Objective: We aimed to study the long-term association of LV mass index (LVMI) and myocardial fibrosis with ventricular arrhythmia (VA) in a population of patients with confirmed hypertrophic cardiomyopathy (HCM) using cardiac magnetic resonance imaging (CMR). Methods: We retrospectively analyzed the data in consecutive HCM patients confirmed on CMR referred to an HCM clinic between January 2008 and October 2018. Patients were followed up yearly following diagnosis. Baseline demographics, risk factors and clinical outcomes from cardiac monitoring and an implanted cardioverter defibrillator (ICD) were analyzed for association of LVMI and LV late gadolinium enhancement (LVLGE) with VA. Patients were then allocated to one of two groups according to the presence of VA (Group A) or absence of VA (Group B) during the follow-up period. The transthoracic echocardiogram (TTE) and CMR parameters were compared between the two groups. Results: A total of 247 patients with confirmed HCM (age 56.2 ± 16.6, male = 71%) were studied over the follow-up period of 7 ± 3.3 years (95% CI = 6.6–7.4 years). LVMI derived from CMR was higher in Group A (91.1 ± 28.1 g/m2 vs. 78.8 ± 28.3 g/m2, p = 0.003) when compared to Group B. LVLGE was higher in Group A (7.3 ± 6.3% vs. 4.7 ± 4.3%, p = 0.001) when compared to Group B. Multivariable Cox regression analysis showed LVMI (hazard ratio (HR) = 1.02, 95% CI = 1.001–1.03, p = 0.03) and LVLGE (HR = 1.04, 95% CI = 1.001–1.08, p = 0.04) to be independent predictors for VA. Receiver operative curves showed higher LVMI and LVLGE with a cut-off of 85 g/m2 and 6%, respectively, to be associated with VA. Conclusions: LVMI and LVLGE are strongly associated with VA over long-term follow-up. LVMI requires more thorough studies to consider it as a risk stratification tool in patients with HCM.

60 Table 1Basic characteristics and vascular risk factors in two groupsCharacteristics Closure group (n=38) MM group (n=40) P value Median age 45 54 0.001 Age range 21-65 23-79 Highest age group 30-39 (n=12) & 50-59 (n=12) 50-59 (n=14) Males 23 (61%) 25 (62%) 0.43 Females 15 (39%) 15 (38%) Diabetes 2 (5%) 8 (20%) 0.02 Hypertension 6 (15%) 18 (45%) 0.002 Current smokers 6 (15%) 5 (12.5%) 0.41 Ex-smokers 4 (11%) 4 (10%) 0.46 Hyperlipidaemia 13 (34%) 23 (57%) 0.018 60 Figure 1PFO MDTs outcome closure group 48% (n=38), Medical Management group 51% (n=40) and one patients is waiting to be reviewed to decide about the closure[Figure omitted. See PDF] 60 Figure 2RoPE score is used to identify the patients whose PFOs are likely to be pathogenic rather than incidental. The score involves multiple variables based on vascular risk factors such as diabetes, hypertension, prior history of stroke or TIA and smoking history as well as patientsage and stroke features (cortical and non cortical infarcts)[Figure omitted. See PDF]ConclusionPFO closures at NUH were deemed to be safe day case procedures with no pressure placed on either the TOE or GA services by performing cases under LA and using ICE during the COVID-19 pandemic. A robust and evidence-based practice was followed to choose the suitable patients for the procedure in structured MDT meetings ensuring equitable access for all surrounding hospitals.Conflict of InterestNone

