BACKGROUND:Subphenotyping cardiogenic shock (CS) patients using nontraditional clustering methods represent a step toward precision medicine, potentially improving outcomes in this heterogeneous and high-mortality condition. OBJECTIVES:This study aimed to apply an unsupervised machine learning approach to integrate clinical and advanced echocardiographic data, identifying CS subphenotypes associated with different outcomes and features, beyond etiology. METHODS:This multicenter observational study prospectively analyzed 172 patients admitted to cardiac intensive care units with overt CS, from 2021. An exploratory statistical analysis preceded patient clustering using the Elbow Method and K-Means algorithm, based on clinical presentation. Dimensionality reduction was performed with principal component analysis. Phenotypes were further stratified according to the Society for Cardiovascular Angiography and Interventions stages. RESULTS:Five distinct phenotypes (I-V) were identified, showing progressively increasing in-hospital mortality rates: 25% (I), 32% (II), 39% (III), 41% (IV), and 60% (V). Kaplan-Meier analysis demonstrated a stepwise increase in mortality risk. Phenotypes IV and V had significantly higher mortality than phenotype I (HR: 2.78 [95% CI: 1.07-7.19] and HR: 2.80 [95% CI: 1.10-7.14]; P < 0.05). Mortality prediction remained independent after adjustment for confounding factors, and independently of Society for Cardiovascular Angiography and Interventions stage. Phenotype I had the lowest mortality, with higher arterial pressure and moderate left ventricular (LV) dysfunction, whereas phenotype II exhibited marked LV failure. Oppositely, phenotypes IV and V had severe congestion despite only mild LV impairment. CONCLUSIONS:Machine learning, newly integrating echocardiographic data, identified 5 distinct CS phenotypes, each with unique clinical/echocardiographic features and mortality risks. These insights could support personalized treatment strategies in CS patients, pending further validation.

The prevalence of advanced heart failure (AdHF) is increasing globally, driven by population aging and improved survival rates in chronic heart failure (CHF). Durable Mechanical Circulatory Support (DMCS), particularly Left Ventricular Assist Devices (LVADs), has become a cornerstone in AdHF management. However, its successful implantation requires a comprehensive preoperative evaluation integrating cardiac, hemodynamic, and systemic assessments. Echocardiography and cardiac magnetic resonance (CMR) provide critical data for risk stratification—e.g., LV ejection fraction < 25%, LV end-diastolic diameter < 60 mm, or free wall RV longitudinal strain (fwRVLS) > −14% predict poorer outcomes. Right heart catheterization (RHC) identifies hemodynamic contraindications (PVR > 6 WU, PAPi < 1.5, cardiac index < 2 L/min/m2), while cardiopulmonary exercise testing (CPET) remains pivotal for assessing functional reserve (peak VO2 < 12 mL/kg/min or <50% predicted). Systemic assessment must address renal, hepatic, oncologic, and psychiatric comorbidities that influence surgical risk. Integrating these multimodal data within a multidisciplinary framework—spanning cardiologists, cardiac surgeons, anesthesiologists, and psychologists—optimizes selection and outcomes for DMCS candidates.

