luciano Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Mario Enrico Canonico Mario Enrico Canonico Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Ciro Santoro Ciro Santoro Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Roberta Esposito Roberta Esposito Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli A 38-year-old pregnant woman at 17 weeks gestational age of her sixth pregnancy presented to a cardiology clinic. Her obstetric anamnesis was significant for 3 previous pregnancies complicated by Foetal growth restriction and for 2 spontaneous pregnancy losses. During her last pregnancy loss, she had a pleuro-pericarditis. In consideration of the previous pleuro-pericarditis, her gynecologist prescribed a cardiological checkup and an echocardiogram. It revealed a large mobile mass with irregular borders, attached to the sub-valvular apparatus of the tricuspid anterior leaflet, presenting heterogeneous echogenicity. Its dimensions, measured by multiplanar 3 D echocardiography were 2 cm x 1.5 cm. Urgent cardiac magnetic resonance with gadolinium confirmed the presence of a highly mobile mass with irregular borders attached to the tricuspid valve chordae with low signal intensity and no contrast uptake suggestive of thrombus. A workup was ordered to rule out antiphospholipid syndrome (APS): anticardiolipin antibody IgG and anti-b2 glycoprotein-1 IgG tested positive, while lupus anticoagulant was negative. As there were no features suggestive of connective diseases, the patient received a diagnosis of primary APS, pending confirmation of the positivity of the antiphospholipid antibodies at second sampling after at least 12 weeks. The mass on the tricuspid valve was reinterpreted as vegetation secondary to Libman-Sacks endocarditis. Despite adequate anticoagulant therapy for 3 weeks, guided by the anti-factor Xa assays for dose adjustment, transthoracic three-dimensional echocardiography showed the persistence of the vegetation, without changes in its size. There are no expert suggestions on management strategy for Libman-Sacks endocarditis on the tricuspid valve. Systemic emboli occur in nearly 50% of patients with nonbacterial thrombotic endocarditis. Therapeutic options for our patient included conservative therapy with anticoagulants, thrombolysis, or surgical excision. Enoxaparin did not give appreciable Results. The thrombolytic approach was discarded because of potentially harmful side effects for the fetus. A multidisciplinary counseling with obstetricians, cardiologists, anesthesiologists, and cardiac surgeons was requested. Considering the high risk of intracardiac mass detachment, with subsequent massive pulmonary embolism, an early lifesaving surgical thrombectomy was recommended. The patient underwent open-heart surgery with vegetation excision. The removed mass appeared slightly attached to the anterior tricuspid leaflet through an inflammatory process and trapped into a 1-order tendon cord. After 2 days in the Intensive Care Unit, she was transferred for 7 days to the Cardiology Department and then discharged. Histological findings of the excised vegetation were consistent with Libman-Sacks endocarditis. At 34 + 3 weeks of gestation, computerized Foetal heart rate analysis presented repeated deceleration and abnormal short term variability. Therefore, an emergency cesarean section was performed. A female newborn weighed 1295 grams was born. The newborn was discharged on day 30 after her clinical condition remained stable. To our knowledge, no case of surgical treatment of isolated tricuspid vegetation, ie not associated with valve regurgitation, has been previously reported. APS should be strongly suspected in any patient with echocardiographic evidence of valvular thickening or valve nodules and history of pregnancy losses and/or thromboses. The indication and timing of the surgical intervention must be decided by a multidisciplinary team. 406 Aseous calcification of the mitral annulus assesed by tridimensional transesophageal echocardiography Giuseppe Fede Giuseppe Fede U.O.C. di Cardiologia, Ospedale Maggiore di Modica Giuseppe Abate Giuseppe Abate U.O.C. di Cardiologia, Ospedale Maggiore di Modica Paola Belluardo Paola Belluardo U.O.C. di Cardiologia, Ospedale Maggiore di Modica Carmelo Di Tommasi Carmelo Di Tommasi U.O.C. di Cardiologia, Ospedale Maggiore di Modica Maria Luisa Guarrella Maria Luisa Guarrella U.O.C. di Cardiologia, Ospedale Maggiore di Modica Nicoletta Guccione Nicoletta Guccione U.O.C. di Cardiologia, Ospedale Maggiore di Modica Guglielmo Piccione Guglielmo Piccione U.O.C. di Cardiologia, Ospedale Maggiore di Modica Salvatore Solarino Salvatore Solarino U.O.C. di Cardiologia, Ospedale Maggiore di Modica Giovanni Tasca Giovanni Tasca U.O.C. di Cardiologia, Ospedale Maggiore di Modica Sabina Ficili Sabina Ficili U.O.C. di Cardiologia, Ospedale Maggiore di Modica U.O.C. di Cardiologia, Ospedale Maggiore di Modica Aims Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification. Transthoracic echocardiography is the first diagnostic step, but a multi-modality imaging approach can be necessary to differentiate among other intra-cardiac masses. We present a case of CCMA in a 88 year-old woman admitted for acute decompensation of chronic heart failure. Transthoracic echocardiography showed pathognomonic findings of CCMA. Tridimensional-transesophageal echocardiography allowed a better characterizations of the CCMA, avoiding further diagnostic procedures. 81 Misalignment of hemodynamic forces in the left ventricle is associate with adverse remodelling following STEMI Domenico Filomena Domenico Filomena Sapienza, Università di Roma Luciano Agati Luciano Agati Sapienza, Università di Roma Sara Cimino Sara Cimino Università di Trieste Sara Monosilio Sara Monosilio Sapienza, Università di Roma Lucia Ilaria Birtolo Lucia Ilaria Birtolo Sapienza, Università di Roma Nicola Galea Nicola Galea Sapienza, Università di Roma Marco Francone Marco Francone Sapienza, Università di Roma Giuseppe Mancuso Giuseppe Mancuso Sapienza, Università di Roma Francesca Riccio Francesca Riccio Sapienza, Università di Roma Nicola Pierucci Nicola Pierucci Sapienza, Università di Roma Gianni Pedrizzetti Gianni Pedrizzetti Università di Trieste Giovanni Tonti Giovanni Tonti Gabriele D’annunzio, Università di Chieti Viviana Maestrini Viviana Maestrini Sapienza, Università di Roma Francesco Fedele Francesco Fedele Sapienza, Università di Roma Università di Trieste Sapienza, Università di Roma Gabriele D’annunzio, Università di Chieti Aims Infarct size (IS), area at risk (AAR) and microvascular obstruction (MVO) are well known predictors of adverse remodelling (aLVr) following acute myocardial infarction, while the pathogenic role of left ventricular (LV) hemodynamic forces (HDFs) is still unknown. Recent evidence suggests the role of HDFs in positive and negative on remodelling after pathogenic or therapeutic events. The aim of the study was to identify LV HDFs patterns associated with aLVr in reperfused ST-segment elevation MI (STEMI) patients. Methods and results Forty-nine acute STEMI patients underwent CMR at 1 week (baseline) and 4 months (follow-up) after MI. The following parameters were measured: left ventricular end-diastolic and end-systolic volume index for body surface area (BSA) (LVEDVi and LVESVi), left ventricular ejection fraction (LVEF), LV mass index, AAR and IS. LV HDFs were computed at baseline from cine CMR long axis datasets using a novel method based on LV endocardial boundary tracking. LV HDFs were calculated both in apex-base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs were evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). All HDFs parameters are computed over the entire heartbeat, in systole and diastole. LV adverse remodelling (aLVr) was defined as a relative increase in LVESV of at least 15% from baseline (ΔLV-ESV ≥15%).Patients with aLVr (n = 18; 37%) had significant greater value of AAR (32 ± 23 vs 22 ± 18; p = 0.03) and slightly larger IS (23 ± 16 vs 15 ± 11; p = 0.07) at baseline. In patients with adverse LVr at FU, baseline systolic L-S HDF were lower (2.7 ± 0.9 vs 3.6 ± 1; p = 0.027) while diastolic L-S/A-B HDF ratio was significantly higher (28 ± 14 vs 19 ± 6; p = 0.03), reflecting higher grade of diastolic HDFs misalignment. At univariate logistic regression analysis, higher IS [Odd ratio (OR) 1.05; 95% confidence interval (95% CI) 1.01-1.1; p = 0.04], lower L-S HDFs (OR 0.41; 95% CI 0.2-0.9; p = 0.04] and higher diastolic L-S/A-B HDFs ratio (OR 1.1; 95% CI 1.01-1.2; p = 0.05) were associated with aLVr at FU. At multivariable logistic regression analysis, L-S/A-B HDF ratio remained the only independent predictor of adverse LV remodelling after correction for other baseline determinants. Conclusion Changes in the hemodynamic forces after STEMI are associated with aLVr observed after 4 months. Specifically, after correction for other known determinants of remodelling, L-S/A-B HDF ratio remained the only independent predictor of adverse LV remodelling. 83 Effect of infarct size on left ventricular mechanics and intraventricular hemodynamic forces: a CMR study in a cohort of STEMI patients Domenico Filomena Domenico Filomena Sapienza, Università di Roma Luciano Agati Luciano Agati Sapienza, Università di Roma Sara Monosilio Sara Monosilio Sapienza, Università di Roma Sara Cimino Sara Cimino Sapienza, Università di Roma Lucia Ilaria Birtolo Lucia Ilaria Birtolo Sapienza, Università di Roma Elena Cozza Elena Cozza Sapienza, Università di Roma Gianni Pedrizzetti Gianni Pedrizzetti Università di Trieste Giovanni Tonti Giovanni Tonti Gabriele D’annunzio, Università di Chieti Nicola Galea Nicola Galea Sapienza, Università di Roma Marco Francone Marco Francone Sapienza, Università di Roma Giuseppe Mancuso Giuseppe Mancuso Sapienza, Università di Roma Michele Sannino Michele Sannino Sapienza, Università di Roma Francesco Fedele Francesco Fedele Sapienza, Università di Roma Viviana Maestrini Viviana Maestrini Sapienza, Università di Roma Sapienza, Università di Roma Università di Trieste Gabriele D’annunzio, Università di Chieti Aims Infarct size (IS) is a well-known predictor of adverse remodelling (aLVr) following acute myocardial infarction. The influence of IS on left ventricular (LV) mechanics by strain analysis and intraventricular (IV) fluid dynamics by analysis of hemodynamic forces (HDFs) is still under debate. The aim of the study was to compare myocardial deformation and IV hemodynamic forces (HDFs) distribution in patients with different ranges of IS. Methods and results Forty-nine acute STEMI patients underwent CMR at 1 week after the acute event. The following parameters were measured: left ventricular end-diastolic and end-systolic volumes indexed for body surface area (BSA) (LVEDVi and LVESVi), left ventricular ejection fraction (LVEF), LV mass index and infarct size (IS). Large IS was defined as IS > 15% of LV mass. LV deformation was evaluated through CMR feature tracking. The following parameters were evaluated: global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS). For GLS and GCS both endocardial and transmural values were computed. LV HDFs were assessed from breath-hold steady-state free-precession cine-CMR long axis datasets using a novel method based on LV endocardial boundary tracking. LV HDFs were calculated both in apex-base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs were evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %).Patients with large IS showed greater LVESVi (41 ± 12 mL vs 30 ± 10 mL; p = 0.01) and lower LVEF (44 ± 9 mL vs 54 ± 9 mL; p = 0.02) compared to smaller IS (Table). No significant differences were found in LVEDVi (72 ± 14 vs 65 ± 12; p = 0.14). With regard to myocardial deformation, larger infarcts showed lower values of endocardial and transmural GLS (GLS-endo -12 ± 5% vs -16 ± 4%; p = 0.008; GLS-myo -11 ± 4% vs -16 ± 3%; p = 0.004) and GCS (GCS-endo -23 ± 5% vs -27 ± 4%; p = 0.01; GCS-myo -15 ± 4% vs -20 ± 4%; p = 0.003) while GRS did not differ between the two groups (GRS 44 ± 16% vs 51 ± 13%; p = 0.149). A-B HDFs were lower among patients with larger infarcts both in systole (17 ± 7% vs 23 ± 5%; p = 0.006) and diastole (7 ± 3%vs 11 ± 8%; p = 0.02). While HDFs distribution did not differ in systole (17 ± 4% vs 16 ± 5%; p = 0.494), patients with larger infarcts had significant misalignment of HDFs in diastole (26 ± 11% vs 20 ± 10%; p = 0.032). Conclusion Infarct size significant affects myocardial mechanics and intraventricular fluid hemodynamic. CMR feature tracking and HDFs estimation may improve physiopathological understanding on wall-fluid mechanic interaction in STEMI patients. 