Background and Introduction Heart failure is a complex clinical syndrome in which the heart fails to meet the metabolic demands of the body. It is multifactorial in aetiology and its burden - health, social and economic, is increasing.The multifactorial aetiology of heart failure consists also of medications that can either provoke it or worsen it. The American Heart Association (AHA) has published a list of such medications divided into different categories, based on their action. Purpose The AHA medications list is lengthy and the impact of these medications on heart failure is not yet fully understood. Nevertheless, its existence and significance are still unknown to a high proportion of the medical community. We aim to raise awareness about medications that can cause or worsen heart failure syndrome and their potential but also to highlight the need to ensure that the patients have been prescribed the prognostic HF drugs. Methods 110 patients admitted with a primary diagnosis of heart failure in Nottingham University Hospitals in February 2020, had their electronic records reviewed retrospectively. We assessed the following parameters: Age, Sex, Background, whether the heart failure decompensation was new or old, the length of stay, AHA medications on admission and discharge, prognostic medications on discharge, and several blood results such as Hb, BNP, creatinine, MCV. We performed statistic evaluations on the above parameters. Results The patients’ average age was 78.5 years (SD: +/- 13) and the average stay in hospital was 10 days (SD: +/- 9). 57% were female (n=62 patients) and 43% male (n=48 patients). More than half of these patients (55%) had hypertension and 41% had ischemic heart disease. It is noteworthy that from the total cases 70% were decompensation of known heart failure and 30% were new diagnoses of HF.The percentage of the patients on AHA list drugs on admission was 37% and 32% were still discharged on AHA drugs. 79% of the patients were discharged on prognostic medications. 21% were not discharged on any prognostic medications, 34% were discharged on either b-blocker, ACEI or ARB only and 45% were discharged on full prognostic regimes such as ACEIs/ARBs, MRAs+ b-blocker. 15 patients were excluded due to death, multiple intolerances, HFpEF and fast-track discharges. 37% of the patients did not have their BNP checked. The mean Hb and MCV were 122 and 92 respectively. Conclusion The vast majority of the heart failure admissions were due to decompensation, so this is an opportunity to focus on how to prevent readmissions, by optimizing the medical management and arranging outpatient follow-up appointments for symptoms monitoring.Furthermore, over 1/3 of the patients were admitted on AHA drugs and still, 32% of these patients were discharged on them. Awareness should be raised about those medications and we should grow a culture of medical optimisation. For instance, an automatically generated alert when completing electronic discharge letters about AHA drugs will prevent discharges on these medications.Nevertheless, it should be highlighted that the BNP check is very important in assessing the severity of the patients’ presentation, which will guide further management.We have now introduced the Heart Failure 5 bundle to promote optimal management of heart failure patients, using keywords, so that they can be easily retained by the medical team. This bundle also endorses a holistic approach, aiming to take into account all the parameters which will lead to the provision of excellent care. Conflict of Interest None

Introduction: Advancement in interventional cardiology has increased the number of percutaneous coronary intervention (PCI) in the elderly. However, clinicians still face tough decision making to select elderly patients who can receive Primary PCI and have improved survival. This study aimed to identify factors that influence the survival in elderly population undergoing PPCI for treatment of ST elevation myocardial infraction (STEMI). Methods: We analyzed the data at our cardiac center prospectively during 2010- 2019 and developed a mathematical model using multi-parameter regression analysis using SPSS and OriginPro data visualization. Results: The factors which may predict survival were identified with help of mathematical model developed on the basis of clinical parameters reported at the time of STEMI presentation and details of the PCI procedure in 248 patients (male = 124, Age 85.78±3.43 years, , female= 124, Age 85.78± 4.08 years, ). The data visualization is shown in figure 1 and the developed model equation is as follows: Y (survival in months) = 126.865 - 0.258 (± 0.030) (Hb in g/dl) - 0.105(± 0.034) (Creatinine in umol/L) - 0.228 (± 0.112) (eGFR in ml/min/1.73 m 2 ) - 4.174 (±2.443) (triglycerides in mmol/l) - 1.201 (± 1.232) (LDL in mmol/l) - 0.001(±0.002) (Call to balloon time in minutes) + 16.874 (±3.119) (log 10 radiation dose)- 1.224(±0.352) Age at time of presentation) (N = 248, R = 0.636, F= 18.043, p = 0.00) Conclusions: Our study shows that hemoglobin, kidney function, lipid profile, call to balloon time, age of the patient at time of STEMI presentation and radiation dose used during the procedure may be important predictors for the survival of patient after PPCI. Nevertheless the patient age at the time of STEMI is negatively correlated with survival period. Similarly, early intervention in event of STEMI will decrease call to balloon time thereby increasing post-procedure survival in elderly patients .