Cardiogenic shock (CS) is a heterogenous, life-threatening condition burdened by high mortality rate. The clinical presentation and the pathophysiological mechanisms underlying CS in acute decompensated cardiogenic shock (ADHF-CS) in comparison with other acute etiology are completely different. Aim of this study was to assess the differences between ADHF-CS and other acute etiology of CS, based on clinical features, echocardiographic and laboratory variables, type of support, outcomes. We prospectively analyzed a cohort of CS patients consecutively admitted in an intensive cardiac care unit (ICCU) of a tertiary center in the period October 2020 to August 2024. This ICCU has a program for cardiac replacement therapy and it is inserted in a regional network for CS and advanced heart failure. A total of 109 patients (pts) with CS consecutively admitted in our ICCU were included in our analysis. ADHF-CS group was composed by 59 pts (male 84.7%, media age 60.4 years), with a significant less number of diabetic patients (25.4% respect of 44.0%, p 0.041). ADHF pts had no significative differences in severity of shock, they have similar SCAI stage, similar value of central venous pressure and lactate ad the admission but a significative lower value of central venous saturation (svcO2 54.8% vs 61.3%, p=0.026). Echocardiographic variables are very different in two groups: in ADHF-CS group the pts have major value of end diastolic diameter at the admission (left ventricle EDD admission 51.6 mm vs 64.4 mm, p< 0.001), lower left ventricular ejection fraction (EF 19.0% vs 23.2%, p=0.016), lower value of RVFAC (32.4% vs 38.1%) and a significative higher value of pulmonary pressure (44.8 mHg vs 35.5 mmHg, p= 0.001), no significative differences in left and right strain value. In ADHF group pts were supported with a major dose of vaso-inotropic drugs and dobutamine were used in 30% of patients in comparison with 14% of other group. The use of microaxial pump and VA-ECMO was no significative different, whereas IABP was used less frequent (41% in ADHF-CS vs 68%, p= 0.004), also ADHF-CS patients had less need of continuous renal replacement therapy (7.0% vs 28.0 p=0.04). ADHF CS patients had a significant liver disfunction (higher bilirubine and INR). ICCU- mortality was inferior in ADHF-CS without a significative value (16.9% vs 32.0%, p=0.065), a similar number of patient were implanted with LVAD but a significative higher number of pts were treated with heart transplantation (22.0% vs 5.0%, p=0.018). In our cohort ADHF-CS population had similar baseline feature population, worse echocardiographic variables, major liver disfunction in comparison with other etiology of CS. ADHF-CS patients needed of higher dose of vaso-inotropic drug, similar mechanical circulatory support, excepted for a less use of IABP, they have a better survival rate in ICCU and they more often treated with successful heart transplantation.

Cardiogenic shock (CS) management is challenging due to the heterogeneity of clinical presentations, complex hemodynamic perturbations and several complications. Therefore a multidisciplinary shock team and dedicated intensive cardiac care unit (ICCU) are necessary to treat these patients (pts). To assess clinical features and outcome of CS pts treated in a ICCU of a single tertiary center,inserted in a regional network for CS. We prospectively analyzed a cohort of CS pts admitted in an ICCU of a tertiary center from October 2020 to October 2024. This ICCU provides cardiac replacement therapy and operates as part of a regional system for advanced heart failure and CS. Early referrals, collaborative multidisciplinary discussions for pts transfers, and shared protocols are common to all network’s centers. We enrolled 145 pts with CS admitted in our ICCU.Mean age of the population was 60.9 years,80.6% were males. CS etiology was ACS in 46.2% of pts, acute decompensated heart failure in 47.6%,other etiologies in 6.2%. Ninty–one pts (62.7%) were transferred from other ICU/ICCU of the regional network for CS. These pts were supported by mechanical circulatory support (58.6% IABP, 13.7% microaxial pump, 20.0% VA–ECMO). The mechanical supports were selected and re–assessed by a multidisciplinary team, considering data from a multiparametric monitoring, and according to an escalation and de–escalation strategy. Sixty–eight pts needed mechanical ventilation, 29 continuous replacement therapy. Despite including a high–risk population, with a significant proportion of pts in SCAI stages D (36.5%) and E (12.4%) and phenotypes of the cardiogenic shock working group type II (40.0%) and type III (22.1%), the overall outcomes were favorable.The successful outcome, comprehensive of pts discharged from hospital or treated with a cardiac replacement therapy, were obtained in 80.6% of the cohort: 23 pts were treated with heart transplantation and 9 with LVAD implantation. The in–hospital mortality rate was 26.2%. [Table 1, Figure 1]. Despite the severity of CS population this study showed lower mortality rate than that reported in literature. A structured network for CS with early referral to ICCU and a multidisciplinary team for evaluation of escalation and de–escalation of mechanical circulatory support may play a role on outcome.Table 1 Figure 1

