Higher Left Ventricular Ejection Fraction Research Articles

Abstract 11429: Post-Mortem Study of the Cause of Excess Mortality in Patients with Atrial Fibrillation and Heart Failure

Aims: To provide robust data on mortality in patients with atrial fibrillation (AF) and heart failure (HF), accounting for differences in mode of death using post-mortem information. Methods and Results: Retrospective cohort of 1009 patients admitted to a Romanian hospital between 2014-2017, with mean age 73±11 years, 47% women, NYHA class 3.0±0.9, left ventricular ejection fraction (LVEF) 40.1±11.0% and 100% anticoagulated. The primary outcome was mortality during 1.5±0.9 years follow-up, of which 291 (29%) died. Post-mortems were performed in 186 (64%) of patients. Baseline factors associated with mortality were dependent on the cause of death. HF-related death in 136 (47%) was associated with higher NYHA class (hazard ratio [HR] 2.45 per one class increase, 95% CI 1.73-3.46; p<0.001) and lower LVEF (0.95 per 1% increase, 0.93-0.97; p<0.001). Vascular death occurred in 75 (26%) and was associated with hypertension (HR 2.83, 1.36-5.90; p=0.005) and higher LVEF (1.08 per 1% increase, 1.05-1.11; p<0.001). Non-cardiovascular death in 80 (28%) was associated with clinical obesity (HR 2.20, 1.21-4.00; p=0.010), and higher LVEF (1.10 per 1% increase, 1.06-1.13; p<0.001). Across all causes, there was no relationship between mortality and AF type (p=0.77), HF type (p=0.85) or LVEF (p=0.58). Conclusions: Supported by post-mortem data, the cause of death in AF and HF patients is heterogeneous, and the relationships with typical markers of mortality are critically dependent on mode of death. The poor prognosis in this group demands further attention to improve management beyond anticoagulation.

Abstract 9320: Biological Sex as a Modifier of the Natural History of Dilated Cardiomyopathy

Introduction: Dilated cardiomyopathy (DCM) has a ~20% 5-year mortality rate. Understanding the impact of biological sex offers scope to improve outcomes. Objective: Investigate potential sex specific differences in the outcome of DCM. Methods: Prospective longitudinal observational cohort study of 604 patients (n=206 women, 398 men) with DCM confirmed by cardiac MRI. The median follow up for cardiovascular death, major heart failure and arrhythmic events was 3.9 years. Results: At baseline women had higher left ventricular ejection fraction (LVEF), smaller left ventricular volumes, less myocardial fibrosis and lower serum troponin concentrations (all p<0.05, Table 1), with no difference in age at study enrolment or medication. Despite this favourable profile, within 2 years women had more primary outcome events than men (Figure) with Kaplan Meier estimates of 10.7% vs 5.1%; adjusted* hazard ratio 3.47, 95% CI 1.81 to 6.65, [*age, LVEF, troponin, LMNA , left atrial volume and myocardial fibrosis]. Between 2-5 years, men and women had similar outcomes (adjusted* HR 0.55; 0.17,1.78). An LVEF <35% in men (HR 3.21, 1.67 to 6.18, C-statistic 0.647) but <40% in women (HR 2.37, 1.05 to 5.36, C statistic 0.602) had the greatest discrimination for predicting outcome. Conclusions: Female sex is an adverse modifier of the early natural history of DCM. There is evidence for sex specific risk stratification thresholds. Sex should be considered a determining variable in DCM care.

Abstract 9995: Predictors of Functional Mitral Regurgitation Severity in Non-Ischemic Cardiomyopathy

Background: Functional mitral regurgitation is a result of left ventricular and/or atrial remodeling and dysfunction leading to the leaflet malcoaptation, and associated with adverse prognosis. This study assesses the associations between clinical and chamber quantification parameters by cardiac magnetic resonance (CMR) imaging with FMR severity. Methods: This study includes a retrospective cohort of adult NICM patients undergoing CMR during 2002-2017. Quantitative left ventricle, left atrial and right ventricle parameters measured by CMR and clinical factors were assessed for their associations with mitral regurgitant fraction using multivariable linear regression analyses. Results: In 633 NICM patients, mean age was 52.6 years, 256 (40.4%) were female and mitral regurgitant volume and fraction were 11±11 mL and 14±13% respectively. Mitral regurgitant fraction was greater than 20%, 30% and 40% in 26.5%, 11.8% and 6.5% of the cohort respectively. In multivariable linear regression analyses(Table), female sex, higher left-ventricular end-diastolic volume indexed, left ventricular ejection fraction and left atrial volume indexed, and reduced right ventricular ejection were all independently associated with higher mitral regurgitation fraction. Conclusion: FMR is prevalent in NICM patients, and interestingly, female sex and higher left ventricular ejection fraction were independently associated with mitral regurgitation severity, while other predictors include adverse left ventricular and left atrial remodeling, and right ventricular dysfunction.