Introduction Coronary artery calcification (CAC) is commonly seen in patients undergoing percutaneous coronary intervention (PCI) in the United Kingdom (UK). An aging population with risk factors such as diabetes and chronic kidney disease (CKD) have contributed to the rise in the prevalence of CAC. Despite advancement in PCI and alternative plaque modifying technology, rotational atherectomy (RA) remains an important adjunct to facilitate stent delivery. The UK records the highest use of RA in Europe, with a rate of 3.1% of total PCI. We report the 10-year experience of RA in a large UK tertiary hospital. Method This was a single tertiary centre, retrospective study of prospectively collected data on 213 patients who underwent RA PCI between October 2010 to February 2020. Procedural success and complications were assessed. The clinical outcomes evaluated were: target lesion revascularisation (TLR), readmission with heart failure, acute coronary syndrome (ACS) within 1 year, 30-day mortality and 18-month mortality. Subgroup analysis of outcomes in patients aged more than 80, severe left ventricular dysfunction and chronic kidney disease was performed. Results Patients had a mean age of 72.9 ± 8.6 years. 77.9% (n=166) were male. 67.6% (n=144) had hypertension, 35.7% (n=76) had diabetes, 9.4% (n=20) were actively smoking, 6.6% (n=14) had CKD 4-5, and 15% (n=32) had severe left ventricular systolic dysfunction (LVSD). 51.2% (n=109) had prior MI, 34.7% (n= 74) had previous PCI and 20.2% (n=43) previously had coronary artery bypass grafts. Indications were: acute coronary syndrome (52.6%), stable angina (41.3%) and bailout during STEMI (6.1%). 75% were discussed at the MDT prior to RA, and 25% were ad-hoc PCI. Predominant access was via the radial artery (74.6%), using 6F sheaths (60.6%). 1.5mm burr was most frequently used (63.4%) but in 14.6% of cases, burr upsize was required. Additional equipment such as cutting balloons (4.7%), intravascular ultrasound (13.6%), microcatheters (58.2%), temporary pacing wires (2.3%) and intra-aortic balloon pumps (1.4%) were used.Complexity of procedures ranged from RA of unprotected left main stem (14.6%), more than 1 vessel RA (2.8%), chronic total occlusions (5.2%) and in-stent restenosis cases (0.9%). Mean stent diameter was 3.5 ± 0.8mm and mean stent length was 37.6 ± 23.4mm. Stents were successfully delivered in 96.2% of cases, with a complication rate of 10.3% (table 1). At 18 months, we observed no significant difference in mortality between the age groups (p=0.26). However, patients with eGFR less than 30 (35.7%, p=0.004) and ejection fraction <35% (17%, p=0.03) undergoing RA had a significantly higher mortality rate at 18 months (figure 1,2). Conclusions Our study suggest that severe LVSD and CKD 4-5 may be a predictor for worse outcomes among rotablation patients. However, advanced age does not appear to be associated with poorer outcomes. Conflict of Interest None

Introduction: With advancement in interventional cardiology an increase in the number of percutaneous coronary intervention (PCI) procedures has been noted in the elderly. However, the post procedure complication and mortality remain a challenge for the physicians. This study aimed to estimate the survival among men and women above 80 years of age who undergo primary PCI for treatment of ST elevation myocardial infarction. Methods: We analyzed the data collected prospectively from our cardiac center. The patients were followed up over 10 years. Most patient received stents followed by anti-platelet drugs and preventive measures to avoid further cardiac event. Kaplan Meier curves were generated to study survival post PCI (SPSS v2.2). Survival curves were developed to determine the influence of age, sex, type of stent and degree of coronary flow (TIMI 0-3) on post procedure survival. Results: From 2010 to 2019, total 502 patients >80 years received PCI (282 males, 218 females). The median survival in the male and female population were 2.16 yrs. (95% CI 1.66 - 2.66) and 2.36 yrs. (95% CI 1.72-2.99)(P= 0.18). Significant difference of around 1 year (2.7 yrs. octogenarian vs 1.6 yrs. nonagenarian, p<0.001, see figure 1) was found in post PCI survival between octogenarian and nonagenarian. However, the survival was longer in case of Bare metal stents (BMS)(n= 113) as compared to Drug eluting stents(DES)(n= 274) (2.7 yrs. vs. 2.0yr, p<0.001). Similarly, post procedure TIMI flow analysis shows maximum survival in TIMI 3 followed by TIMI 2 and TIMI 1 ensuring the significance of TIMI grade flow. Conclusions: Our results demonstrate that PPCI in elderly patients have a better outcome and longer survival in octogenarians than nonagenarians. Similarly, use of BMS could be considered over DES in population above 80 years of age irrespective of gender. No difference in post PCI survival in male and female population.