Aims:Myocardial work (MW) is a relatively novel non-invasive echocardiographic method with increasing fields of application. Normal reference ranges of MW indices in patients who have undergone a heart transplant (HTx) have not been determined yet. The aim of this study was to obtain the reference ranges for 2D echocardiographic indices of MW for adult HTx patients and to compare them with the results of the European Association of Cardiovascular Imaging (EACVI) Normal Reference Ranges for Echocardiography (NORRE) study. Methods and results:All consecutive HTx patients admitted at our institution (University Hospital of Siena, Italy) between September 2019 and May 2022 who underwent endomyocardial biopsy (EMB) were considered. Patients with a history of rejection, a history of coronary artery vasculopathy, either acute cellular rejection or acute antibody-mediated rejection at EMB, and donor-specific antibodies were excluded. MW retrospectively performed for the included patients was retrieved, and the results were compared with those from the EACVI NORRE study. Out of 176 HTx patients who underwent EMB, 94 patients were excluded. The study population consisted of 82 HTx patients [68.3% male, median age 53 (46-62) years]. The median duration from HTx was 5 (2-22) months. The main MW indices such as global work efficiency (GWE, 84 ± 8%), global work index (GWI, 1447 ± 409 mmHg%), global constructive work (GCW, 2067 ± 423 mmHg%), and global wasted work [GWW, 310 (217-499) mmHg%] did not differ according to gender. Each of these indices significantly differed from those reported in the EACVI NORRE study (P-value <0.001), with lower GWI, GCW, and GWE and higher GWW values in the HTx population. Conclusion:This study provides reference ranges for MW indices in an adult HTx population free from transplant-related complications which proved to be different from those previously reported in healthy volunteers.

Cardiac resynchronization therapy has evolved in recent years to provide a reduction of morbidity and mortality for many patients with heart failure. Its application and optimization is an evolving field and its use requires a multidisciplinary approach for patient and device selection, technical preprocedural planning, and optimization. While echocardiography has always been considered the first line for the evaluation of patients, additional imaging techniques have gained increasing evidence in recent years. Today different details about heart anatomy, function, dissynchrony can be investigated by magnetic resonance, cardiac computed tomography, nuclear imaging, and more, with the aim of obtaining clues to reach a maximal response from the electrical therapy. The purpose of this review is to provide a practical analysis of the single and combined use of different imaging techniques in the preoperative and perioperative phases of cardiac resynchronization therapy, underlining their main advantages, limitations, and information provided.

The implantation of left ventricular assist devices (LVADs) has been increasing, with good long-term results, in parallel with a growing population with advanced heart failure (HF). However, in some European countries, LVADs are still underused, with one of the main issues being the patient's late referral. On the contrary, the use of transcatheter edge-to-edge mitral valve repair (TEER) has exponentially increased over the past decade, expanding its potential use even in patients on the heart transplantation waiting list. Even though the study populations of the main trials that investigated the prognostic impact of LVAD and TEER are different, in clinical practice a clear distinction might not be so clear. Therefore, patients with refractory HF symptoms and significant mitral regurgitation should be thoroughly evaluated through a multidisciplinary Heart Team meeting with both an advanced HF specialist and interventional cardiologist, to avoid futile procedures and to define the optimal timing for advanced HF therapies, when they are indicated. We analyzed the main available studies and registries on both TEERs and LVADs and we compared their populations and outcomes, to provide the current evidence on the use of LVAD and TEER in the HF population, especially in the light of the recently released 5-year follow-up results, giving some insights on the Italian situation, and finally to stress the importance of a solid HF network between hospitals, aiming for advanced HF patients’ timely referral for LVAD or heart transplants.

The use of left ventricular assist devices (LVAD) has significantly increased in the last years, trying to offer a therapeutic alternative to heart transplantation, in light also to the significant heart donor shortage compared to the growing advanced heart failure population. Despite technological improvements in the devices, LVAD-related mortality is still fairly high, with right heart failure being one of the predominant predictors. Therefore, many efforts have been made toward a thorough right ventricular (RV) evaluation prior to LVAD implant, considering clinical, laboratory, echocardiographic, and invasive hemodynamic parameters. However, there is high heterogeneity regarding both which predictor is the strongest as well as the relative cut-off values, and a consensus has not been reached yet, increasing the risk of facing patients in which the distinction between good or poor RV function cannot be surely reached. In parallel, due to technological development and availability of mechanical circulatory support of the RV, LVADs are being considered even in patients with suboptimal RV function. The aim of our review is to analyze the current evidence regarding the role of RV function prior to LVAD and its evaluation, pointing out the extreme variability in parameters that are currently assessed and future prospective regarding new diagnostic tools. Finally, we attempt to gather the available information on the therapeutic strategies to use in the peri-operative phase, in order to reduce the incidence of RV failure, especially in patients in which the preoperative evaluation highlighted some conflicting results with regard to ventricular function.