Abstract 11074: Worsening Renal Function in Acute Heart Failure in the Context of Diuretic Response

Background: For patients with acute heart failure (AHF), a substantial diuresis after administration of loop diuretics is generally associated with better clinical outcomes but may cause creatinine to rise, suggesting a decline in renal function. We investigated the interaction between diuretic response and worsening renal function (WRF) on clinical outcomes in patients with AHF. Methods: In two cohorts of patients with AHF (PROTECT, n=1,698 and RELAX-AHF-2, n=5,586 in current analysis), the prognostic impact of WRF (creatinine ≥0.3 mg/dL increase baseline-day 4, sensitivity analyses were performed incorporating baseline renal function) by diuretic response (kg weight loss per 40 mg furosemide equivalent from baseline-day 4) was investigated with regards to (CV) death or cardiovascular/renal hospitalisation using subpopulation treatment effect pattern (STEPP) plots and survival analyses. Results: WRF occurred in 286 (16.8%) patients in PROTECT and 1,031 (18.5%) patients in RELAX-AHF-2. Patients with WRF had higher left ventricular ejection fraction and lower estimated glomerular filtration rate at baseline (P<0.05). Patients with WRF also received higher doses of loop diuretics and had a worse diuretic response (all P<0.001). In patients with a poor diuretic response (≤0.35 kg weight loss/40 mg furosemide equivalent as identified by STEPP), WRF was associated with a higher risk of (CV) death or cardiovascular/renal hospitalisation (P<0.001 in both cohorts), but this was not the case for patients with a good diuretic response (P=0.900 for both cohorts). Conclusion: In two large cohorts of patients with AHF, WRF in the first 4 days was not associated with worse outcomes when patients had a good diuretic response. The occurrence of WRF in patients with AHF should therefore be considered in the context of diuretic response.

Abstract 10536: Adenosine Triphosphate - Sensitive Potassium Channel Opener Diazoxide Reduces Myocardial Stunning in a Porcine Lad Occlusion Model

Introduction: Adenosine triphosphate - sensitive potassium (K ATP ) channels provide endogenous myocardial protection by coupling cell membrane potential to metabolism, as they are inhibited by ATP and open during times of metabolic stress. Pharmacologic opening of K ATP channels mimics ischemic preconditioning, and diazoxide (DZX) preserves myocardial function following prolonged global ischemia. Hypothesis: We hypothesized that DZX would reduce myocardial stunning after left anterior descending coronary artery (LAD) occlusion followed by global ischemia, similar to a clinical situation of acute myocardial infarction followed by coronary revascularization. Methods: Twelve swine underwent LAD occlusion (30 min), followed by 120 min global ischemia protected with hyperkalemic cardioplegia (CPG) +/- DZX (N=6 each), followed by intermittent CPG (q 20 min), then 60 min reperfusion (RF). Cardiac output (CO), mean time to wean from cardiopulmonary bypass (CPB), left ventricular ejection fraction (LVEF), left ventricular developed pressure (LVDP), caspase - 3 (apoptosis), and infarct size were compared. Results: All 6 animals in the DZX group separated from CPB by 30 min RF whereas only 1 and 4 animals in the CPG group had separated at 15 and 30 min, respectively (Figure). DZX was associated with shorter average time to wean from CPB (17.5 vs 27.0 min, p=0.13) and higher CO at all time points during reperfusion (2.9 vs 1.5 L/min at 30 min RF, p=0.05), however, these were not significantly different. DZX was associated with higher LVEF after 30 minutes of reperfusion (42.5 vs 15.8%, p=0.009; Figure). There were no differences between groups in vasopressor use, infarct size, caspase - 3, or LVDP. Conclusions: DZX reduces myocardial stunning and facilitates separation from CPB following LAD occlusion and subsequent global ischemia in a porcine model. The addition of DZX to hyperkalemic cardioplegia has the potential to reduce myocardial stunning in the clinical setting.