84 Relationship of infarct location, left ventricular mechanics and intraventricular hemodynamic forces: results from a CMR study Domenico Filomena Domenico Filomena Sapienza, Università di Roma Luciano Agati Luciano Agati Sapienza, Università di Roma Sara Monosilio Sara Monosilio Sapienza, Università di Roma Sara Cimino Sara Cimino Sapienza, Università di Roma Lucia Ilaria Birtolo Lucia Ilaria Birtolo Sapienza, Università di Roma Federica Toto Federica Toto Sapienza, Università di Roma Gianni Pedrizzetti Gianni Pedrizzetti Università di Trieste Giovanni Tonti Giovanni Tonti Gabriele D’annunzio, Università di Chieti Nicola Galea Nicola Galea Sapienza, Università di Roma Marco Francone Marco Francone Sapienza, Università di Roma Giuseppe Mancuso Giuseppe Mancuso Sapienza, Università di Roma Viviana Maestrini Viviana Maestrini Sapienza, Università di Roma Francesco Fedele Francesco Fedele Sapienza, Università di Roma Sapienza, Università di Roma Università di Trieste Gabriele D’annunzio, Università di Chieti Aims Patients with acute anterior myocardial infarction (MI) experience more pronounced adverse left ventricular (LV) remodelling and have worse prognosis. Myocardial deformation imaging and intracardiac fluid dynamic hold the potential to add physiolopathological insight, however their relation with infarct location is not known. The aim of the study was to evaluate the effects of infarct location on left ventricular mechanics and intraventricular hemodynamic forces (HDFs). Methods and results Forty-nine acute STEMI patients underwent CMR at 1 week after the acute event. Left ventricular end-diastolic and end-systolic volumes indexed for body surface area (LVEDVi), left ventricular ejection fraction (LVEF), LV mass index, area at risk (AAR) and infarct size (IS) were measured. LV deformation was evaluated through CMR feature tracking. The following parameters were evaluated: global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS). For GLS and GCS both endocardial and transmural values were computed. LV HDFs were assessed from breath-hold steady-state free-precession cine-CMR long axis datasets using a novel method based on LV endocardial boundary tracking. LV HDFs were calculated both in apex-base (A-B) and latero-septal (L-S) directions. HDFs were computed in systole, diastole and over the entire cardiac cycle. The distribution of LV HDFs were evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). STEMI patients were divided on the base of location (anterior vs. non-anterior). Anterior STEMI (63%) had larger IS (32 ± 21% vs 14 ± 13%; p = 0.012) and AAR (22 ± 14 vs 11 ± 10; p = 0.016). Even if LVEF did not differed between two groups, anterior STEMI had lower values of GLS (GLS-endo: -12 ± 4% vs -18 ± 3%; p = 0.001 and GLS-myo: -12 ± 4% vs-13 ± 5%; p = 0.02) while no significant differences in GCS and GRS were detected. Patients with anterior STEMI had slightly lower systolic and diastolic A-B HDFs (respectively 18 ± 6% vs 22 ± 6%; p = 0.08, 7 ± 4% vs 11 ± 9%, p = 0.08), but without reaching significant statistical difference. On the other side, systolic but not diastolic L-S HDFs were significantly lower in anterior STEMI (respectively 2.8 ± 0.9% vs 3.9 ± 1%, p = 0.01; 1.6 ± 0.6% vs 2 ± 1.4%, p = 0.782). HDFs distribution, assesses by L-S/A-B HDFs ratio was not affected by infarct location (systolic L-S/A-B HDFs ratio: 16 ± 5% vs 18 ± 4%, p = 0.494; diastolic L-S/A-B HDFs ratio: 24 ± 10% vs 20 ± 12%, p = 0.075). Conclusion Patients with anterior STEMI had larger MI and area at risk, significantly reduced longitudinal strain and systolic L-S HDFs. The clinical impact of these observations should be further assesses in larger cohort. 298 Right atrial three-dimensional volume is a major determinant of tricuspid annulus area in functional tricuspid regurgitation Florescu Diana Ruxandra Florescu Diana Ruxandra Department of Medicine and Surgery, University of Milano-Bicocca italy, Via Cadore 48, Monza Craiova University of Medicine and Pharmacy, 2 Petru Rares St romania, Craiova Luigi Paolo Badano Luigi Paolo Badano Department of Medicine and Surgery, University of Milano-Bicocca italy, Via Cadore 48, Monza Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Istituto Auxologico Italiano, IRCCS, S. Luca Hospital italy, Piazzzale Brescia 20, Milan Karima Addetia Karima Addetia Department of Medicine, Section of Cardiology, University of Chicago usa, 5801 S Ellis Ave, Chicago, IL Andrada C Guta Andrada C Guta Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Carol Davila University of Medicine and Pharmacy Romania, 8 Eroii Sanitari BLD., Bucharest Roberto C Ochoa-Jimenez Roberto C Ochoa-Jimenez Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Internal Medicine Department, Mount Sinai St. Luke and Mount Sinai West usa, New york Davide Genovese Davide Genovese Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Federico Veronesi Federico Veronesi University of Bologna, Department of Electrical, Electronic and Information Engineering Italy, Via Zamboni 33, Bologna Cristina Basso Cristina Basso Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Sabino Iliceto Sabino Iliceto Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Roberto M Lang Roberto M Lang Department of Medicine, Section of Cardiology, University of Chicago usa, 5801 S Ellis Ave, Chicago, IL Denisa Muraru Denisa Muraru Department of Medicine and Surgery, University of Milano-Bicocca italy, Via Cadore 48, Monza Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Istituto Auxologico Italiano, IRCCS, S. Luca Hospital italy, Piazzzale Brescia 20, Milan Department of Medicine and Surgery, University of Milano-Bicocca italy, Via Cadore 48, Monza Craiova University of Medicine and Pharmacy, 2 Petru Rares St romania, Craiova Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua italy, Via Giustiniani 2, Padua Istituto Auxologico Italiano, IRCCS, S. Luca Hospital italy, Piazzzale Brescia 20, Milan Department of Medicine, Section of Cardiology, University of Chicago usa, 5801 S Ellis Ave, Chicago, IL Carol Davila University of Medicine and Pharmacy Romania, 8 Eroii Sanitari BLD., Bucharest Internal Medicine Department, Mount Sinai St. Luke and Mount Sinai West usa, New york University of Bologna, Department of Electrical, Electronic and Information Engineering Italy, Via Zamboni 33, Bologna Aims Tricuspid annulus (TA) dilation and functional tricuspid regurgitation (FTR) are generally considered to be secondary to right ventricular (RV) remodelling. Our aim was to assess the relationship of TA area (TAA) with right atrial maximal volume (RAVmax) and RV end-diastolic volume (RVEDV) in FTR patients and healthy subjects. Methods and results We enrolled 280 patients (median age 66 years, 59% women) with FTR due to left heart disease (LHD), pulmonary hypertension (PH), corrected Tetralogy of Fallot (TOF), chronic atrial fibrillation (AF), and 210 healthy volunteers (45 years, 53% women). We measured TAA at mid-systole and end-diastole, tricuspid tenting volume, RAVmax and RVEDV by 3 D echocardiography. Irrespective of TA measurement timing, TAA correlated more closely with RAVmax than with RVEDV in both controls and FTR patients. On multivariable analysis, RAVmax was the most important determinant of TAA, accounting for 41% (normals) and 56% (FTR) of TAA variance. In FTR patients, age, RVEDV and left ventricular ejection fraction were also independently correlated with TAA. RAVmax (AUC = 0.81) and TAA (AUC = 0.78) had a greater ability than RVEDV (AUC = 0.72) to predict severe FTR (p < 0.05). Among FTR patients, those with AF had the largest RAVmax and smallest RVEDV. RAVmax and TA were significantly dilated in all FTR groups, except TOF. PH and TOF had largest RVEDV, yet tenting volume was increased only in PH and LHD. Conclusion RA volume is a major determinant of TAA, and RA enlargement is an important mechanism of TA dilation in FTR irrespective of cardiac rhythm and RV loading conditions. 245 Additional prognostic role of strain with stress cardiac magnetic resonance (progress study) Marco Guglielmo Marco Guglielmo Centro Cardiologico Monzino , Milano Laura Fusini Laura Fusini Centro Cardiologico Monzino , Milano Francesca Baessato Francesca Baessato Centro Cardiologico Monzino , Milano Antonella Loffreno Antonella Loffreno Centro Cardiologico Monzino , Milano Giuseppe Muscogiuri Giuseppe Muscogiuri Centro Cardiologico Monzino , Milano Andrea Baggiano Andrea Baggiano Centro Cardiologico Monzino , Milano Alberico Del Torto Alberico Del Torto Centro Cardiologico Monzino , Milano Stefano Scafuri Stefano Scafuri Centro Cardiologico Monzino , Milano Mario Babbaro Mario Babbaro Centro Cardiologico Monzino , Milano Rocco Mollace Rocco Mollace Centro Cardiologico Monzino , Milano Andrea Igoren Guaricci Andrea Igoren Guaricci Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari , Bari Saim Mushtaq Saim Mushtaq Centro Cardiologico Monzino , Milano Edoardo Conte Edoardo Conte Centro Cardiologico Monzino , Milano Mauro Pepi Mauro Pepi Centro Cardiologico Monzino , Milano Gianluca Pontone Gianluca Pontone Centro Cardiologico Monzino , Milano Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari , Bari Centro Cardiologico Monzino , Milano Aims Stress cardiovascular magnetic resonance (S-CMR) has been recognized as a reliable technique for the diagnosis and prognostic stratification of patients with known or suspected coronary artery disease (CAD). Recently, the novel technique of feature-tracking (FT) strain has been applied to S-CMR in order to improve the risk stratification of patients. However, no data are available on the prognostication role of FT strain in patients undergoing a S-CMR with dypiridamole. Aim of this study is to assess the additional role of FT strain in the longterm risk stratification of a large population of patients with known or suspected CAD undergoing a S-CMR with dypiridamole. Methods and results 731 consecutive patients (age: 63 ± 10 y, male 84%) with stable typical or atypical symptoms suggesting possible cardiac ischemia underwent dipyridamole S-CMR. The patients were followed up for 5.8 ± 1.2 years. CMR-FT analysis of steady state free precession (SSFP) short and long axis cine images obtained in rest and stress conditions was performed in each patient to obtain 2 D global peak systolic rest and stress longitudinal (GLS), circumferential (GCS) and radial strains (GRS). Major adverse cardiac events (MACE) were defined as myocardial infarction and cardiac death. MACE occurred in 64 (8.7%) patients. Patients experiencing MACE showed higher indexed left ventricular (LV) end-diastolic (EDVi), end-systolic (ESVi) volumes and lower LV ejection fraction (LVEF), higher late-gadolinium enhancement (LGE) presence and reduced both rest and stress GLS, GCS and GRS. At multivariable analysis, LVEDVi (HR 1,01 [95% CI 1.001-1.022]) and LGE (HR 2.399 [95% CI 1.322-4.355] were independently associated with MACE (p = 0.027 and p = 0.04 respectively). By Kaplan-Meier analysis, patients with stress GLS ≥ -15.35% had significantly reduced event-free survival compared with those with stress GLS < -15.35 (log-rank p = 0.001). A model based on stress GCS > - 15.3% plus LVEDVi showed a similar prognostication value of a model made of LVEDVi plus LGE. Conclusion In patients with known or suspected CAD undergoing S-CMR with dypiridamole, a model based on LVEDVi plus stress GCS owns a prognostication value similar to LVEDVi plus LGE. 246 Computed tomography for the prediction of structural valve deterioration in patients undergoing transcatheter aortic valve implantation Marco Guglielmo Marco Guglielmo Centro Cardiologico Monzino, IRCCS , Milano Laura Fusini Laura Fusini Centro Cardiologico Monzino, IRCCS , Milano Manuela Muratori Manuela Muratori Centro Cardiologico Monzino, IRCCS , Milano Valentina Mantegazza Valentina Mantegazza Centro Cardiologico Monzino, IRCCS , Milano Giuseppe Muscogiuri Giuseppe Muscogiuri Centro Cardiologico Monzino, IRCCS , Milano Andrea Baggiano Andrea Baggiano Centro Cardiologico Monzino, IRCCS , Milano Stefano Scafuri Stefano Scafuri Centro Cardiologico Monzino, IRCCS , Milano Mario Babbaro Mario Babbaro Centro Cardiologico Monzino, IRCCS , Milano Rocco Mollace Rocco Mollace Centro Cardiologico Monzino, IRCCS , Milano Ada Collevecchio Ada Collevecchio Centro Cardiologico Monzino, IRCCS , Milano Saima Mushtaq Saima Mushtaq Centro Cardiologico Monzino, IRCCS , Milano Edoardo Conte Edoardo Conte Centro Cardiologico Monzino, IRCCS , Milano AndreaIgoren Guaricci AndreaIgoren Guaricci Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari , Bari Mauro Pepi Mauro Pepi Centro Cardiologico Monzino, IRCCS , Milano Gianluca Pontone Gianluca Pontone Centro Cardiologico Monzino, IRCCS , Milano Centro Cardiologico Monzino, IRCCS , Milano Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari , Bari Aims Computed tomography (CT) provides excellent anatomy assessment of the aortic annulus (AoA) and is currently routinely utilized for pre-procedural planning of transcatheter aortic valve implantation (TAVI). This study sought to investigate if geometrical characteristics of the AoA determined by CT may represent predictors of structural valve deterioration (SVD) in patients undergoing transcatheter aortic implantation (TAVI) with balloon-expandable valves. Methods and results AoA maximum diameter (Dmax), minimum diameter (Dmin), and area were assessed using preprocedural CT in patients undergoing TAVI in our Institution. SVD was identified with transthoracic echocardiography at 5.9 ± 1.7 follow-up years. 