Mechanical circulatory support (MCS) systems are increasingly employed in cardiogenic shock and advanced heart failure. A thorough understanding of the complex interactions occurring among heart, vasculature, and device is essential to optimize patient's management. The aim of this study is to explore non‐invasive haemodynamic profiling of patients undergoing MCS based on pressure–strain (PS) analysis.

Abstract Aims The presence of anti‐human leucocyte antigen (HLA) antibodies has been implicated in a higher incidence of complications as well as mortality rate in heart transplantation. The aim of the study was to identify through non‐invasive parameters early signs of myocardial dysfunction in the presence of anti‐HLA antibodies but without evidence of antibody‐mediated rejection (AMR) and its possible prognostic impact. Methods and results A total of 113 heart‐transplanted patients without acute cellular rejection (ACR) and AMR or cardiac allograft vasculopathy (CAV) were prospectively enrolled and divided into two groups [‘HLA+’ (50 patients) and ‘HLA−’ (63 patients)], based on the presence of anti‐HLA antibodies. Each patient was followed for 2 years after the enrolment, recording episodes of AMR, ACR, CAV, and mortality. Clinical characteristics were similar between the two groups. Among laboratory data, N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity cardiac troponin values were significantly higher in the presence of anti‐HLA antibodies (P < 0.001 and P = 0.003, respectively). The echocardiographic parameters that showed a statistically significant difference between the two groups were deceleration time of E wave (DecT E, P < 0.001), left ventricular global longitudinal strain (P < 0.001), tricuspid annular plane systolic excursion (P = 0.011), tricuspid S′ wave (P = 0.002), and free wall right ventricular longitudinal strain (fwRVLS, P = 0.027), whereas left atrial strain did not differ significantly (P = 0.408). Univariate analysis showed that anti‐HLA antibodies were associated with the development of CAV at both 1 and 2 year follow‐up [odds ratio (OR) 11.90, 95% confidence interval (CI) 1.43–90.79, P = 0.022 and OR 3.37, 95% CI 1.78–9.67, P = 0.024, respectively]. Bivariate analysis demonstrated that both fwRVLS and DecT E were predictors of CAV development independently from HLA status. Conclusions The presence of circulating anti‐HLA antibodies is correlated with a mild cardiac dysfunction, even in the absence of AMR, and CAV development. Interestingly, reduced values of DecT E and fwRVLS were predictors of future development of CAV, independently from anti‐HLA antibody.

Abstract Background Non-invasive myocardial work (MW) is a relatively novel echocardiographic method with increasing fields of application. Normal reference ranges of MW indices in a healthy population have already been determined but these may differ in patients who have undergone a heart transplant (HTX). Purpose To obtain the reference ranges for 2D echocardiographic indices of MW for HTX patients and to compare them with the results of the EACVI NORRE study regarding healthy volunteers. Methods All consecutive HTX patients admitted at our Institution under Day Hospital regimen from September 2019 to May 2022 who performed endomyocardial biopsy (EMB) were considered. Patients with echocardiographic exam or brachial artery cuff pressure unavailability, history of rejection, history of coronary artery vasculopathy (CAV) and either acute cellular rejection (ACR) or acute antibody-mediated rejection (AMR) at EMB were excluded. Non-invasive MW calculation through Speckle-tracking Echocardiography (STE) was retrospectively performed for included patients. Further, MW analysis results were compared to those from the EACVI NORRE study. Results Out of 176 HTX patients who had performed EMB and had available echocardiographic and blood pressure data, 35 patients were excluded because of history of rejection, 4 patients because of history of CAV and 55 patients because of either ACR or AMR at EMB. Therefore, study population consisted of 82 HTX patients (68.3% male, median age 53 (46 – 62) years). Median age from HTX was 5 (2 – 22) months. Mean global work efficiency (GWE, 84 ± 8 %), global work index (GWI, 1447 ± 409 mmHg%), global constructive work (GCW, 2067 ± 423 mmHg%) and median global wasted work (GWW, 310 (217 – 499) mmHg%) did not differ between sex categories (p-value > 0.05). Each of these indices significantly differed from those reported in the EACVI NORRE study (p-value < 0.001), with lower GWI, GCW, GWE and higher GWW in the HTX population. Conclusion This study provides reference ranges for non-invasive MW indices in a HTX population free from transplant-related complications which are different from those regarding a population of healthy volunteers.Table 1