Abstract 11341: Diabetes and Chronic Kidney Disease: Prevalence, Associated Factors and Influence on Optimal Medical Therapy in Patients with Coronary Artery Disease

Introduction: Diabetes mellitus (DM) and chronic kidney disease (CKD) are comorbidities of great therapeutic and prognostic importance in patients with coronary artery disease (CAD). Knowledge about their prevalence, associated factors and influence on optimal medical therapy are needed to best manage this population. Methods: This is a unicentric cross-sectional analysis of 869 patients enrolled in a CAD registry in Brazil. To be included, patients needed to have a previous coronary artery revascularization procedure (either percutaneous or surgical), documented previous acute coronary syndrome, or known coronary stenosis greater than 50%. CKD was defined as creatinine clearance < 60 mL/min. DM was defined as prescription of glucose-lowering drugs or a HbA1c > 6.5%. Results: Overall, mean age was 64.7 years, 261 (30%) were women, 528 (61%) had previous myocardial infarction, and 547 (63.4%) had a previous revascularization procedure. DM was prevalent in 449 (51.7%) patients and CKD in 280 (32.2%). Both comorbidities were concomitant in 151 (17.4%) patients. On multivariate analysis, CKD was correlated to female sex (OR 2.94; 95%CI 1.88-4.67), age (OR 1.20; 95%CI 1.16-1.23), BMI (OR 0.80, 95%CI 0.76-0.84), and HDL-cholesterol (OR 0.97; 95%CI 0.96-0.99). DM was associated with age (OR 1.02, 95%CI 1.00-1.04), BMI (OR 1.05, 95%CI 1.01-1.08), high blood pressure (OR 2.1, 95%CI 1.39-3.21), and heart rate (OR 1.02, 95%CI 1.00-1.03). Concomitant presence of CKD and DM was associated with age (OR 1.09, 95%CI 1.06-1.13) and left ventricular ejection fraction (OR 0.97, 95%CI 0.95-0.98). Patients with DM were more likely to receive ACE inhibitors or ARBs (79.3% x 67.1%, p< 0.001) and calcium channel blockers (41.9% x 31.2%, p=0.001). Patients with DM and CKD had higher use of nitrates (38.4% x 25.6%, p=0.002). There was no difference in the prescription of antithrombotic drugs, beta-blockers or statins between groups. Conclusion: DM and CKD are both very prevalent comorbidities in patients with CAD. They are associated with age and risk markers such as high blood pressure and lower left ventricular ejection fraction. Although typically these populations are undertreated in others registries, this fact was not observed in our study.

Myocardial Viability, Functional Status, and Collaterals of Patients With Chronically Occluded Coronary Arteries.

Objective: Viability and functional assessments are recommended for indication and intervention for chronic coronary total occlusion (CTO). We aimed to evaluate myocardial viability and left ventricular (LV) functional status by using cardiovascular magnetic resonance (CMR) and to investigate the relationship between them and collaterals in patients with CTO.Materials and Methods: We enrolled 194 patients with one CTO artery as detected by coronary angiography. Patients were scheduled for CMR within 1 week after coronary angiography.Results: A total of 128 CTO territories (66%) showed scar based on late gadolinium enhancement (LGE) imaging. There were 1,112 segments in CTO territory, while only 198 segments (18%) subtended by the CTO artery showed transmural scar (i.e., >50% extent on LGE). Patients with viable myocardium had higher LV ejection fraction (LVEF) (56.7 ± 13.5% vs. 48.3 ± 15.4%, p < 0.001) than those with transmural scar. Angiographically, well-developed collaterals were found in 164 patients (85%). There was no significant correlation between collaterals and the presence of myocardial scar (p = 0.680) or between collaterals and LVEF (p = 0.191). Nevertheless, more segments with transmural scar were observed in patients with poorly-developed collaterals than in those with well-developed collaterals (25 vs. 17%, p = 0.010).Conclusion: Myocardial infarction detected by CMR is widespread among patients with CTO, yet only a bit of transmural myocardial scar was observed within CTO territory. Limited number of segments with transmural scar is associated with preserved LV function. Well-developed collaterals are not related to the prevalence of myocardial scar or systolic functioning, but could be related to reduce number of non-viable segments subtended by the CTO artery.

Clinical Profile and Prognosis of a Real-World Cohort of Patients With Moderate or Severe Cancer Therapy-Induced Cardiac Dysfunction.