124 consecutive patients (mean age: 79 ± 7 years old; female: 61%) were retrospectively enrolled. AoA Dmax, Dmin and area were significantly smaller in patients with SVD compared to patients without SVD (27.1 ± 2.8 mm vs 25.6 ± 2.2 mm, p = 0.012; 21.8 ± 2.1 mm vs 20.5 ± 2.1 mm, p = 0.001 and 467 ± 88 mm2 vs 419 ± 77 mm2 p = 0.002 respectively). At univariate analysis, female sex, body surface area, the use of a -23 mm prosthetic valve a Dmax <27.1 mm and a Dmin < 19.9 mm were all variables independently associated with SVD whereas at multivariate analysis, only Dmin <19.9 mm (OR = 2.873, 95% CI: 1.191-6.929, p = 0.019) and female sex (OR = 2.659, 95% CI: 1.095-6.458, p = 0.031) were independent predictors of SVD. Conclusion Female sex and AoA Dmin < 19.9 mm are associated to SVD in patients undergoing TAVI with balloon explandable valves. 92 Evaluation of aortic regurgitation severity grade in bicuspid valve patients: differences between echocardiography and CMR Lucia La Mura Lucia La Mura Department of Advanced Biomedical Sciences—University of Naples, Federico II (Italy) Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Marta Barletta Marta Barletta Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Regina Sorrentino Regina Sorrentino Department of Advanced Biomedical Sciences—University of Naples, Federico II (Italy) Maria Luz Servato Maria Luz Servato Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Andrea Guala Andrea Guala Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Gisela Teixido-Tura Gisela Teixido-Tura Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Aroa Ruiz-Munoz Aroa Ruiz-Munoz Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Arturo Evangelista Arturo Evangelista Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Jose F Rodriguez-Palomares Jose F Rodriguez-Palomares Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Department of Advanced Biomedical Sciences—University of Naples, Federico II (Italy) Cardiovascular Imaging Department- University Hospital” Vall D’hebron”, Ciber-CV, Barcelona (Spain) Aims EACVI recommends the use of an ‘‘integrative approach’’, using several parameters, in aortic regurgitation (AR) quantification. This approach is easily achieved by echocardiography, although cardiovascular magnetic resonance (CMR) remains the gold standard for the quantification of regurgitant fraction (RF). The aim of the study was to analyze the accuracy of AR grading by CMR (using RF) compared to the ‘‘integrative approach’’ of echocardiography in Bicuspid Valve (BAV) patients. Methods and results 96 BAV patients (33% female, 54.6 ± 15.6 years) with different severity grades of chronic AR were enrolled. All patients underwent CMR and echocardiography studies. AR by CMR was considered as absent ( < = 1%), mild ( < =15%), moderate (>15% and <30%) or severe ( > =30%) depending on RF value at valve level. AR was graded by echocardiography as absent, mild, moderate or severe, according to current recommendations. Furthermore, AR was divided by regurgitant jet type in central (41.2%) and eccentric (58.8%). AR was quantified by the same qualified cardiologist in both Methods. Cohen’s K was run to determine if there was agreement between echocardiography and CMR: poor concordance was found (k = 0.202, p < 0.0005). Fair agreement was found only on absent (k = 0.368) and severe AR (k = 0.290), p < 0.005. More than mild AR was found in 47 (49%) patients by echocardiography, vs. 19 (19.8%) by CMR (Table.1). 60 patients (62.5%), almost all with mild or moderate AR, showed different severity grades in the two imaging Methods. In this class of patients, the disagreement does not depend on the jet type (chi-square = 0.43, p = 0.51), neither on age (p = 0.672) or aortic sinus diameter (p = 0.747) Conclusion In BAV patients, the quantification of AR severity by CMR has a poor concordance with the severity grade by the echocardiography. No influence seems to derive from the regurgitant jet type, age or aortic diameter. Nowadays echocardiography remains the gold standard for AR quantification. It is necessary to validate the assessment of chronic AR severity by CMR identifying additional parameters. Table 1 . AR SEVERITY GRADE BY CMR . AR SEVERITY GRADE BY ECHO . ABSENT . MILD . MODERATE . SEVERE . TOTAL . ABSENT 10 18 0 0 28 MILD 2 19 0 0 21 MODERATE 0 27 6 3 36 SEVERE 0 1 7 3 11 TOTAL 12 65 13 6 96 . AR SEVERITY GRADE BY CMR . AR SEVERITY GRADE BY ECHO . ABSENT . MILD . MODERATE . SEVERE . TOTAL . ABSENT 10 18 0 0 28 MILD 2 19 0 0 21 MODERATE 0 27 6 3 36 SEVERE 0 1 7 3 11 TOTAL 12 65 13 6 96 Open in new tab Table 1 . AR SEVERITY GRADE BY CMR . AR SEVERITY GRADE BY ECHO . ABSENT . MILD . MODERATE . SEVERE . TOTAL . ABSENT 10 18 0 0 28 MILD 2 19 0 0 21 MODERATE 0 27 6 3 36 SEVERE 0 1 7 3 11 TOTAL 12 65 13 6 96 . AR SEVERITY GRADE BY CMR . AR SEVERITY GRADE BY ECHO . ABSENT . MILD . MODERATE . SEVERE . TOTAL . ABSENT 10 18 0 0 28 MILD 2 19 0 0 21 MODERATE 0 27 6 3 36 SEVERE 0 1 7 3 11 TOTAL 12 65 13 6 96 Open in new tab 565 Normal reference ranges of non invasive left ventricular myocardial work in paediatric age Isabella Leo Isabella Leo Magna Graecia University , Catanzaro Jolanda Sabatino Jolanda Sabatino Magna Graecia University , Catanzaro Nunzia Borrelli Nunzia Borrelli Royal Brompton Hospital , London Martina Avesani Martina Avesani Royal Brompton Hospital , London Enrico Piccinelli Enrico Piccinelli Royal Brompton Hospital , London Manjit Josen Manjit Josen Royal Brompton Hospital , London Josefa Paredes Josefa Paredes Royal Brompton Hospital , London Antonio Strangio Antonio Strangio Magna Graecia University , Catanzaro Sabrina La Bella Sabrina La Bella Magna Graecia University , Catanzaro Salvatore De Rosa Salvatore De Rosa Magna Graecia University , Catanzaro Ciro Indolfi Ciro Indolfi Magna Graecia University , Catanzaro Giovanni Di Salvo Giovanni Di Salvo University of Padua , Padova Magna Graecia University , Catanzaro Royal Brompton Hospital , London University of Padua , Padova AIMS Myocardial work (MW) estimation by pressure-strain loops (PSL) allows a non-invasive evaluation of myocardial performance, as recently demonstrated in adult patients. Aim of this study is to provide the reference values for global myocardial work index (MWI), constructive work (MCW), wasted work (MWW), and work efficiency (MWE) in a group of healthy children. Methods and results Assessment of MW was performed using a commercially available software package (Echopac, GE). MW was measured from PSLs areas, derived from non-invasive LVP curves combined with strain acquired speckle tracking echocardiography (STE). After calculating GLS, values of brachial blood pressure were inserted and the time of valvular events by echocardiography were indicated, then the software was able to measure non-invasive PSLs. Two-dimensional (2 D) standard and speckle-tracking echocardiography were performed in 90 healthy children (mean age 9.9 ± 4.9 [1-17] years, females: 57%) together with the assessment of MW by means of PSLs. Mean ± standard deviation, 5° and 95° percentile values for global MWI, MCW, MWW, and MWE in the whole population were 1769 ± 254 mm Hg, (1354-2193); 2201 ± 290 mm Hg, (1657-2658); 78 ± 47 (29-163) mm Hg%; 96 ± 1.8 (92-99)%, respectively. CONCLUSION The assessment of MW is feasible in healthy children. This study provides useful 2-dimensional echocardiographic reference ranges for novel indices of non-invasive MW. 403 Anthracyclines therapy and regional myocardial damage in breast cancer patients: how, when and where? Roberto Licordari Roberto Licordari Department of Clinical and Experimental Medicine—Cardiology Unit, University of Messina , Messina Roberta Manganaro Roberta Manganaro Department of Clinical and Experimental Medicine—Cardiology Unit, University of Messina , Messina Giorgio Firetto Giorgio Firetto Department of Clinical and Experimental Medicine—Cardiology Unit, University of Messina , Messina Filippo Mancuso Filippo Mancuso Department of Clinical and Experimental Medicine—Cardiology Unit, University of Messina , Messina Maurizio Cusmà Piccione Maurizio Cusmà Piccione Department of Clinical and Experimental Medicine—Cardiology Unit, University of Messina , Messina Rosalinda Madonna Rosalinda Madonna Institute of Cardiology, University of Pisa , Pisa Ines Monte Ines Monte Department of General Surgery and Medical-Surgery Specialities—Cardiology, University of Catania , Catania Giuseppina Novo Giuseppina Novo Department of Cardiology, University of Palermo , Palermo Valentina Mercurio Valentina Mercurio Department of Traslational Medical Sciences, Federico II Unive italy Rsity, Naples Christian Cadeddu Dessalvi Christian Cadeddu Dessalvi Department of Medical Sciences and Public Health, University of Cagliari , Cagliari Martino Deidda Martino Deidda Department of Medical Sciences and Public Health, University of Cagliari , Cagliari Pasquale Pagliaro Pasquale Pagliaro Department of Clinical and Biological Sciences, University of Torino , Turin Paolo Spallarossa Paolo Spallarossa Cardiovascular Diseases Unit, IRCSS Ospedale Policlinico San Martino , Genova Carlo Gabriele Tocchetti Carlo Gabriele Tocchetti Interdepartmental Centre of Clinical and Traslational Research (Circet), Federico II University , Naples Concetta Zito Concetta Zito Department of Clinical and Experimental Medicine—Cardiology Unit, University of Messina , Messina Department of Clinical and Experimental Medicine—Cardiology Unit, University of Messina , Messina Institute of Cardiology, University of Pisa , Pisa Department of General Surgery and Medical-Surgery Specialities—Cardiology, University of Catania , Catania Department of Cardiology, University of Palermo , Palermo Department of Traslational Medical Sciences, Federico II Unive italy Rsity, Naples Department of Medical Sciences and Public Health, University of Cagliari , Cagliari Department of Clinical and Biological Sciences, University of Torino , Turin Cardiovascular Diseases Unit, IRCSS Ospedale Policlinico San Martino , Genova Department of Human Pathology of Adult and Evolutive Age G. Barresi, Medical Oncology Unit, University of Messina , Messina Interdepartmental Centre of Clinical and Traslational Research (Circet), Federico II University , Naples Aims In breast cancer (BC) patients treated with anthracyclines-based therapies we aim at assessing whether adjuvant drugs impact cardiac function differently, and whether their cardiotoxicity has a regional pattern. Cardiotoxicity is a leading cause of morbidity and mortality in cancer survivors. Cardiac dysfunction related to chemotherapy treatment is the main manifestation (Cancer Therapeutics Related - Cardiac Dysfunction CTR-CD). Methods and results In a multicenter study, 146 BC patients with anthracycline-naïve breast cancer (mean age 56 ± 11 years) were prospectively enrolled and divided into 3 groups according to the received treatments: AC/EC(doxorubicin or epirubicin + cyclophosphamide)-Group (n = 30), AC/EC/Tax (AC/EC + taxanes)-Group (n = 69), FEC/Tax (AC/EC/Tax + fluorouracil)-Group (n = 47). Fifty- six patients of the total cohort also received trastuzumab. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were calculated before starting chemotherapy (T0), at 3 months (T3), at 6 (T6) and 12 months (T12). We defined cardiotoxicity as a ≥ 10% reduction in the ejection fraction (EF) of the left ventricle between pre- and post-chemotherapy. A relative reduction of ≥ 15% in GLS values between pre- and post-chemotherapy was considered clinically significant for the definition of cardiac dysfunction related to chemotherapy treatment. The calculated mean duration of the overall follow-up was 309 ± 109 days. A ≥ 10% drop of EF, while remaining within the normal range, was reached at T6 in 25.3% of patients from the whole cohort with an early decrease only in FEC/Tax-Group (p = 0.04). A ≥ 15% GLS reduction was observed in many more (61.6%) patients. GLS decreased early both in the whole population (p < 0.001) and in the subgroups. The FEC-Tax Group showed the worst GLS at T6 (Figure 3). Trastuzumab further worsened GLS at T12 (p = 0.031, Fig.2). A significant decrease in LS was observed in all segments of the left ventricle, but greater impairment was found in the (basal-mid-apical) segments of the anterior septum (mean value after chemotherapy = -14.8 ± 2.3%; Δ-LS ≥ 4%) and at the apex (mean value after chemotherapy = -16,5 ± 2,6%; Δ-LS ≥ 4%), Figure 1 CONCLUSION The decrease of GLS is more precocious and pronounced in BC patients who received FEC + taxanes. Cardiac function further worsens after 6-months of adjuvant trastuzumab. All LV segments are damaged, with the anterior septum and the apex showing the greatest impairments. 