Aims Right heart failure (RHF) after left ventricular assist device (LVAD) implant is burdened by high morbidity and mortality rates and should be prevented by appropriate patient selection. Adequate right ventricular function is of paramount importance but its assessment is complex and cannot disregard afterload. Myocardial work (MW) is a non-invasive Speckle Tracking Echocardiography-derived method to estimate pressure-volume loops. The aim of this study was to evaluate the performance of right ventricular myocardial work to predict RHF and long-term mortality after LVAD implant. Methods and results Consecutive patients from May 2017 to February 2022 undergoing LVAD implant were retrospectively reviewed. Patients without a useful echocardiographic exam prior to LVAD implant were excluded. MW analysis was performed. The primary endpoints were early RHF (<30 days from LVAD implant) and death at latest available follow-up. We included 23 patients (mean age 64 & PLUSMN; 8 years, 91% men). Median follow-up was 339 days (IQR: 30-1143). Early RHF occurred in six patients (26%). A lower right ventricular global work efficiency [RVGWE, OR 0.86, 95% confidence intervals (CI) 0.76-0.97, P = 0.014] was associated with the occurrence of early RHF. Among MW indices, the performance for early RHF prediction was greatest for RVGWE [area under the curve (AUC) 0.92] and a cut-off of 77% had a 100% sensitivity and 82% specificity. At long-term follow-up, death occurred in 4 of 14 patients (28.6%) in the RVGWE > 77% group and in 6 of 9 patients (66.7%) in the RVGWE < 77% group (HR 0.25, 95% CI 0.07-0.90, P = 0.033). Conclusion RVGWE was a predictor of early RHF after LVAD implant and brought prognostic value in terms of long-term mortality.

Background: The gold-standard treatment for end-stage heart failure is heart transplantation, but the lack of organ donors remains an important limitation in this field. An accurate selection of marginal hearts is fundamental to increase organ availability. Purpose: In our study we analyzed if recipients receiving marginal donor (MD) hearts, selected by dipyridamole stress echocardiography according to the ADOHERS national protocol, had different outcomes compared to recipients with acceptable donor (AD) hearts. Methods: Data were collected and retrospectively analyzed from patients who received an orthotopic heart transplant at our institution between 2006 and 2014. Dipyridamole stress echo was performed on identified marginal donors and selected hearts were eventually transplanted. Clinical, laboratory and instrumental features of the recipients were evaluated and patients with homogenous baseline characteristics were selected. Results: Eleven recipients transplanted with a selected marginal heart and eleven recipients transplanted with an acceptable heart were included. Mean donor age was 41 ± 23. The median follow-up was 113 months (IQR 86–146 months). Age, cardiovascular risk and morpho-functional characteristics of the left ventricle were comparable between the two populations (p > 0.05). Left atrial size was significantly higher in patients with marginal hearts (acceptable atrial volume: 23 ± 5 mL; marginal atrial volume: 38 ± 5 mL; p = 0.003). Acceptable donor recipients showed a higher impact of Cardiac Allograph Vasculopathy (p = 0.019). No rejection differences were found between the two groups. Four patients deceased, three were standard donor recipients and one was from the marginal donor group. Conclusions: Our study shows how cardiac transplant (Htx) from selected marginal donor hearts through a non-invasive bedside technique can alleviate the shortage of organs without a difference in survival compared to acceptable donor hearts.