Introduction and Objectives: Cancer therapy-related cardiac dysfunction (CTRCD) is a common cause of cancer treatment withdrawal, related to the poor outcomes. The cardiac-specific treatment could recover the left ventricular ejection fraction (LVEF). We analyzed the clinical profile and prognosis of patients with CTRCD in a real-world scenario.Methods: A retrospective study that include all the cancer patients diagnosed with CTRCD, defined as LVEF < 50%. We analyzed the cardiac and oncologic treatments, the predictors of mortality and LVEF recovery, hospital admission, and the causes of mortality (cardiovascular (CV), non-CV, and cancer-related).Results: We included 113 patients (82.3% women, age 49.2 ± 12.1 years). Breast cancer (72.6%) and anthracyclines (72.6%) were the most frequent cancer and treatment. Meantime to CTRCD was 8 months, with mean LVEF of 39.4 ± 9.2%. At diagnosis, 27.4% of the patients were asymptomatic. Cardiac-specific treatment was started in 66.4% of patients, with LVEF recovery-rate of 54.8%. Higher LVEF at the time of CTRCD, shorter time from cancer treatment to diagnosis of CTRCD, and younger age were the predictors of LVEF recovery. The hospitalization rate was 20.4% (8.8% linked to heart failure). Treatment with trastuzumab and lower LVEF at diagnosis of CTRCD were the predictors of mortality. Thirty point nine percent of patients died during the 26 months follow-up. The non-CV causes and cancer-related were more frequent than CV ones.Conclusions: Cardiac-specific treatment achieves LVEF recovery in more than half of the patients. LVEF at the diagnosis of CTRCD, age, and time from the cancer treatment initiation to CTRCD were the predictors of LVEF recovery. The CV-related deaths were less frequent than the non-CV ones. Trastuzumab treatment and LVEF at the time of CTRCD were the predictors of mortality.

Clinical Impact of Cardiovascular Magnetic Resonance in Cancer Patients With Suspected Cardiomyopathy.

Objectives: To assess the clinical impact of Cardiovascular Magnetic Resonance (CMR) in clinical decision making of cancer patients with a suspected cardiomyopathy in a tertiary cancer center.Background: Cardiomyopathies of diverse etiologies are frequently encountered in a Cardio-Oncology practice. The clinical impact of CMR after a presumptive diagnosis of cardiomyopathy has not been studied in cancer patients.Methods: We reviewed data on cancer patients with presumptive diagnosis of cardiomyopathy who underwent CMR in a tertiary cancer center. The clinical impact of CMR was defined as either change in clinical diagnosis or management post CMR results. Univariate and multivariate logistic regression models were used to assess whether any of the baseline characteristics were predictive of the clinical impact of CMR.Results: A total of 110 consecutive patients were identified. Clinical impact of CMR was seen in 68 (62%) patients. Change in the clinical diagnosis and management was seen in 56 (51%) and 41 (37%) of patients, respectively. The most common change was prevention of endomyocardial biopsy in 26 patients (24%). Overall, patients with higher left ventricular ejection fraction (LVEF) by echocardiography (echo), clinical impact was influenced more by CMR (LVEF of 37.2 ± 12.3% vs. 51.5 ± 11.6%, p < 0.001). Cancer diagnosis of multiple myeloma was associated with change in the management post CMR (adjusted OR of 25.6, 95% CI 4.0–162.4, p = 0.001). Suspicion of infiltrative cardiomyopathy was associated with a higher likelihood of change in diagnosis. Having an LVEF≥40 by echo was associated with change in diagnosis and management by CMR.Conclusions: Utilization of CMR has a significant clinical impact in cancer patients with suspected cardiomyopathy. Patients with cancer diagnosis of multiple myeloma, suspicion of infiltrative cardiomyopathy and those with higher LVEF by echo seem to benefit more from CMR.

Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients: the CONDI-2/ERIC-PPCI CMR substudy

The effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1–17.1)% of LV mass; control: 11.1 (7.0–17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial.

HER2 positive breast cancer: is there a preventive role of cardioprotective drugs?