Background Familial hypercholesterolaemia (FH) is an important and under-diagnosed cause of premature cardiovascular disease. It is recommended that all patients with suspected myocardial infarction should have their lipid profile measured on admission. The advantages of statins have been indisputably demonstrated in secondary prevention and the greatest benefit has been established with early intensive therapy following acute coronary syndrome. Aims and Methods The main objective was to improve assessment of lipid profile in the acute setting in all patients admitted with ST-elevation myocardial infarction (STEMI). Through this, there was capacity to aid in recognition and diagnosis of familial hypercholesterolaemia (FH). A retrospective assessment of all patients referred via the primary percutaneous intervention (PCI) pathway to the Trent Cardiac Centre between April 2016 and April 2017. We evaluated whether a random in-patient lipid profile was obtained, if patients met biochemical Simon Broome criteria for FH (total cholesterol >7.5 mmol/L +/- low-density lipoprotein cholesterol >4.9 mmol/L); were they were referred to a Lipid Clinic; was a statin prescribed and followed up was also investigated. We then implemented several changes throughout the cardiology department. These included the development of an electronic blood request order set including lipid profile for primary PCI patients. We also designed a new clerking proforma reminding clinicians to check the lipid profile. Information posters were distributed throughout the department and educational departmental sessions were held. A re-assessment was then performed of all patients between April 2018 and April 2019. Results The original data showed that from the 383 patients referred, 52 did not meet inclusion criteria. Of the remaining 331 patients, 67 (20%) patients did not have lipid profile checked as an in-patient. Of the 264 patients who had a lipid profile checked, 8 (3%) met biochemical Simon Broome criteria and 0 were referred to lipid clinic. Following the intervention, the re-audit showed that from the included 284 patients, 20 (7%) patients did not have a lipid profile checked as an in-patient. Seven (3%) of the 264 patients who had an in-patient lipid profile met biochemical Simon Broome criteria; 1 (14%) was referred to lipid clinic. Conclusion and Interpretation These results demonstrate an improvement in assessment of lipid profile in patients admitted with STEMI from 80% to 93%. There was also advancement in referral of patients to specialist lipid clinic from 0% to 14%. It is estimated that less than 10% of the FH population in the UK have been diagnosed. Greater efforts must be made to not only perform lipid profiles in patients admitted with STEMI, but also to ensure that these results are checked and appropriate clinical decisions are made. These simple changes could potentially have hugely beneficial clinical and financial implications. Conflict of Interest None

Current echocardiographic data reporting the impact of concomitant mitral regurgitation (MR) on outcome in patients who undergo transcatheter aortic valve replacement (TAVR) are conflicting. Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MR severity on cardiac reverse remodeling and patient outcome. 85 patients undergoing TAVR with CMR pre- and 6m post-TAVR were evaluated. The CMR protocol included cines for left (LV) and right ventricular (RV) volumes, flow assessment, and myocardial scar assessment by late gadolinium enhancement (LGE). Patients were dichotomised according to CMR severity of MR fraction at baseline (non-significant' vs significant') and followed up for a median duration of 3years. Forty-two (49%) patients had significant MR' at baseline; they had similar LV and RV size and function compared to the non-significant MR' group but had greater LV mass at baseline. In those with significant MR at baseline, 77% (n=32) had a reduction in MR post-TAVR, moving them into the non-significant' category at 6-months, with an overall reduction in MR fraction from 34 to 17% (p<0.001). Improvement in MR was not associated with more favourable cardiac reverse remodeling when compared with the non-improvers'. Significant MR at baseline was not associated with increased mortality at follow-up. Significant MR is common in patients undergoing TAVR and improves in the majority post-procedure. Improvement in MR was not associated with more favourable LV reverse remodeling and baseline MR severity was not associated with mortality.

To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).

OBJECTIVE:To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the first-generation CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA). DESIGN:A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up. SETTING:University hospitals of Leeds and Leicester, UK. PATIENTS:66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015. MAIN OUTCOME MEASURES:Incidence of new cerebral microinfarction and objective decline in neurocognitive performance. RESULTS:All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains. CONCLUSIONS:There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis.