Background: The hemodynamic definition of PH has recently been revised with unchanged threshold of peak tricuspid regurgitation velocity (TRV). The aim of this study was to evaluate the predictive accuracy of peak TRV for PH based on the new (>20 mmHg) and the old (>25 mmHg) cut-off value for mean pulmonary artery pressure (mPAP) and to compare it with the mean right ventricular–right atrial (RV–RA) pressure gradient. Methods: Patients with advanced heart failure were screened from 2016 to 2021. The exclusion criteria were absent right heart catheterization (RHC) results, chronic obstructive pulmonary disease, any septal defect, inadequate acoustic window or undetectable TR. The mean RV–RA gradient was calculated from the velocity–time integral of TR. Results: The study included 41 patients; 34 (82.9%) had mPAP > 20 mmHg and 24 (58.5%) had mPAP > 25 mmHg. The AUC for the prediction of PH with mPAP > 20 mmHg was 0.855 for peak TRV and mean RV–RA gradient was 0.811. AUC for the prediction of PH defined as mPAP > 25 mmHg for peak TRV was 0.860 and for mean RV–RA gradient was 0.830. A cutoff value of 2.4 m/s for peak TRV had 65% sensitivity and 100% positive predictive value for predicting PH according to the new definition. Conclusions: Peak TRV performed better than mean RV–RA pressure gradient in predicting PH irrespective of hemodynamic definitions. Peak TRV performed similarly with the two definitions of PH, but a lower cutoff value had higher sensitivity and equal positive predictive value for PH.

Left ventricular assist devices (LVADs) have been representing a cornerstone therapy for patients with end-stage heart failure during the last decades. However, their use induces several pathophysiological modifications which are partially responsible for the complications that typically characterize these patients, such as right ventricular failure, thromboembolic events, as well as bleedings. During the last years, biomarkers involved in the pathways of neurohormonal activation, myocardial injury, adverse remodeling, oxidative stress and systemic inflammation have raised attention. The search and analysis of potential biomarkers in LVAD patients could lead to the identification of a subset of patients with an increased risk of developing these adverse events. This could then promote a closer follow-up as well as therapeutic modifications. Furthermore, it might highlight some new therapeutic pharmacological targets that could lead to improved long-term survival. The aim of this review is to provide current evidence on the role of different biomarkers in patients with LVAD, in particular highlighting their possible implications in clinical practice.

Heart transplant (HTx) still represents the most effective therapy for end-stage heart failure, with a median survival time of 10 years. The transplanted heart shows peculiar physiology due to the profound alterations induced by the operation, which inevitably influences several echocardiographic parameters assessed during these patients' follow-ups. With these premises, the diastolic function is one of the main aspects to take into consideration. The left atrium (LA) plays a key role in this matter, and that same chamber is significantly impaired with the transplant, with different degrees of altered function based on the surgical technique. Therefore, the traditional echocardiographic evaluation of diastolic function applied to the general population might not properly reflect the physiology of the graft. This review attempts to provide current evidence on diastolic function in HTx starting from defining its different physiology and how the standard echocardiographic parameters might be affected to its prognostic role. Furthermore, based on the experience of our center and the available evidence, we proposed an algorithm that might help clinicians distinguish from actual diastolic dysfunction from a normal diastolic pattern in HTx population.

The prevalence of cardiac amyloidosis has progressively increased over the last years, being recognized as a significant cause of heart failure. In fact, the management of advanced heart failure is a cornerstone treatment of amyloid cardiomyopathy due to the frequent delay in its diagnosis. Left ventricular assist devices (LVADs) have been gaining importance in the scenario of end-stage heart failure, representing an alternative to heart transplant. However, only few studies have investigated the role of LVAD in restrictive cardiomyopathies such as cardiac amyloidosis, since there are several problems to consider. In fact, both anatomical factors and the restrictive physiology of this condition make LVAD implant a relevant challenge in this subset of patients. Furthermore, due to the systemic involvement of amyloidosis, several factors have to be considered after LVAD implant, such as an increased risk of bleeding and right ventricular failure. This review attempts to summarize the current evidence of LVAD in cardiac amyloidosis, especially focusing on the challenges that this cardiomyopathy imposes both to the implant and to its management thereafter.