65 Usefulness of myocardial work assessment for the understanding of mechanisms underlying sacubitril/valsartan efficacy in patients with heart failure and reduced ejection fraction Federica Luciano Federica Luciano Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Valentina Capone Valentina Capone Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Ofelia Casciano Ofelia Casciano Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Mario Enrico Canonico Mario Enrico Canonico Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Silvia Orefice Silvia Orefice Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Teresa Fedele Teresa Fedele Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Vittoria Cuomo Vittoria Cuomo Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Ludovica Fiorillo Ludovica Fiorillo Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Ciro Santoro Ciro Santoro Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Roberta Esposito Roberta Esposito Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Dipartimento di Scienze Biomediche Avanzate Aou Federico II Napoli Dipartimento di Clinica Medica e Chirurgia Aou Federico II Napoli Aims Sacubitril/valsartan has shown the ability in reducing the risk of death and of hospitalization in patients with HF (heart failure) and is recommended in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite conventional therapies. Strain imaging derived myocardial work (MW) is an emerging tool for the evaluation of left ventricular (LV) mechanics by incorporating both systolic deformation and afterload burden in the analysis. To evaluate in a prospective fashion the impact of sacubitril/valsartan therapy in HF patients on MW derived parameters in relation with standard echocardiographic indices. Methods and results We recruited thirteen HF patients with indication to sacubitril/valsartan therapy according to current guidelines. Sacubitril/valsartan therapy titrated at the maximum tolerated dose. A comprehensive echo-Doppler exam, including speckle tracking derived assessment of global longitudinal strain (GLS) (in absolute value), was performed before and after a three months therapy with sacubitril/valsartan. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were calculated according to standardized procedures. Patients with more than mild aortic and mitral stenosis and/or regurgitation were excluded. Other exclusion criteria included permanent and/or persistent atrial fibrillation and inadequate echo images. The 13 patients (M/F = 11/2, age: 57 ± 8.2 years, aetiology: idiopathic in 3 patients, ischaemic in 7 patients and chemotherapy related cardiotoxicity in 3 patients, NYHA Class: II in 7 and III in 6 patients). All patients tolerated sacubitril/valsartan therapy. After the three months therapy an improvement of LVEF (from 32.3 ± 2% to 36.2 ± 6%, p = 0.015), GLS (from 9.8 ± 1% to 11.6 ± 2%, p = 0.019), GWI (from 845.0 ± 175.0 mmHg% to 1091.6 ± 336.8 mmHg%, p = 0.003), GCW (from 993.4 ± 211.6 mmHg% to 1262.7 ± 404 mmHg%, p = 0.002) and GWE (from 77 ± 11% to 81 ± 10%, p = 0.002) was observed, without significant changes in GWW (from 190 ± 121 mmHg% to 211 ± 145 mmHg%, p = 0.307). We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.66, p = 0.014). This relation remained significant even after adjusting for the extent of systolic blood pressure reduction (r = 0.54, p = 0.033). Conclusion Three months sacubitril/valsartan therapy significantly improves standard and advanced indices of LV systolic function. This improvement is due to the increase of constructive work more than to the reduction of wasted work and the increase of LVEF can be predicted by the global constructive work levels at baseline. MW assessment may help to understand the mechanisms underlying the sacubitril/valsartan therapy efficacy in HF patients. 468 Detection of coronary allograft vasculopathy by multi-layer left ventricular longitudinal strain in heart transplant recipients Carlotta Sciaccaluga Carlotta Sciaccaluga Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Giulia Elena Mandoli Giulia Elena Mandoli Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Nicolò Sisti Nicolò Sisti Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Benedetta Maria Natali Benedetta Maria Natali Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Aladino Ibrahim Aladino Ibrahim Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Daniele Menci Daniele Menci Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Luna Cavigli Luna Cavigli Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Antonio D´Errico Antonio D´Errico Department of Internal Medicine, University of Siena italy, Siena Giovanni Donati Giovanni Donati Department of Internal Medicine, University of Siena italy, Siena Serafina Valente Serafina Valente Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Sonia Bernazzali Sonia Bernazzali Department of Cardiac Surgery, University of Siena italy, Siena Massimo Maccherini Massimo Maccherini Department of Cardiac Surgery, University of Siena italy, Siena Sergio Mondillo Sergio Mondillo Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Matteo Cameli Matteo Cameli Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Marta Focardi Marta Focardi Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Department of Internal Medicine, University of Siena italy, Siena Department of Cardiac Surgery, University of Siena italy, Siena Aims Cardiac allograft vasculopathy (CAV) is an obliterative coronaropathy that develops in the transplanted human heart, representing a major cause of graft failure and mortality. Non-invasive CAV detection, especially in the early stages of the disease, is still challenging, and coronary angiography remains the gold standard. The aim of our study was to investigate the role of speckle tracking echocardiography (STE), in particular three-layer STE, in predicting CAV at early stages, and if other traditional echocardiographic, clinical or biochemical parameters could relate to CAV. Methods and results A total of 33 heart transplanted patients were enrolled and subsequently divided accordingly to the presence or absence of CAV (12 CAV +, 22 CAV -). All subjects underwent a complete transthoracic echocardiographic examination on the same day of the CA, and all conventional parameters of myocardial function were obtained, including strain values assessed by STE. Strain values were significantly reduced in presence of CAV, at each myocardial layer but in particular the endocardial-epicardial gradient (-4.15 ± 1.6 vs -1.7 ± 0.4% <.0001) that was also highly predictive of CAV (AUC at ROC curve 0.97). Among diastolic parameters, the E wave deceleration time (DT) and the mean E/e’ ratio were strongly positively associated with CAV. (Figures 1 and 2). Conclusion In our population, left ventricular global longitudinal strain (GLS), layer-specific GLS and the endocardial-epicardial LS gradient, E wave DT and E/e’ ratio were the best independent non-invasive predictors of CAV. Figure 1. Open in new tabDownload slide Figure 1. Open in new tabDownload slide Figure 2. Open in new tabDownload slide Figure 2. Open in new tabDownload slide 470 Heart transplant and antibody-mediated rejection: the role of myocardial strain as an early marker of cardiac dysfunction in patients with anti-HLA antibodies Benedetta Maria Natali Benedetta Maria Natali Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Carlotta Sciaccaluga Carlotta Sciaccaluga Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Giulia Elena Mandoli Giulia Elena Mandoli Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Nicolò Sisti Nicolò Sisti Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Francesca Maria Righini Francesca Maria Righini Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Daniele Menci Daniele Menci Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Luna Cavigli Luna Cavigli Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Flavio D´Ascenzi Flavio D´Ascenzi Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Marta Focardi Marta Focardi Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Antonio D´Errico Antonio D´Errico Department of Internal Medicine, University of Siena italy, Siena Giovanni Donati Giovanni Donati Department of Internal Medicine, University of Siena italy, Siena Serafina Valente Serafina Valente Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Sonia Bernazzali Sonia Bernazzali Department of Cardiac Surgery, Aous Le Scotte italy, Siena Massimo Maccherini Massimo Maccherini Department of Cardiac Surgery, Aous Le Scotte italy, Siena Sergio Mondillo Sergio Mondillo Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Matteo Cameli Matteo Cameli Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Department of Medical Biotechnologies, Section of Cardiology, University of Siena italy, Siena Department of Internal Medicine, University of Siena italy, Siena Department of Cardiac Surgery, Aous Le Scotte italy, Siena Aims Antibody-mediated rejection of the transplanted heart is diagnosed through endomyocardial biopsy, which represents the gold standard, whereas clinical elements, antibody anti-Human Leukocite Antigens (HLA) and graft dysfunction are supplementary components. The aim of the study was to identify though a non-invasive technique, such as transthoracic echocardiography, early signs of impaired cardiac function in heart transplanted patients, in presence of anti-HLA antibodies but without any histological sign of antibody-mediated rejection, assessed through endomyocardial biopsy. Methods and results A total of 117 heart transplanted patients were enrolled, and they were divided into two groups ‘HLA+’ (45 patients) and ‘HLA-’ (72 patients), based on the presence and the absence of circulating anti-HLA antibodies, respectively. Patients were excluded in presence of coronary allograft vasculopathy or antibody-mediated rejection, attested by endomyocardial biopsy. Each patient underwent an echocardiographic exam, within one month from the biopsy, analysing standard parameters of both systolic and diastolic function, together with strain analysis of right and left ventricle (RV and LV) and left atrium (LA). Clinical and demographic characteristics did not different significantly between the two groups, and neither did standard echocardiographic parameters. The only significant parameter that showed a statistically significant difference was deceleration time of E wave (DT), which resulted to be lower in the ‘HLA+’ group (165 ± 39,5 vs 196,5 ± 25; p < 0.005). Regarding strain analysis, the study attested a strong difference of both LV global longitudinal strain (-16,0 ± 3,4 vs -19,8 ± 2,0; p < 0.005) and RV strain between the two analysed subsets (-17,2 ± 3,6 vs -20,6 ± 3,9 p < 0.005), whereas left atrial strain did not different significantly (Figure 1). Conclusion The presence of circulating anti-HLA antibodies might be correlated with a mild cardiac dysfunction, even in the absence of antibody-mediated rejection. Standard echocardiographic parameters might not completely reveal this subclinical impairment, whereas strain analysis has showed promising results since it revealed more clearly an impaired function of both ventricles in heart transplanted patients HLA+, with potentially important clinical repercussions. 114 Why left ventricular diastolic dysfunction is not steadily associated with increased pulmonary pressure? The buffer effect of left atrium unmasked by atrial strain Luca Maritan Luca Maritan Universita di Verona, Sezione di Cardiologia Riccardo Inciardi Riccardo Inciardi Universita di Verona, Sezione di Cardiologia Caterina Maffeis Caterina Maffeis Universita di Verona, Sezione di Cardiologia Luca Cerrito Luca Cerrito Universita di Verona, Sezione di Cardiologia Corinna Bergamini Corinna Bergamini Universita di Verona, Sezione di Cardiologia Giovann Benfari Giovann Benfari Universita di Verona, Sezione di Cardiologia Elvin Tafciu Elvin Tafciu Universita di Verona, Sezione di Cardiologia Mariantonietta Cicoira Mariantonietta Cicoira Universita di Verona, Sezione di Cardiologia Flavio Ribichini Flavio Ribichini Universita di Verona, Sezione di Cardiologia Andrea Rossi Andrea Rossi Universita di Verona, Sezione di Cardiologia Universita di Verona, Sezione di Cardiologia Aims The backward transmission of the increase in left ventricular (LV) filling pressure is not always associated to an increase in pulmonary pressure. To what extent a preserved left atrium (LA) function may modulate the consequences of the increase of LV filling pressure on the pulmonary circulation in terms of hemodynamics and symptoms has not been yet investigated. Methods and results We retrospectively studied 300 patients with available data of diastolic function, systolic pulmonary artery pressure (PAP-S) and LA function analyzed with two-dimensional speckle-tracking echocardiography. 