Abstract Introduction In patients with breast cancer, anti-HER2-targeted therapies (AHT) are highly associated with cardiotoxicity (CT), being the main reason for treatment interruption in patients receiving adjuvant trastuzumab. Guidelines recommend regular left ventricular ejection fraction (LVEF) assessments and CT's management with cardioprotective drugs (CPD). However, while secondary prevention has already entered clinical practice, primary prevention is still in the research domain. Our aim was to evaluate risk of CT and the role of CPD in a subset of breast cancer patients treated with AHT. Methods We retrospectively analyzed a population of breast cancer female patients treated with AHT referred to Cardio-oncology consultation at a tertiary center from January 2017 to March 2020. All patients were evaluated with echocardiogram before treatment initiation and at least at 3, 6, 9 and 12-months. CT was defined as LVEF under 50% or decline of at least 10% in LVEF during follow-up. As CPD we considered renin-angiotensin-aldosterone system inhibitors and beta-blockers. Results A total of 85 patients were included with mean age of 52.4±10.2 year-old. Concerning cardiovascular risk factors 11.8% had diabetes, 32.9% dyslipidaemia, 29.4% hypertension and 22.4% were smokers or previous smokers; most patients had a high or very-high CT risk score (98.8% with score ≥5). Besides AHT, 68.2% and 80% were also on anthracyclines and radiotherapy, respectively. Patients were followed for a median follow-up of 16 months. At baseline, mean high sensitivity troponin I was 3.9 ng/L, mean LVEF was 63.1% and mean global longitudinal strain was −19.7, with all patients having normal cardiac function. During follow-up, 15.7% developed CT with a higher prevalence in patients concomitantly on anthracyclines (19.6% vs 7.4%, p=0.151). CPD was initiated or titrated in 84.6% of patients and 30.8% needed to suspend AHT; overall 92.3% of CT patients recovered. Unlike AHT suspension, CPD initiation after CT was associated with a higher rate of cardiac function recovery (100.0% vs 50.0%, p=0.020). When comparing patients already medicated with CPD before cancer treatment (41.7%) to those naïve of CPD, the first group presented a significative lower incidence of CT [2.9% vs 25.0%, p=0.006, OR=0.09 (95% CI 0.01 – 0.72)]. When analysed all sample (with or without CT), patients already on CPD also presented a higher LVEF at 6 months follow-up (62.5% vs 59.2%, t(69)=−2.4, p=0.017 at 6 months), despite a non-significative lower LVEF at baseline (62.3% vs 63.6%, p=0.139). Medication with statins before chemotherapy didn't reduce the risk of CT. Conclusion Pre-treatment with CPD was significantly associated with a lower prevalence of CT and a higher LVEF at 6-months follow-up. CPD initiation after CT was associated with cardiac function recovery. These results highlights the importance of cardiac evaluation in HER2+ patients and strengthen the primary prevention field in these patients. Funding Acknowledgement Type of funding sources: None.

Prognostic value of relative wall thickness in heart failure with preserved ejection fraction: what is the best method for its calculation?

Abstract Background The HFA-PEFF diagnostic algorithm is a recently published tool to help in the diagnosis of heart failure with preserved ejection fraction (HFpEF). One of the echocardiographic diagnostic criteria is left ventricular (LV) relative wall thickness (RWT), an index of LV concentricity. LV wall thickness can be measured by echocardiography at the posterior wall (PW) and/or the interventricular septum (IVS) in parasternal long axis view. There are three methods of RWT calculation: RWTPW= 2xPW/LV dimension at end diastole (LVDd) – the most used method, RWTIVS = 2 x IVS / LVDd and RWTPW + IVS = (PW + IVS) / LVDd. This study compares the prognostic value of these 3 methods of calculation in patients with acute HFpEF. Methods All patients admitted with acute HFpEF in a Cardiology Department during 7 years were included. RWT was considered elevated if superior to its median and was calculated with the 3 formulas. In-hospital mortality (IHM) was evaluated. The primary endpoint (EP) was a composite of all-cause mortality or hospitalization for HF during follow-up of 24 months. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions, and Kaplan-Meier curves. Results 478 patients were studied (61.3% female, mean age 79.4±8.3 years). Mean RWTPW, RWTIVS and RWTPW+IVS were 0.46±0.16, 0.50±0.17 and 0.48±0.16, respectively. IHM was 3.4% and primary EP occurred in 57.8%. High RWTPW was associated with higher LV ejection fraction (LVEF) (p&amp;lt;0.001). Patients with high RWTIVS were older (p=0.044). High RWTPW+IVS was associated with higher left atrial area (p=0.037) and higher LVEF (p=0.002). There was no statistically significant difference between patients with high and low RWT, calculated using the 3 formulas, in other indices that are commonly used to assess diastolic function, namely in e' and E/e'. None of the 3 methods of RWT calculation was a predictor of IHM. Survival analysis showed that patients with high RWTPW had higher incidence of the primary EP (43.2% vs. 16.8%, Kaplan-Meier χ2=5.99; p=0.014), but not patients with high RWTIVS (Kaplan-Meier χ2=0.23; p=0.631) or RWTPW+IVS (Kaplan-Meier χ2=1.92; p=0.166). RWTPW was a predictor of primary EP (OR 1.81; 95% CI 1.15–2.85; p=0.011) and this result was independent from e' and E/e' (OR 2.96; 95% CI 1.08–8.10; p=0.035). Conclusion In this study comparing 3 formulas for calculation of RWT, RWTPW had better risk prediction during follow-up than RWTIVS or RWTPW+IVS. RWTPW was a predictor of all-cause mortality and hospitalization for HF, and was independent from e' and E/e', indexes that are also recommended in HFA-PEFF diagnostic algorithm. Therefore, the formula incorporating PW should be preferred in the evaluation of patients with suspected or diagnosed HFpEF. Funding Acknowledgement Type of funding sources: None.