Abstract Background Right ventricular failure (RVF) complicates 10 to 40% of left ventricular assist device (LVAD) implants, with necessity of high dose inotropic/vasodilatory drugs and right ventricular assist devices in severe cases. Prevention of RVF starts with appropriate patient selection for LVAD implant through extensive clinical, echocardiographic and hemodynamic evaluation. Purpose This study aimed to evaluate the performance of a novel non-invasive echocardiographic method for estimation of right ventricular myocardial work to predict RVF and death after LVAD implant. Methods Consecutive patients from May 2017 to February 2022 undergoing LVAD implant were retrospectively reviewed. Patients without a useful echocardiographic exam and/or a right heart catheterization prior to LVAD implant were excluded. Myocardial work analysis by Speckle Tracking Echocardiography (STE) was performed in these patients. The primary endpoints were RVF and death. Results The study included 23 patients (mean age 64±8 years, 91% men). Median follow-up time was 304 days (IQR: 23–1017). GWI significantly correlated with invasively-derived right ventricular stroke work index (RVSWI, r=0.538; p=0.008) and pulmonary arterial compliance (PAC, r=−0.522; p=0.013). Patients who experienced RVF (26.1%) had lower GWI (p=0.047) and GWE (p=0.001) and higher GWW (p=0.001). Patients who experienced death at 30 days after LVAD implant (26.1%) had lower GWE (p=0.005) and higher GWW (p=0.006). Performance for prediction of RVF after LVAD implant was greatest for GWE (AUC 0.92), followed by GWW (AUC 0.88) and GWI (AUC 0.78). A cut-off of 77% for GWE have a 100% sensibility and 82% specificity for prediction of RVF. At long term follow-up, death occurred in 4 patients (29%) in the GWE>77% group and in 6 patients (67%) in the GWE<77% group (hazard ratio for death, 0.24; 95% CI, 0.07 to 0.89, p=0.032). Conclusions Right ventricular myocardial work is a strong predictor of RVF after LVAD implant and death at long-term follow up. Its calculation should be implemented in the evaluation for LVAD candidacy. Funding Acknowledgement Type of funding sources: None.

Background: Cardiac Magnetic Resonance (CMR) has a key role in subjects presenting with acute myocarditis, independent from left ventricular ejection fraction; it is widely used as a non-invasive imaging test for both diagnostic and prognostic purposes. However, poor data is available about the CMR-derived prognostic parameters of acute myocarditis with preserved ejection fraction (AMpEF). The aim of this study was to investigate the role of CMR in predicting outcomes in patients followed up for AMpEF, using a composite endpoint of all-cause mortality and hospitalization for heart failure (HF). Methods: We retrospectively enrolled 61 patients with diagnosed AMpEF. All patients underwent biohumoral, echocardiographic and CMR evaluation in the acute phase. Myocarditis was confirmed by Lake–Louis criteria assessed on CMR images. Mean follow-up was 4.8 ± 0.6 years during which a composite endpoint of all-cause mortality and hospitalization for HF was investigated. Results: The population was fairly homogeneous regarding baseline clinical features. In particular, no significant differences in age and main cardiovascular risk factors were found between patients with and without events at follow-up. Seven patients met the endpoint. They had significantly higher levels of circulating neutrophils in the acute phase (76 ± 7% vs. 61 ± 11%, p = 0.014) and a higher amount of left ventricular mass with delayed enhancement (DE-LVM, 18 (14–29.5) vs. 12 (8–16) g, p = 0.028). At Cox univariate analysis, DE-LVM was the only significant predictor of endpoint, regardless of the site of inflammation. Conclusions: DE-LVM can predict the composite endpoint of all-cause mortality and hospitalization for HF in a population of patients with AMpEF, representing a new added tool for prognostic stratification.