28 patients (9.3%) had E/e’ > 14, considered the threshold of elevated LV filling pressure; 30 (10%) had PAP-S > 35mmHg; 114 (38%) had LA dysfunction; 68 (23%) were symptomatic for dyspnoea and, notably, 87 (29%) with E/e’ > 14 were asymptomatic. We found a positive association between E/e’ and PAP-S (p < 0.001); however, PAP-S was significatively higher among patients with impaired LA function (p < 0.0001). In a multivariate analysis including clinical and echocardiographic values, only E/e’ > 14 was significantly associated with PAP-S (p = 0.006) exclusively in the group of patients with LA dysfunction. The overall relationship between E/e’ and PAP-S was significantly modified by LA function (p = 0.01). In a univariate analysis including clinical and echocardiographic predictors of dyspnoea, E/e’ > 14 was a significant predictor exclusively in patients with LA dysfunction (p = 0.001) but not in patients with normal LA function. Conclusion A preserved LA function may modulate the consequences of elevated LV filling pressure on the pulmonary circulation representing a potential protective factor for the presence and intensity of cardio-pulmonary symptoms. 374 Left ventricular force adaptation and cardiac deformation in the progression of aortic stenosis Linda Pagura Linda Pagura Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Alessia Paldino Alessia Paldino Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Giorgio Faganello Giorgio Faganello Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Elisa Croatto Elisa Croatto Internal Medicine, Department of Experimental and Medical Sciences, University of Udine Dario Collia Dario Collia Department of Engineering and Architecture, University of Trieste Stefano Furlotti Stefano Furlotti Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Matteo Dal Ferro Matteo Dal Ferro Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Andrea Di Lenarda Andrea Di Lenarda Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Gianfranco Sinagra Gianfranco Sinagra Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Gianni Pedrizzetti Gianni Pedrizzetti Department of Engineering and Architecture, University of Trieste Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste Internal Medicine, Department of Experimental and Medical Sciences, University of Udine Department of Engineering and Architecture, University of Trieste Aims Aortic stenosis (AS) is one of the most common valvular heart diseases; however, the association between left ventricular (LV) myocardial deformation and hemodynamic forces (HDFs) is still mostly unexplored. This study aimed to assess the differences in LV myocardial deformation and HDFs in a large cohort of patients with aortic stenosis retrospectively. Methods and results Two-hundred fifty-four subjects (median age 77 years, 50% women) with preserved LV ejection fraction (LVEF), and mild (n = 87), moderate (n = 92) or severe (n = 75) AS, were included in the study. The 2 D LV global longitudinal strain (GLS), circumferential strain (GCS), and HDFs were measured with new software that allowed us to calculate all these values and parameters from the three apical views. When comparing severe AS to mild AS, LV mass appeared increased while the LV hypertrophy phenotype was concentric (p < 0.0001). Along with the progression of the AS, LVEF was decreased. All GLS, GCS, and HDFs parameters were uniformly reduced in severe AS compared to mild AS (p < 0.0001), in the same way, LV longitudinal force, LV longitudinal systolic force, and LV impulse have proven to be accurate on ROC curves (AUC 70%, 73%, and 73% respectively). Conclusion The integrated approach of deformation and cardiac mechanics allows the description of pathophysiological changes during the progression of mild to severe aortic stenosis. 139 Improvement of left ventricular systolic performance during sacubitril/valsartan in a cohort of patients with heart failure and reduced ejection fraction Sara Monosilio Sara Monosilio Sapienza Università di Roma Domenico Filomena Domenico Filomena Sapienza Università di Roma Sara Cimino Sara Cimino Sapienza Università di Roma Matteo Neccia Matteo Neccia Sapienza Università di Roma Federico Luongo Federico Luongo Sapienza Università di Roma Marco Mariani Marco Mariani Sapienza Università di Roma Lucia Ilaria Birtolo Lucia Ilaria Birtolo Sapienza Università di Roma Giulia Benedetti Giulia Benedetti Sapienza Università di Roma Viviana Maestrini Viviana Maestrini Sapienza Università di Roma Luciano Agati Luciano Agati Sapienza Università di Roma Francesco Fedele Francesco Fedele Sapienza Università di Roma Sapienza Università di Roma Aims Sacubitril/valsartan is a well-established therapeutic option for patients with heart failure with reduced ejection fraction (HFrEF). While it was clearly demonstrated to improve patients’ clinical conditions, its potential role in inducing left ventricle (LV) reverse remodelling is still under investigation. to evaluate clinical and echocardiographic effect of sacubitril/valsartan on a cohort of patients with HFrEF after six months of therapy. Methods and results 36 patients with HFrEF eligible to start a therapy with sacubitril/valsartan were enrolled. A standard and advanced echocardiographic evaluation was performed before starting the therapy and after six months of Follow-up (FU). Off-line analysis of left ventricle global longitudinal strain (GLS), longitudinal strain of the free wall of the right ventricle (RVFWSL) and left atrial strain (LAS) was conducted. Clinical and biochemical parameters were evaluated as well. At six months of FU NYHA class improved in the vast majority of patients (NYHA class III at baselione vs FU: 56% vs 5%, p 0.001). We observed a significant reduction in LV end-diastolic (100 ± 33 vs 92 ± 33, p 0.043) and end-systolic (70 ± 26 vs 59 ± 25, p 0.001) volumes and an improvement of LV ejection fraction (30 ± 5% vs 37 ± 6%, p < 0.001). After six months of therapy, GLS significantly improved (-9.7 ± 2.9 vs -13.0 ± 3.1, p < 0.001). No differences in left and right atrial volumes (respectively 57 ± 29 vs 54 ± 30, p 0.349; 54 ± 24 vs 48 ± 19, p 0.157), RVFWSL (-16,5 ± 5,4 vs -16,8 ± 1,5) and LAS (14 ± 6 vs 19 ± 8, p 0.197) were found at FU. Conclusion Left ventricular function evaluated with standard and advanced echocardiographic parameters improved after six months of therapy with sacubitril/valsartan in HFrEF patients. Reduction in LV volumes was found as well. 140 Left ventricular hemodynamic forces evaluation in patients with heart failure and reduced ejection fraction treated with sacubitril/valsartan Sara Monosilio Sara Monosilio Sapienza Università di Roma Domenico Filomena Domenico Filomena Sapienza Università di Roma Sara Cimino Sara Cimino Sapienza Università di Roma Federico Luongo Federico Luongo Sapienza Università di Roma Matteo Neccia Matteo Neccia Sapienza Università di Roma Marco Mariani Marco Mariani Sapienza Università di Roma Domenico Laviola Domenico Laviola Sapienza Università di Roma Gianni Pedrizzetti Gianni Pedrizzetti Università di Trieste Giovanni Tonti Giovanni Tonti Università Degli studi G. D’annunzio Chieti e Pescara Giulia Benedetti Giulia Benedetti Sapienza Università di Roma Viviana Maestrini Viviana Maestrini Sapienza Università di Roma Luciano Agati Luciano Agati Sapienza Università di Roma Francesco Fedele Francesco Fedele Sapienza Università di Roma Sapienza Università di Roma Università di Trieste Università Degli studi G. D’annunzio Chieti e Pescara Aims Hemodynamic forces (HDFs) represent the forces exchanged between the blood and the myocardium. Recently, HDFs estimation by echocardiography, using the tracking of the endocardial border with dedicated software, permitted their study in different clinical contests. to describe left ventricular (LV) HDFs in patients with heart failure with reduced ejection fraction (HFrEF) and to evaluate their possible change after six months of therapy with sacubitril/valsartan. Methods and results 20 patients with HFrEF undergoing therapy with sacubitril/valsartan were enrolled. Echocardiography was performed at baseline and after six months of follow-up. Off-line HDFs estimation using dedicated software was conducted. In order to compare ventricles of different sizes, HDFs were normalized for the LV volume and expressed as a percentage of the force of gravity. HDFs were assessed over the entire cardiac cycle, in systole and diastole by calculating the mean square value over the selected time period. LV HDFs were calculated both in apex-base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). 13 healthy volunteers were enrolled as a control group. Comparing healthy and HFrEF subjects, the latters showed smaller values of A-B HDFs during the entire cardiac cycle (5.8 ± 0.83% vs 12.37 ± 3.7%, p 0.001), in systole (8.47 ± 1.49%vs 16.6 ± 6.5%, p 0.001) and diastole (3.2 ± 0.6% vs 7.1 ± 3.7%, p 0.001). While systolic L-S HDFs were lower in HFrEF subjects (1.56 ± 0.66% vs 2.29 ± 0.81%, p 0.005), we observed an inappropriately high value of diastolic L-S HDFs (1.88 ± 0.68% vs 1.81 ± 0.91%, p 0.837), compared with healthy volunteers. Consequently, L-S/A-B ratio in HFrEF patients was higher during the entire cardiac cycle (29.24 ± 7.60% vs 15.5 ± 7.95%, p 0.001), in systole (19.14 ± 8.64% vs 14.76 ± 4.32%, p 0.006), but particularly in diastole (58.24 ± 14.63% vs 28.54 ± 13.92%, p 0.001). At six months Follow-up we observed a trend in amelioration of HDFs distribution, but the reduction of L-S/A-B ratios did not reach statistical significance (diastolic L-S/A-B HDFs ratio: baseline 58,24 ± 14,63 vs 6 months FU 44,57 ± 18,8, p = 0,222). Conclusion Our cohort of HFrEF patients presented low A-B HDFs values and a significant misalignment of HDFs, especially in diastole. Those fluid alterations partially improved at 6 months FU but a larger cohort of patients is needed to confirm these initial observations. 476 Left ventricular diastolic function and atrial function in Middle-aged endurance athletes: differences with age-matched hypertensive patients Loredana Nunno Loredana Nunno Hospital Clìnic and Universitat de Barcelona , Spain Institute of Biomedical Research August PI I Sunyer (Idibaps) Spain, Barcelona Filip Loncaric Filip Loncaric Institute of Biomedical Research August PI I Sunyer (Idibaps) Spain, Barcelona Maria Sanz Maria Sanz Hospital Clìnic and Universitat de Barcelona , Spain Maria Mimbrero Maria Mimbrero Hospital Clìnic and Universitat de Barcelona , Spain Institute of Biomedical Research August PI I Sunyer (Idibaps) Spain, Barcelona Silvia Montserrat Silvia Montserrat Hospital Clìnic and Universitat de Barcelona , Spain Laura Sanchis Laura Sanchis Hospital Clìnic and Universitat de Barcelona , Spain Institute of Biomedical Research August PI I Sunyer (Idibaps) Spain, Barcelona Bart Bijnens Bart Bijnens Institute of Biomedical Research August PI I Sunyer (Idibaps) Spain, Barcelona Institució Catalana de Recerca I Estudis Avançats (Icrea) , Spain Barcelona Marta Sitges Marta Sitges Hospital Clìnic and Universitat de Barcelona , Spain Institute of Biomedical Research August PI I Sunyer (Idibaps) Spain, Barcelona Hospital Clìnic and Universitat de Barcelona , Spain Institute of Biomedical Research August PI I Sunyer (Idibaps) Spain, Barcelona Institució Catalana de Recerca I Estudis Avançats (Icrea) , Spain Barcelona Aims There is an ongoing debate on whether endurance training, like hypertension (HTN), may in the long run create atrial fibrosis and thus affect left atrial (LA) function, promoting incidental atrial fibrillation (AF). Our aim was to compare left ventricular (LV) diastolic function and LA function between two cohorts of amateur master endurance athletes and age-matched hypertensive patients. Methods and results 240 subjects aged 40 through 66 years were enrolled in this study: 120 hypertensive patients with a sedentary lifestyle [mean duration of HTN: 10 (5 to 15) years] and 120 healthy age-matched amateur athletes, without a history or evidence of HTN, who had undergone intensive endurance training over many years [mean years of training: 34 (24,5 to 40)], with an average of 8 hours of training per week [mean lifetime training hours: 10.924 (6.195 to 15.150)]. All patients underwent a comprehensive two-dimensional echocardiography (2DE) with Doppler and Tissue Doppler study (TD) to assess LV systolic and diastolic function and speckle-tracking echocardiography (STE) and three-dimensional echocardiography (3DE) to assess LA volumes and function according to current guidelines. Mean age of the pooled population was 54,55 ± 6,71 year old, 65% males. The two groups were comparable for age (P = 0.195). LV ejection fraction was not significantly different among the two groups (P = 0.978), while LV mass index was higher in athletes (P = 0.014). None of the 120 athletes had diastolic dysfunction, 4 athletes had indeterminate diastolic pattern. In the group of hypertensive patients, 5 of them had diastolic dysfunction, 16 had indeterminate diastolic function, while the remaining 99 patients had normal diastolic function. 