Clinical characteristics and outcomes of myocardial infarction with nonobstructive coronary arteries

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) is caused by a heterogenous group of conditions with clinically significant sequelae. Purpose This study aims to compare the clinical characteristics and prognosis of MINOCA with myocardial infarction with obstructive coronary artery disease (MICAD). Methods Data was obtained from the Singapore Cardiac Longitudinal Outcomes Database (SingCLOUD), a national multicenter registry of patients with cardiovascular disease. Patients with a first presentation of acute myocardial infarction who underwent coronary angiography between 1 January 2011 and 31 December 2014 were extracted from the database. Follow up was conducted until 31 December 2017. Subjects were classified as having either MICAD or MINOCA based on angiographic findings. The primary outcomes were all-cause mortality and major adverse cardiac events (MACE) defined as a composite of all-cause mortality, recurrent myocardial infarction, hospitalization for heart failure and ischemic stroke. Results All 4124 patients who met the inclusion criteria were included in this study, of which 159 (3.9%) were diagnosed with MINOCA. Patients with MINOCA were more likely to be female, present with a non-ST elevation myocardial infarction (NSTEMI), have a higher left ventricular ejection fraction and less likely to have diabetes mellitus, previous ischemic stroke or smoking history. Over a mean follow-up duration of 4.5 years, MINOCA patients had a lower incidence of all-cause mortality (10.1% vs. 16.5%, p=0.030) and MACE (20.8% vs. 35.5%, p&amp;lt;0.0001) compared to patients with MICAD. On multivariable analysis, patients with MINOCA had a significantly lower risk of all-cause mortality (HR 0.42; 95% CI 0.21–0.82; p=0.011), MACE (HR 0.42; 95% CI 0.26–0.69; p=0.001) and recurrent myocardial infarction (HR 0.35; 95% CI 0.15–0.85; p=0.021). Within the MINOCA group, older age, higher creatinine, a STEMI presentation and the absence of antiplatelet use predicted all-cause mortality and MACE. Conclusions While patients with MINOCA had better clinical outcomes compared to MICAD patients, MINOCA is not a benign entity with about one in five patients experiencing a major adverse cardiovascular event in the mid-term. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council Project Grant

Aortic regurgitation and left ventricle remodeling on cardiac magnetic resonance and transthoracic echocardiography.

Transthoracic echocardiography (TTE) is the first imaging modality used to assess aortic regurgitation (AR). However, it is not possible to provide precise quantification in all patients. Our aim was to compare TTE and cardiovascular magnetic resonance (CMR) measurements in grading AR and left ventricle (LV) remodeling. A total of 51 consecutive patients with AR in TTE (New York Heart Association I/II, 55%/38%) were enrolled into the study and 49 individuals (age, 57.1 [14]; 61% males) underwent a non-contrast CMR (2 patients excluded) obtained on 1.5 T system (GE Optima MR450w). The comprehensive quantitative grading with AR volume (AR vol) and regurgitant fraction (RF) were measurable in TTE in 24 cases and showed an association with CMR parameters (AR vol: r = 0.75; P <0.001 and RF: r = 0.55; P <0.01). CMR revealed larger LV end-diastolic volumes (EDV) (185.5 [61] vs 158.4 [61] ml; P = 0.03) and a trend towards higher left ventricular ejection fraction (59% [8] vs 56% [8]; P = 0.08). The association of AR vol and LV EDV was stronger in CMR (r = 0.85; P <0.0001) compared to TTE (r = 0.6; P = 0.001). The inter-modality agreement (TTE-CMR) in AR grading was low (κ = 0.15), with highly concordant grading in mild AR (91%). CMR provides a comprehensive assessment of AR severity and LV remodeling with a weak or a moderate agreement with TTE.