Background The advantages of statins have been indisputably demonstrated in secondary prevention and the greatest benefit has been established with early and intensive therapy following acute coronary syndrome. According to ESC and NICE guidelines, a lipid profile should be obtained as soon as possible after admission. Though recommendations are to commence therapy in all patients irrespective of lipid profile, levels still need to be assessed at baseline and 6–12 weeks. Project Aims The main objectives were to improve assessment of lipid profile in the acute setting in all patients admitted with ST-elevation myocardial infarction (STEMI). Through this, there was capacity to aid in recognition and diagnosis of familial hypercholesterolaemia (FH). Methodology A retrospective assessment of all patients referred via primary percutaneous intervention (PPCI) pathway to the Trent Cardiac Centre between April 2016 and April 2017. It was evaluated whether a random inpatient lipid profile was obtained, whether patients met biochemical Simon Broome criteria for FH (TC >7.5± LDL-C >4.9) and whether they were referred Lipid Clinic. Whether a statin was prescribed and whether they were followed up was also investigated. Results From the 383 patients referred, 52 did not meet inclusion criteria. Of the remaining 331 patients, 20.2% (n=67) of patients did not have lipid profile checked as an inpatient. Of the 264 patients who had a lipid profile checked, 3% (n=8) met biochemical Simon Broome criteria and 0 were referred to lipid clinic. Abstract 67 Figure 1 Flow chart demonstrating project pathway, patients included and excluded and whether they were investigated and referred 41.3% (n=133) of patients had a follow up lipid profile. Only 32.2% (n=104) had both inpatient and follow up lipid profile There was good adherence to prescription of lipid lowering medication with 98.4% (n=326) of patients prescribed a statin. All patients that were not commenced on a statin had a documented reason. Conclusion and interpretation These results demonstrate that more than 1 in 5 patients referred via the PPCI pathway did not have a random lipid profile checked. This shows a lack of adherence to guidelines. The 3% of patients meeting criteria for possible FH and were not referred to lipid clinic could have potential clinical implications in the future for patients and their families.

OBJECTIVES:We sought to compare using serial CMR, the quantity of AR and associated valve hemodynamics, following the first-generation CoreValve (Medtronic, Minneapolis, MN) and the second-generation Lotus valve (Boston Scientific, Natick, MA). BACKGROUND:Aortic regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR) confers a worse prognosis and can be accurately quantified using cardiovascular magnetic resonance (CMR). Second generation valves have been specifically designed to reduce paravalvular AR and improve clinical outcomes. METHODS:Fifty-one patients (79.0 ± 7.7 years, 57% male) were recruited and imaged at three time points: immediately pre- and post-TAVR, and at 6 months. RESULTS:CMR-derived AR fraction immediately post-TAVR was greater in the CoreValve compared to Lotus group (11.7 ± 8.4 vs. 4.3 ± 3.4%, P = 0.001), as was the frequency of ≥moderate AR (9/24 (37.5%) versus 0/27, P < 0.001). However, at 6 months AR fraction had improved significantly in the CoreValve group such that the two valve designs were comparable (6.4 ± 5.0 vs 5.6 ± 5.3%, P = 0.623), with no patient in either group having ≥moderate AR. The residual peak pressure gradient immediately following TAVR was significantly lower with CoreValve compared to Lotus (14.1 ± 5.6 vs 25.4 ± 11.6 mmHg, P = 0.001), but again by 6 months the two valve designs were comparable (16.5 ± 9.4 vs 19.7 ± 10.5 mmHg, P = 0.332). There was no difference in the degree of LV reverse remodeling between the two valves at 6 months. CONCLUSION:Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.

Rare case of concurrent subarachnoid haemorrhage and ST elevation myocardial infarction, highlighting the importance of detailed history in an emergency.

Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling.

It is unknown whether circumferential strain is associated with prognosis after treatment of aortic stenosis (AS). We aimed to characterise strain in severe AS, using myocardial tagging cardiovascular magnetic resonance (CMR), prior to and following Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR), and determine whether abnormalities in strain were associated with outcome.