99 athletes (82,5%) had dilated LA (> 34 mL/m2), whereas only 34 (28,3%) hypertensive patients had dilated LA. Early diastolic transmitral flow velocity 5 was similar in the two cohorts (P = 0.441), but athletes had significantly decreased A velocities (P < 0.001) with increased E/A ratios (P < 0.001), compared to hypertensive patients. Athletes showed higher TD-derived septal (P < 0.001) and lateral (P < 0.001) e’ velocities and lower septal (P = 0.247) and lateral (P < 0.001) a’ velocities, compared to hypertensive patients. Speckle-tracking analysis of the LA showed in athletes significant lower strain values of the contractile function (P = 0.015), higher strain values of the conduit function (P < 0.001) and higher strain values of the reservoir function (P < 0.001) compared to hypertensive patients. 3DE was in line with the results obtained from the STE, confirming in athletes a better LA total emptying fraction (P = 0.047) and a better passive atrial EF (P < 0.001). Conclusion Master athletes showed less diastolic dysfunction and more preserved atrial function as compared to age-matched hypertensive patients. Hence, a reduction in LA conduit or reservoir function in an athlete should raise the suspicion of a cardiac disorder. LA was more dilated in athletes than in hypertensive patients, therefore LA volume seems not to be a useful tool for the differential diagnosis between these populations. 10 Arterial stiffness in asymptomatic type 2 diabetic normotensive postmenopausal women Maria Maiello Maria Maiello ASL Brindisi, Cardiology Equipe italy, Brindisi Annagrazia Cecere Annagrazia Cecere Department of Cardiac-Thoracic-Vascular Science and Public Health, University of Padova italy, Padova Annapaola Zito Annapaola Zito ASL Brindisi, Cardiology Equipe italy, Brindisi Marco Matteo Ciccone Marco Matteo Ciccone Cardiovascular Disease Section, Deto, University of Bari italy, Bari Pasquale Palmiero Pasquale Palmiero ASL Brindisi, Cardiology Equipe italy, Brindisi Cardiovascular Disease Section, Deto, University of Bari italy, Bari Department of Cardiac-Thoracic-Vascular Science and Public Health, University of Padova italy, Padova ASL Brindisi, Cardiology Equipe italy, Brindisi Aims arterial stiffness is a marker of cardiovascular disease useful to identify, at an early stage, subjects with higher cardiovascular risk. the goal of our study was to assess the prevalence of arterial stiffness, assessed by global Pulse Wave Velocity (gPWV), among diabetic normotensive postmenopausal women (DPMW) and its correlation with glycosylated hemoglobin (HbA1c) levels. Methods and results we enrolled 641 consecutive DPMW affected by type 2 diabetes, diagnosed over five years. 300 normotensive normoglycemic postmenopausal women were included as control group (CG). We assessed arterial stiffness by gPWV, performed by pulsed Doppler (3.5 MHz probe) using 2-dimensional guidance and ECG trigger. Philips Epiq 7 was used which is an echo-Doppler system equipped with a multifrequency transducer. The gPWV was assessed as normal for a velocity equal or lower than 7.1 m/s. 29 (4.5%) women had an increased gPWV among 641 DPMW, and 4 (1.3%) among 300 women of CG, p < 0.01. There was no difference for mean age between the two groups: 57 ± 12 and 56 ± 4 respectively, p = 0.2. DPMW with HbA1c > 7.5% were 228 (35.6%), 205 (32%) had an increased gPWV, 23 (3.6%) a normal gPWV. Women with HbA1c < 7.5% were 413 (64,4%), 6 had an increased gPWV (0.9%), p < 0.0000. DPMW with abnormal ECG were 207 (32.3%), 11 of them had an increased gPWV (5.3%), p = 0.5 vs. women with an increased gPWV and normal ECG, 18 (4.1%). Conclusion we found a high prevalence of increased gPWV in asymptomatic normotensive DPMW; there is a statistically significant correlation between increased gPWV and HbA1c high levels, but there is not between increased gPWV and abnormal ECG rate, however ECG is the unique cardiologic test recommended by current Guidelines in all diabetic patients. We conclude that early detection of high level of HbA1c and increased PWV may identify asymptomatic DPMW with higher risk to develop organ damages; while a simple ECG, when normal, is not enough to assess the cardiovascular risk in our population. 368 Stress-echocardiography and diagnosis of coronary artery disease: new echocardiographic parameters Nicolò Pellegrino Nicolò Pellegrino Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Annita Bava Annita Bava Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Nunzio Fichera Nunzio Fichera Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Celeste Guglielmini Celeste Guglielmini Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Chiara Ruggieri Chiara Ruggieri Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Filippo Mancuso Filippo Mancuso Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Maurizio Cusmà Piccione Maurizio Cusmà Piccione Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Olimpia Trio Olimpia Trio Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Roberta Manganaro Roberta Manganaro Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Scipione Carerj Scipione Carerj Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Concetta Zito Concetta Zito Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Azienda Ospedaliera Universitaria Policlinico G. Martino , Messina Aims Myocardial work (MW) is a new interesting non-invasive tool to study left ventricle (LV) performance by pressure-strain loops. We proposed to investigate the role of global longitudinal strain (GLS) and MW, during dipyridamole stress-echocardiography (DSE), in identifying coronary artery disease (CAD) detected at coronary angiography. Methods and results Forty-eight patients, (mean age 65.3 ± 8.7 years) undergone DSE and subsequent coronary angiography, were retrospectively enrolled. The study population was divided in two groups according to the presence of CAD: group 1, patients without CAD (n = 18, mean age 63.3 ± 6.4 years); group 2, patients with CAD (n = 30, mean age 67.2 ± 5.9 years). Multilayer longitudinal strain and MW indices, namely global work index (GWI), global constructive work (GCW), global work efficiency (GWE), global work waste (GWE), were obtained at basal, low-dose and peak-dose of DSE. The percentage change between basal and peak-dose was calculated for every parameter. No significant differences were observed between the two groups of patients about all traditional and advanced echocardiographic parameters at basal stage. GLS, endocardial longitudinal strain (endoGLS) and epicardial longitudinal strain (epiGLS) increased at every step in both groups, even if the trend was more evident for group 2 (Figure). GWI, GCW and GWE increased from basal to peak dose, while GWW decreased, in group 1; the opposite was observed in group 2 (Figure). GWI change (13.6 ± 1.6% vs 4.8 ± 1.1%, p = 0.001), GWE change (2.4 ± 1.28% vs 0.7 ± 4.6%, p = 0.001) and GWW change (-51.1 ± 2.8% vs 31.5 ± 1.1%, p < 0.001) were significantly different between group 1 and group 2. The reduction of every entity or no increment of GWI showed a 85% sensitivity and 55% specificity in predicting CAD. A GWE increase >44% had a 85% sensitivity and 68% specificity. The association of both endoGLS increase >16% and GLS increase >18% showed a 73% sensitivity and 75% specificity in identifying significant CAD. The only evaluation of LV segmental kinesis had lower sensitivity and specificity (67% and 33%, respectively). Conclusion Myocardial strain and even more the non-invasive evaluation of MW, overcoming the subjective evaluation of LV segmental kinetics, lead to an improvement in the diagnostic accuracy of DSE in the identification of myocardial ischemia. 338 Right ventricular basal diameter, but not volume, can predict severe tricuspid regurgitation Alessandra Pina Alessandra Pina Universita’ Degli Studi di Milano Bicocca Luigi Badano Luigi Badano Universita’ Degli Studi di Milano Bicocca Denisa Muraru Denisa Muraru Universita’ Degli Studi di Milano Bicocca Gianfranco Parati Gianfranco Parati Universita’ Degli Studi di Milano Bicocca Marco Previtero Marco Previtero Universita’ Degli Studi di Milano Bicocca Chiara Palermo Chiara Palermo Universita’ Degli Studi di Milano Bicocca Universita’ Degli Studi di Milano Bicocca Aims According to current EACVI guidelines, right ventricle (RV), tricuspid annulus (TA) and right atrium (RA) dilatation are supportive signs to identify severe functional tricuspid regurgitation (TR) by echocardiography. However, the ranking by which those parameters should be considered to identify severe TR remains to be clarified. Accordingly, the aim of this study is to compare RV, RA and TA association with severe TR and to rank them in order of importance to predict severe TR. Methods and results 302 patients (59 ± 13 years, 54% women) with functional TR underwent two and threedimensional echocardiography. Using the nonparametric Variable Importance (VIMP) software package, we assessed the relative importance of 6 different parameters (indexed by body surface area) to identify severe TR: 3 D RV end diastolic volume (RVEDVi), 3 D RV end systolic volume (RVESVi), 3 D RA max volume (3DRAi), 2 D RA systolic volume (2DRAi), 2 D RV basal diameter (2DRVdi) and 2 D TAi measured in the apical 4chamber view. According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. 3DRAi (VIMP = 0.075) was the most important predictor of severe TR. 2DRVdi (VIMP= 0.005) was the second most important parameter and was the only parameter of RV dilation (RVEDVi= 0.0011 and RVESVi= 0.0012) associated to severe TR. Also, 2DRAi (VIMP= 0.023), and 2 D TAi (VIMP= 0.004) showed good predictive ability. Conclusion Among the various right heart structures undergoing remodelling in patients with functional TR, RA dilation was the most important predictor of severe TR. Also the RV basal diameter, but not the volumes, was a predictor of severe TR. This underlines the importance of the shape, more than the volume of the RV as a predictor of severe TR. 435 Cardiac magnetic resonance imaging in differential diagnosis of cardiac masses Emanuela Concetta D´Angelo Emanuela Concetta D´Angelo Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Luca Bergamaschi Luca Bergamaschi Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Pasquale Paolisso Pasquale Paolisso Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Ilenia Magnani Ilenia Magnani Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Sebastiano Toniolo Sebastiano Toniolo Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Alberto Foa Alberto Foa Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Andrea Rinaldi Andrea Rinaldi Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Francesco Donati Francesco Donati Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Francesco Angeli Francesco Angeli Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Lorenzo Bartoli Lorenzo Bartoli Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Andrea Stefanizzi Andrea Stefanizzi Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Chiara Chiti Chiara Chiti Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Michele Fabrizio Michele Fabrizio Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Paola Rucci Paola Rucci Department of Hygiene and Biostatistics, University of Bologna Italy Matteo Renzulli Matteo Renzulli Radiology Unit Department, University of Bologna Italy Luigi Lovato Luigi Lovato Radiology Unit Department, University of Bologna Italy Domenico Attinà Domenico Attinà Radiology Unit Department, University of Bologna Italy Davide Pacini Davide Pacini Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, University of Bologna Italy Carmine Pizzi Carmine Pizzi Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Nazzareno Galiè Nazzareno Galiè Department of Hygiene and Biostatistics, University of Bologna Italy Radiology Unit Department, University of Bologna Italy Department of Experimenatl, Diagnostic and Specialty Medicine—Dimes, University of Bologna Italy Department of Hygiene and Biostatistics, University of Bologna Italy Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, University of Bologna Italy Aims Differential diagnosis of cardiac masses represents a challenging diagnostic issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a no-invasive imaging technique used to describe morphologic and functional features of masses. Integration of these information can lead to correct diagnosis near to histological certain. To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods and results One-hundred-fourteen patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certain, obtained with biopsy and/or surgical samples or, in cases of cardiac thrombi, throughout radiological evidence of thrombus resolution after adequate anticoagulant treatment. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion; tissue characterization resulted from an estimation of contrast enhancement-including early gadolinium enhancement (EGE), late gadolinium enhancement (LGE), sequences-and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours. The descriptive analysis of the morphologic features showed that diameter > 50 mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p < 0.001), as for tissue characteristics heterogeneous signal intensity, independently from T1 and T2 weighted acquisitions, and EGE were more common in malignant lesions (p < 0.001). Two blinded expert radiologists were able to correctly diagnose malignancy with a kappa coefficient of 0.9. Subgroup analysis confirmed two-group analysis, but features described cannot discriminate amog malignant tumor; instead hyperintensity signal and EGE is able to distinguish benign primitive lesions from pseudotumor (p = 0.002). Moreover, left ventricle dilatation (p < 0.01) and reduced ejection fraction (p = 0.04) were associated to pseudotumors, due to presence in this group of thrombi which often underlie structural heart diseases. Furthermore, using CART analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes identifies malignant tumors; if invasion is not present, we evaluate gadolinium enhancement: presence of contrast uptake is able to identify malignant lesions; in conclusion, in case of absence of invasion and contrast uptake, the last step of decision three includes reduced ejection fraction which increases probability of pseudotumors and reduce probability of primary benign tumor. Conclusion Cardiac magnetic resonance is a very useful diagnostic tool for differential diagnosis of cardiac masses in particular to discriminate among benign and malignant heart lesions, throughout morphologic and tissues features. 563 Left ventricular twist predicts prognosis in children with non-compaction cardiomyopathy Jolanda Sabatino Jolanda Sabatino Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Enrico Piccinelli Enrico Piccinelli Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Nunzia Borrelli Nunzia Borrelli Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Josefa Paredes Josefa Paredes Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Manjit Josen Manjit Josen Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Martina Avesani Martina Avesani Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Domenico Sirico Domenico Sirico Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Alain Fraisse Alain Fraisse Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Ciro Indolfi Ciro Indolfi Magna Graecia University of Catanzaro Piers Daubeney Piers Daubeney Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Giovanni Di Salvo Giovanni Di Salvo Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Paediatric Cardiology—Royal Brompton Hospital—Imperial College —London Magna Graecia University of Catanzaro Aims Left ventricular non-compaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood, with heart failure, arrhythmias, and embolic events as main clinical manifestations. LV twist has recently been demonstrated having good predictive value in diagnosing LVNC in young patients. However, how LV twist may influence long-term clinical outcome of LVNC children and adolescents is still unknown. The aim of this study was to analyse a set of echocardiographic parameters to find imaging predictors of worse clinical outcomes in a long-term follow-up of LVNC children and young patients. Methods and results Children and adolescents, followed from May 2012 to June 2020, were enrolled in a retrospective study. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging (1.5 Tesla) at our Institution’s first evaluation. Death, heart failure hospitalization, aborted sudden cardiac death, ventricular arrhythmias (sustained and non-sustained ventricular tachycardia), and embolisms (i.e. stroke, peripheral arterial embolism and/or pulmonary thromboembolism) were registered and referred to as major adverse cardiovascular events (MACEs). Recruited for the study were 47 children (mean age: 11.1 ± 5; age range: 0–18 years). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group (LVHT). They were followed for 4.9 ± 1.0 years, and MACEs were registered. Thirteen children (56% of LVNC, 28% of total) had at least one MACE. Global longitudinal, circumferential and radial strains (GLS, GCS, GRS), LV twist and LVEF resulted being significantly reduced in children with MACEs at follow-up. A multivariable analysis was performed by combining four parameters: LV ejection fraction, GLS, GCS, LV twist. These independent variables were chosen according to univariable analyses and clinical relevance. The results from the analysis demonstrated that LV twist was the only independent predictor (P = 0.033, coeff. B 0.726) of worse clinical outcomes in young patients with LVNC. Conclusion LV twist is a promising tool to stratify and predict prognosis in LVNC young patients. Our findings show the importance of LV twist assessment to detect the severity of LVNC and to plan for early clinical intervention. 580 Assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis Antonio Strangio Antonio Strangio Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Jolanda Sabatino Jolanda Sabatino Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Isabella Leo Isabella Leo Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Marco Maglione Marco Maglione Global Marketing Esaote Fabio Troilo Fabio Troilo Marketing Italia Esaote Giuseppe Loliva Giuseppe Loliva Marketing Italia Esaote Giovanni Canino Giovanni Canino Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Carmen Anna Carmen Anna Maria Spaccarotella Maria Spaccarotella Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Salvatore De Rosa Salvatore De Rosa Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Ciro Indolfi Ciro Indolfi Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro Italy Global Marketing Esaote Marketing Italia Esaote Aims assessment of intracardiac flows and turbulence, has acquired rising significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have shown that alterations in intracardiac fluid dynamics can be helpful to identify abnormalities in cardiac function. This study investigates the additional information provided by the quantitative assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods and results ten patients with severe AS (5 females) and 10 healthy sex- and BSA-matched controls (CTRL) (5 females) were prospectively included and underwent echocardiographic assessment of intracardiac flow dynamics. Echocardiographic measurements were performed on apical three chamber views recorded by means of MyLab™ X8 Platform. The HyperDoppler software adapted to an Esaote echo-scanner without contrast injection was used to assess intracardiac vortex properties. The endocardial border was manually contoured in one still frame and, then, automatically tracked during the whole cardiac cycle. The following parameters were obtained: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex centre from the LV base relative to the total LV long axis). Inter-rater variability was measured using intraclass correlation coefficients (ICCs) between two independent operators. patients with severe AS (mean gradient: 50.1 ± 10 mmHg; aortic valve area: 0.7 ± 0.2 cm2; ejection fraction: 53 ± 7%) had increased LV wall thickness (p < 0.001) and mass index (p < 0.001) compared with controls. Greater indexed left atrial volume (p < 0.001), E/e' (p < 0.001) and trans-tricuspid gradient (p < 0.001) were also observed in the AS group. The assessment of VA, VL and VD was feasible in the whole population. Their calculation was reliable, as ICCs were very good for VA (0.878, p = 0.033), VL (0.960, p = 0.004) and VD (0,905, p = 0.021). Mean VA was significantly larger in patients with severe aortic stenosis compared with CTRL (p = 0.031). VL and VD (p = 0.001 and p = 0.001, respectively) were significantly higher in AS patients compared with CTRL. Conclusion the newly defined VA, VL and VD, quantitative indices of vortical flow, were significantly increased in the LV cavity of patients with severe AS compared to normal subjects. These indices, whose measurement was feasible and reliable, might provide complementary information to standard echocardiography, useful for the further diagnostic and prognostic characterization of the heterogeneous population of patients with severe AS. 581 Left atrial strain predicts prognosis in patients with aortic stenosis after TAVI Antonio Strangio Antonio Strangio Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Jolanda Sabatino Jolanda Sabatino Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Isabella Leo Isabella Leo Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Sabrina La Bella Sabrina La Bella Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Oscar Ripepi Oscar Ripepi Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Alberto Polimeni Alberto Polimeni Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Sabato Sorrentino Sabato Sorrentino Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Carmen Anna Maria Spaccarotella Carmen Anna Maria Spaccarotella Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Salvatore De Rosa Salvatore De Rosa Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Ciro Indolfi Ciro Indolfi Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Division of Cardiology, Department of Medical and Surcigal Sciences, Magna Graecia University italy, Catanzaro Aims altered left atrial (LA) function is associated with a poor prognosis in a number of cardiovascular conditions. Our aim was to test the relationship between LA strain (LAS) and prognosis in patients with severe aortic stenosis (AS) undergoing TAVI. Methods and results we retrospectively collected 80 patients with severe AS (mean age 80.9 years) undergoing TAVI. LA volume was calculated by the area-length method in apical four-and two-chamber views before and 3 months after TAVI. LAS was measured using a dedicated software package before and three months after TAVI. The difference, or delta (Δ), between LAS after TAVI – LAS before TAVI (ΔLAS) was then calculated. The outcome selected for the study was a composite endpoint comprising hospitalization for heart failure and death from any cause. at baseline, LAS was significantly correlated with LV diastolic parameters, and PASP (all, P < 0.05). At a median follow-up of 21 months, 9 patients had events. LAS 3 months after TAVI and ΔLAS were associated with events (P < 0.05) at Cox hazard analysis. The Kaplan-Meier survival curve (Figure 1) showed a significant difference of survival between patients with negative and positive ΔLAS (P = 0.045). Conclusion in patients with severe AS undergoing TAVI, left atrial strain after TAVI and ΔLAS are independently linked to events. 