Coronary Artery Z Score is Associated with Postoperative Outcomes in Patients with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly that occurs in approximately 1 in 300,000 live births. This study aimed at identifying preoperative predictors of immediate postoperative outcomes. We conducted a retrospective, cross-sectional, single-center study and reviewed echocardiographic and hemodynamic data from all patients before and after surgical repair of ALCAPA at our center from January 2004 to February 2018. In all cases, the left coronary artery arose from the main pulmonary artery or a major branch. A total of 10 patients (age 1month to 10years, median 3months) underwent ALCAPA surgical repair during the study period. No patients required a left ventricular assist device (LVAD) before surgery, but 4 patients (40%) received an LVAD after the surgery. The left ventricular ejection fraction (LVEF) improved in all patients following surgery. The utility of preoperative factors associated with pre- and post-procedure LVEF was investigated. LV dimension, as well as right coronary artery (RCA) and left coronary circumflex artery (LCX) Z scores were associated with a higher LVEF in the preoperative state. Patients with larger RCA, left ascending artery (LAD), and LCX Z scores also had a shorter duration of mechanical ventilation and ICU stay following surgery. Patients with a RCA Z score < 4 required implantation of an LVAD postoperatively. ALCAPA patients with larger RCA and LCX demonstrated a higher preoperative LVEF, while those with larger RCA, LAD, and LCX had superior postoperative hemodynamics and clinical outcomes.

Founder mutation in myosin-binding protein C with an early onset and a high penetrance in males

ObjectiveOne of the challenges in hypertrophic cardiomyopathy (HCM) is to determine the pathogenicity of genetic variants and to establish genotype/phenotype correlations. This study aimed to: (1) demonstrate that MYBPC3 c.2149–1G>A...

Value of near-infrared spectroscopy in monitoring intestinal tissue oxygen saturation in preterm infants with hemodynamically significant patent ductus arteriosus: a prospective research.

To study the change in regional oxygen saturation (rSO2) of intestinal tissue in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA) by near-infrared spectroscopy, and the clinical significance of the change in intestinal oxygen level in preterm infants with hsPDA. The preterm infants with patent ductus arteriosus (PDA) who had gestational age <32 weeks and/or birth weight <1 500 g were prospectively enrolled, who were admitted to the Department of Neonatology, Shenzhen Longgang Central Hospital from October 2017 to October 2020.According to the diagnostic criteria for hsPDA, the preterm infants with patent ductus arteriosus (PDA) were divided into two groups: hsPDA and non-hsPDA. According to closure of the ductus arteriosus after oral administration of ibuprofen, the preterm infants in the hsPDA group were subdivided into two groups: hsPDA closure and hsPDA non-closure. Hemodynamic parameters were measured at diagnosis of PDA and after treatment, and the level of intestinal tissue rSO2 was monitored continuously to analyze its change. A total of 241 preterm infants with PDA were enrolled, with 55 infants (22.8%) in the hsPDA group and 186 infants (77.2%) in the non-hsPDA group. There were 36 infants (65%) in the hsPDA closure group and 19 infants (35%) in the hsPDA non-closure group. Compared with the non-hsPDA group, the hsPDA group had a significantly higher left atrial diameter/aortic root diameter ratio and significantly lower left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 6 hours after diagnosis (1, 2, 4, and 6 hours), the hsPDA group had significantly lower intestinal tissue rSO2 than the non-hsPDA group (P<0.05), and intestinal tissue rSO2 gradually decreased over time in the hsPDA group (P<0.05), with the lowest level of 0.448±0.014 at 6 hours. Compared with the hsPDA non-closure group, the hsPDA closure group had a significantly lower left atrial diameter/aortic root diameter ratio and significantly higher left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 48-96 hours after treatment (48, 72, and 96 hours), the hsPDA closure group had significantly higher intestinal tissue rSO2 than the hsPDA non-closure group (P<0.05), and intestinal tissue rSO2 gradually increased since 24 hours after treatment in the hsPDA closure group (P<0.05), with the highest level of 0.578±0.031 at 96 hours. hsPDA has an impact on intestinal tissue oxygenation in preterm infants, and continuous monitoring of intestinal tissue rSO2 by near-infrared spectroscopy can help to guide the clinical management of hsPDA in preterm infants.

Wild-Type Transthyretin Amyloidosis in Female Patients - Consideration of Sex Differences.

Background: With recent advances in non-invasive diagnostic tools, some studies indicate that wild-type transthyretin amyloidosis (ATTRwt) may be more common in females than previously reported. However, the clinical characteristics of female ATTRwt patients have not been determined.Methods and Results: Of the 78 consecutive patients with ATTRwt in our cohort, 14 (17.9 %) were female. Compared with male patients, female ATTRwt patients had smaller left ventricular (LV) wall thicknesses (ventricular septum thickness 12.9 vs. 14.2 mm [P=0.081]; posterior wall thickness 12.7 vs. 13.6 mm [P=0.035]) and a higher LV ejection fraction (EF; mean [±SD] 58.4±8.9% vs. 48.9±11.8%; P=0.006). However, the severity of heart failure (HF), as assessed by HF stage, New York Heart Association functional class and B-type natriuretic peptide concentrations, did not differ between female and male patients. Moreover, LV mass index and relative wall thickness were increased and the stroke volume index was reduced in both female and male patients. In organ biopsies, female patients had a higher sensitivity to transthyretin deposition from abdominal fat than male patients (positive abdominal fat biopsy 80.0 % vs. 26.5%; P=0.016).Conclusions: This study suggests that a relatively large proportion of elderly females have ATTRwt. Female ATTRwt patients had HF symptoms even at the stage of mild LV hypertrophy and preserved EF. Abdominal fat biopsy may be useful to diagnose ATTRwt, especially in female patients with HF.