BACKGROUND:Symptomatic severe aortic stenosis (AS) is a class I indication for replacement in patients when left ventricular ejection fraction (LVEF) is preserved. However, symptom reporting is often equivocal and decision making can be challenging. We aimed to quantify myocardial deformation using cardiovascular magnetic resonance (CMR) in patients classified by symptom severity.METHODS:Forty-two patients with severe AS referred to heart valve clinic were studied using tagged CMR imaging. All had preserved LVEF. Patients were grouped by symptoms as either "none/mild" (n=21, NYHA class I, II) or "significant" (n=21, NYHA class III, IV, angina, syncope) but were comparable for age (72.8±5.4 vs. 71.0±6.8 years old, P=0.345), surgical risk (EuroSCORE II: 1.90±1.7 vs. 1.31±0.4, P=0.302) and haemodynamics (peak aortic gradient: 55.1±20.8 vs. 50.4±15.6, P=0.450). Thirteen controls matched in age and LVEF were also studied. LV circumferential strain was calculated using inTag© software and longitudinal strain using feature tracking analysis.RESULTS:Compared to healthy controls, patients with severe AS had significantly worse longitudinal and circumferential strain, regardless of symptom status. Patients with "significant" symptoms had significantly worse peak longitudinal systolic strain rates (-83.352±24.802%/s vs. -106.301±43.276%/s, P=0.048) than those with "no/mild" symptoms, with comparable peak longitudinal strain (PLS), peak circumferential strain and systolic and diastolic strain rates.CONCLUSIONS:Patients with severe AS who have no or only mild symptoms exhibit comparable reduction in circumferential and longitudinal fibre function to those with significant symptoms, in whom AVR is clearly indicated. Given these findings of equivalent subclinical dysfunction, reportedly borderline symptoms should be handled cautiously to avoid potentially adverse delays in intervention.

AIMS:Myocardial injury assessed using cardiac biomarker release is ubiquitous following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), preventing accurate discrimination between focal myocardial infarction (MI) and global injury. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging was used to compare rates of new MI following SAVR and TAVI. METHODS AND RESULTS:Identical CMR scans were obtained at baseline and six months post procedure in ninety-six patients undergoing SAVR (n=39) and TAVI (n=57). The rate of new MI was greater following SAVR than TAVI (SAVR, n=10 [26%] vs. TAVI, n=3 [5%], p=0.004). Infarct mass was similar between groups (SAVR 1.1±0.6 vs. TAVI 2.0±1.4 g, p=0.395). New MI did not impact on change in LV ejection fraction (SAVR:LGE[+]2.2±4.7 vs. LGE[-]0.9±8.0%, p=0.437, TAVI:LGE[+]-0.9±6.0 vs. LGE[-]2.0±7.8%, p=0.420). Thirty-four patients (60%) in the TAVI group had non-revascularised coronary artery disease (CAD) at the time of TAVI, of whom three (9%) had new MI. CONCLUSIONS:MI is an infrequent complication of TAVI but is more common following SAVR. Infarct size is small following both procedures. The low new infarct rate in TAVI, especially in the context of high rates of non-revascularised CAD, strengthens data from previous studies suggesting that coronary revascularisation pre-TAVI may be unnecessary.

Background Recent concerns regarding long term transcatheter aortic valve implantation (TAVI) prosthesis failure have been raised. Studies with long term failure outcomes are limited. Objective A cross sectional study to assess TAVI prosthesis function after more than 5 years implantation. Method All successful TAVI procedures at a single high volume centre between January 2007 to December 2012 were included. The most recent clinical transthoracic study assessing for prosthetic function performed by accredited cardiac sonographers and physicians were reviewed. The duration of follow up scan was categorised to early (<12 months), medium term (12 to 48 months) and long term (>48 months). Patient mortality data was recorded. Results 212 TAVI procedures were successfully implanted with follow up ranging from 4 to 9 years. The characteristics are similar to the first generation TAVI population with predominant use of a femoral approach and a self-expanding device. 4 (1.8%) patients died pre-discharge. 30 day mortality was, 3.3%. 1st, 2nd, 3rd, 4th years mortality were 11.9%, 7.0%, 13.9%, 16.9% respectively. Survival at 5 years was 53.3%. There were fewer patients with follow-up scans beyond 48 months. Cross sectional comparison did not show a change in valve gradient. Mild paravalvular regurgitation was present consistently. There was no evidence of late aortic stenosis or severe AR. Conclusion The medium to long term 1st generation TAVI valve function is promising, but long term follow up will be difficult due to high mortality in the earlier implantations.

Background Cardiac biomarker release is ubiquitous following surgical and transcatheter aortic valve replacement (SAVR and TAVR), preventing accurate discrimination between release due to focal myocardial infarction (MI) and global myocardial injury. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement imaging (LGE) is the most sensitive imaging method to detect post-procedural new MI. Our study aimed to compare rates of new MI using CMR LGE before and 6m after TAVR and SAVR.