534 Effects of ivabradine on coronary flow reserve and left ventricular contractile reserve in patients with coronary microvascular disease Alessandro Di Vilio Alessandro Di Vilio Department of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital naples, Italy Simona Sperlongano Simona Sperlongano Department of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital naples, Italy Franco Iodice Franco Iodice Department of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital naples, Italy Francesco Gambardella Francesco Gambardella Department of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital naples, Italy Caterina Montuori Caterina Montuori Deartment of Cardiology, San Giuliano Hospital, Gugliano In Campania italy, Naples Ercole Tagliamonte Ercole Tagliamonte Dpartment of Cardiology, Umberto I Hospital, Nocera Inferiore (Sa) , Italy Antonello D´Andrea Antonello D´Andrea Dpartment of Cardiology, Umberto I Hospital, Nocera Inferiore (Sa) , Italy Department of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital naples, Italy Dpartment of Cardiology, Umberto I Hospital, Nocera Inferiore (Sa) , Italy Deartment of Cardiology, San Giuliano Hospital, Gugliano In Campania italy, Naples Aims Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. Transthoracic Doppler-derived coronary flow reserve (CFR), as an index of coronary arterial reactivity, can be impaired in both obstructive coronary artery disease (CAD) and CMD, and have demonstrated prognostic importance in these patients. Otherwise, left ventricular contractile reserve (LVCR), which assesses contractile reserve independently from preload and afterload changes, have demonstrated to be prognostically powerful in identifying patients at higher risk. The aim of our study was to assess the combined effect of ivabradine on CFR and LVCR in patients with CMD. Methods and results 158 patients (94 M, 64 F; mean age 66 ± 5 years) without obstructive CAD, assessed by invasive coronary angiogram, underwent Doppler-derived CFR. 41 of them (25 M, 16 F; mean age 62 ± 2 years), with CMD (defined as CFR < 2) were enrolled in the study. Coronary flow was assessed in the left anterior descending coronary artery (LAD) and was identified as the colour signal directed from the base to the apex of the left ventricle, containing the characteristic biphasic pulsed-Doppler flow signals. CFR were determined as the ratio of hyperaemic, induced by intravenous dipyridamole administration, to baseline diastolic coronary flow velocity. LVCR was defined as the stress/rest ratio of force, calculated as the ratio between systolic pressure and left ventricular end-systolic volume index. Patients were randomly assigned to ivabradine or placebo for one month (after up-titration phase). Doppler echocardiography, CFR and LVCR assessment were performed again at the end of treatment period. There were no significant differences in baseline characteristics between ivabradine and placebo group. Baseline CFR and LVCR were not significantly different in both groups. After treatment, in ivabradine group both CFR and LVCR significantly increased (2.78 ± 0.36 vs. 1.84 ± 0.12 - p < 0.01 and 1.34 ± 0.33 vs. 1.18 ± 0.24 - p < 0.01), while in placebo group they did not significantly changed. There were a weak correlation between CFR and LVCR in study group. Conclusion In patients with CMD, ivabradine is able to improve both CFR and LVCR. Improvement of both parameters suggest a significant effect on the prognosis of these patients. Larger studies could confirm our data. 49 Multi-parametric vs. inferior vena cava-based estimation of right atrial pressure by echocardiography Matteo Toma Matteo Toma Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Stefano Giovinazzo Stefano Giovinazzo Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Gabriele Crimi Gabriele Crimi Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Giovanni Masoero Giovanni Masoero Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Manrico Balbi Manrico Balbi Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Department of Internal Medicine, University of Genova Marco Canepa Marco Canepa Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Department of Internal Medicine, University of Genova Italo Porto Italo Porto Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Department of Internal Medicine, University of Genova Pietro Ameri Pietro Ameri Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Department of Internal Medicine, University of Genova Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino Department of Internal Medicine, University of Genova Aims To evaluate an echocardiographic multiparametric approach for right atrial pressure (RAP) estimation in a general population undergoing right heart catheterization (RHC). Methods and results We prospectively enrolled patients undergoing RHC between September 2018 and January 2020. A trans-thoracic echocardiogram was performed on the same day by cardiologists blinded to the haemodynamic RAP was estimated by evaluation of inferior vena cava (eRAPIVC), hepatic vein pulsed wave Doppler spectra (eRAPHV), tricuspid E/e’ ratio (eRAPE/e’) and by the mean of the aforementioned parameters (eRAPmean), according to a pre-specified protocol (Figure panel A). The relationship between invasive RAP (iRAP), eRAPmean and its components was analyzed by Spearman correlation or Wilcoxon signed-rank test. ROC area under the curves (AUC) were used to test eRAP thresholds against the same thresholds as obtained by RHC. 43 patients were included in the analysis (69 (58-75) year-old, 49% males). There was a positive correlation between eRAPmean and iRAP (r = 0.66, P < 0.001, Figure panel B). There was also a trend for decreased concordance between eRAPIVC, eRAPE/e’, eRAPHV and iRAP across 5- to 20-mmHg categories, and iRAP was significantly different from eRAPE/e’ and eRAPHV for the 20-mmHg category (Figure panel C, * and ** are for P < 0.05 and P < 0.001 respectively). The area under the curve in predicting iRAP were non-significantly better for eRAPmean than for eRAPIVC at both 5-mmHg (0.64, 95%CI 0.49-0.80 vs. 0.70, 95%CI 0.53-0.87; Wald test P = 0.41) and 10-mmHg (0.76, 95%CI 0.60-0.92 vs. 0.81, 95%CI 0.67-0.96; P = 0.43) thresholds. Conclusion Our data suggest that multi-parametric eRAPmean does not provide a clear-cut advantage over eRAPIVC, despite being more complex and time-consuming. 387 Sex, body size, right atrial and right ventricular volumes are the main determinants of tricuspid annulus geometry in healthy volunteers. A 3D echo study using a novel, commercially available dedicated software package Serena Vaghi Serena Vaghi Universita’ Degli Studi di Milano Bicocca Diana Mihalcea Diana Mihalcea Carol Davila University of Medicine and Pharmacy of Bucharest Andrada C Guta Andrada C Guta Carol Davila University of Medicine and Pharmacy of Bucharest Sergio Caravita Sergio Caravita Universita’ Degli Studi di Milano Bicocca Denisa Muraru Denisa Muraru Universita’ Degli Studi di Milano Bicocca Luigi Badano Luigi Badano Universita’ Degli Studi di Milano Bicocca Gianfranco Parati Gianfranco Parati Universita’ Degli Studi di Milano Bicocca Universita’ Degli Studi di Milano Bicocca Carol Davila University of Medicine and Pharmacy of Bucharest Aims Tricuspid annulus (TA) sizing is essential for planning percutaneous or surgical tricuspid procedures. By current guidelines, TA dimensions are assessed using 2 D echocardiography (2DE). However, TA is a complex 3 D structure. To characterize TA geometry, dynamics and its physiological determinants using 3 D echocardiography (3DE) and a novel dedicated software package in healthy volunteers. Methods and results 254 healthy volunteers (113 men; mean age 47 ± 11 years) were enrolled and evaluated using both 2DE and 3DE. 3 D TA analysis was feasible in 228 of them (feasibility = 90%). 3 D TA area, perimeter, diameters, sphericity index and coaptation were assessed at mid-systole, early-diastole and end-diastole using a dedicated software package (4 D Auto TVQ, GE Healthcare, Horten, N). Right atrial (RA) and right ventricular (RV) volumes were measured using 3DE. 3 D TA area, perimeter and diameters were largest and smallest in end-diastole and mid-systole, respectively. Normal TA metrics in end-diastole were 9.6 ± 2.1cm2 for area, 11.2 ± 1.2 cm for perimeter, 38 ± 4 mm, 31 ± 4 mm, 33 ± 4 mm and 34 ± 5 mm for major, minor, 4-ch and 2-ch diameters, respectively, and 81 ± 11% for sphericity index. All TA parameters assessed correlated with BSA (r = 0.42 to r = 0.58, p < 0.001). Except for excursion and sphericity index, TA parameters were significantly larger in men than in women, independently of BSA (p < 0.0001). Conversely, there were no age-related changes in TA parameters (r < 0.25, p < 0.001). 2 D TA diameters measured in 4ch and RV focused views were significantly smaller than the corresponding 3 D 4ch diameter (29 ± 5 mm and 30 ± 5 mm vs 33 ± 4 mm, respectively, p < 0.0001). RA minimum volumes had the strongest correlation with 3 D TA area (r = 0.74, p < 0.0001), compared with RV end-diastolic (r = 0.61, p < 0.0001) and end-systolic (r = 0.57, p < 0.0001) volumes. At multivariable linear regression analysis, RA minimum volume, RV end-diastolic volume, BSA and sex were independent predictors of 3 D TA area (R2=0.56, p < 0.0001). Conclusion During cardiac cycle TA changes in size, reaching minimum dimensions during mid-systole and largest dimensions during end-diastole. Reference values for TA metrics should be sex-specific and indexed to BSA. 2DE underestimates actual 3 D TA dimensions. RA minimum volume, and not the maximum volume, together with RV end-diastolic volume, BSA and sex were the only independent predictors for TA size. 464 Does the assessment of the proportionality and disproportionality of secondary tricuspid regurgitation to right ventricular dilation improve the prognostic stratification of patients over the conventional severity grading? Stefano Vicini Stefano Vicini Department of Medicine and Surgery, University of Milano-Bicocca italy, Milano Denisa Muraru Denisa Muraru Department of Medicine and Surgery, University of Milano-Bicocca italy, Milano Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, Irccs italy, Milano Marco Previtero Marco Previtero Department of Cardiac, Thoracic and Vascular Sciences, University of Padova italy, Padova Chiara Palermo Chiara Palermo Department of Cardiac, Thoracic and Vascular Sciences, University of Padova italy, Padova Davide Soranna Davide Soranna Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, Irccs italy, Milano Gianfranco Parati Gianfranco Parati Department of Medicine and Surgery, University of Milano-Bicocca italy, Milano Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, Irccs italy, Milano Luigi Badano Luigi Badano Department of Medicine and Surgery, University of Milano-Bicocca italy, Milano Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, Irccs italy, Milano Department of Medicine and Surgery, University of Milano-Bicocca italy, Milano Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, Irccs italy, Milano Department of Cardiac, Thoracic and Vascular Sciences, University of Padova italy, Padova Aims Proportionate or disproportionate severity of valvular regurgitation to ventricular dilation is a new concept firstly introduced to describe the functional impact of secondary mitral regurgitation. Theoretically, the same conceptual framework could be extended to secondary tricuspid regurgitation (STR) to stratify the prognosis of these patients. Methods and results To evaluate the added prognostic value of classifying tricuspid regurgitation in proportionate/disproportionate STR compared to the classical grading in mild, moderate, or severe. 294 patients with STR underwent 2 D and 3 D echocardiography and were followed for 48 (IQR = 17-80) months. The Endpoint was a composite event of death (n = 32) and hospitalization for right heart failure (n = 72). Conventional grading of STR and measured regurgitant volume (mRegVol) were obtained as recommended by ESC/EACVI guidelines. Then, we assessed the proportionality of severe STS establishing a theoretical threshold of regurgitant volume (tRegVol) by defining severe STR as an STR with a regurgitant fraction > 50%. According to RV end-diastolic volume and ejection fraction, tRegVol = 50% x RVEF x RVEDV. Then, for each patient we compared mRegVol with tRegVol to define STR as: Non severe (NS): mRegVol was significantly lower than tRegVol. Severe proportionate (SP): mRegVol was similar to tRegVol (± 5 mL). Severe disproportionate (SD): mRegVol was significantly higher than tRegVol. Using the new classification, 8% of patients (16/196) with mild TR were reclassified as SP TR; 66,6% of patients (36/54) with moderate TR were reclassified as SP TR and 9% (n = 5) as SD TR; 2% of patients (1/44) with severe TR, were reclassified as NS TR, 22% (n = 10) as SP, and 75% (n = 33) as SD. The Kaplan-Meyer curves are showed in figure. The predictive power of both classifications was similar (C-statistics= 0.92, 95%CI 0.89-0.94 vs 0.91, 95%CI 0.88-0.93) Conclusion The new system reclassified 53/294 (18%) patients, but it did not significantly improve the prognostic power of the classical grading system in mild, moderate, severe. 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 - 67 Echocardiography vs. computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis
JF - European Heart Journal Supplements
DO - 10.1093/eurheartj/suaa195
DA - 2020-12-01
UR - https://www.deepdyve.com/lp/oxford-university-press/67-echocardiography-vs-computed-tomography-and-cardiac-magnetic-bJxVBJJ8Sf
SP - N28
EP - N44
VL - 22
IS - Supplement_N
DP - DeepDyve
ER -