Influence of Obstructive Sleep Apnoea on Outcomes in Patients With ST Elevation Myocardial Infarction (STEMI): the Role of the Coronary Collateral Circulation

Obstructive sleep apnoea (OSA) occurs frequently in patients with coronary artery disease, with associated intermittent hypoxia a possible stimulus for coronary collateral recruitment through ischaemic preconditioning. We sought to determine whether OSA affects recruitment of coronary collaterals and prognosis of patients presenting with ST elevation myocardial infarction (STEMI). Patients with a STEMI undergoing percutaneous coronary intervention (PCI) from July 2010 to December 2019 were reviewed. Electronic medical records were accessed to determine documented patient history of OSA. Patients with robust collaterals were defined as Rentrop Grade 2 or3. 1,863 patients were included, of which 143 (7.7%) patients had documented evidence of OSA in their health record. Patients with OSA had a higher body mass index (BMI) (30.2 kg/m2 vs 27 kg/m2, p<0.0001), greater rate of hypertension (61.1% vs 45.1%, p<0.0001), hypercholesterolaemia (47.4% vs 38.4%, p<0.05) and diabetes mellitus (22.6% vs 15.9%, p<0.05). Patients with OSA were more likely to have robust coronary collaterals (OR: 2.2 [95% CI: 1.5-3.2]) and a lower rate of left ventricular (LV) impairment (50.7% vs 63.1%, p<0.01), a higher LV ejection fraction (50.3% vs 46.7%, p<0.0001) and a lower peak troponin-I level (26,452 ng/L vs 39,469 ng/L, p<0.01). There were no differences in rates of in-hospital or longer term mortality, in patients with OSA compared to those without. Patients with documented OSA presenting with STEMI appear to have more robust coronary collaterals observed on angiography which likely mediates lower myocardial necrosis. Broader implications of this finding on treatment require further investigation.

B-PO05-156 ASSOCIATION AND PREDICTORS OF CARDIOMYOPATHY IN RATE-RELATED LEFT BUNDLE BRANCH BLOCK

Left bundle branch block (LBBB) has been identified as an independent cause of non-ischemic cardiomyopathy. Rate-related LBBB is an infrequent finding on stress tests (0.5% incidence) and has been associated with a higher all-cause mortality. However, the progression of rate-related LBBB to cardiomyopathy has not been well studied. We conducted a retrospective chart review to assess the characteristics of patients with rate-related LBBB and predictors of cardiomyopathy in this population. We identified all patients with LBBB during stress testing at our tertiary hospital from 2008-2020. Further we included those who developed rate-related LBBB and had transthoracic echocardiography (TTE) to assess their left ventricular ejection fraction (LVEF). Patients with right bundle branch block, resting LBBB, stress QRS<120 milliseconds, no TTE and ischemic cardiomyopathy were excluded. A total of 694 patients had LBBB on stress testing. Among these, 34 patients developed rate-related LBBB and met entry criteria. Females comprised 64.7%. Treadmill, dobutamine and vasodilator stress tests were performed in 23 (68%), 5 (15%) and 6 (17.6%) patients, respectively. Analysis of continuous variables showed moderate correlation (r=-0.4, p= 0.02) between LVEF and maximum stress QRS duration (maxQRS) and no significant correlation (r=0.3, p=0.08) with heart rate at which LBBB starts (HRstart). Patients with LVEF<40% had a wider maxQRS in rate-related LBBB than those with higher LVEF (157±11 vs 144±13, p=0.04). LBBB was noted earlier at a numerically lower mean HRstart in the LVEF<40% group but was not significantly different from the higher EF group (105±27 vs 116±28, p=0.45). Pre and post-stress QRS duration, sex, hypertension, coronary artery disease, beta blocker use and ACEi/ARB/ARNI use were not significant predictors of cardiomyopathy. Rate-related LBBB is not benign. Wider QRS duration during rate-related LBBB was associated with left ventricular dysfunction among these patients. Further prospective studies with larger sample size are needed to explore management options for patients with rate-related LBBB.