Abstract Introduction Myocardial strain quantification by speckle-tracking of the right ventricle (RV) and left atrium (LA) can be performed by manual or automatic methods. Purpose The objective of our study is to evaluate the degree of correlation between manual measurement method and automatic software used in our imaging laboratory, in a population of healthy individuals and patients with cardiac transthyretin amyloidosis (ATTR). Methods Fifty-seven individuals were included, 30 patients with ATTR and 27 healthy volunteers, who underwent a transthoracic echocardiogram (TTE) from January to December 2019. Classic echocardiographic parameters and myocardial deformation were obtained according to the ASE/ EACVI guidelines. Global and free wall longitudinal strain of the RV (RVGLS, RVFWLS) and LA global strain (LAGS) analysis were obtained using speckle-tracking with two different software: QLAB Philips 10.7 and AutoSTRAIN Tomtec. Measurements analysis was performed by two experienced echocardiographers. Correlation and reproducibility analysis was performed using Pearson correlation coefficient (PCC) and intraclass correlation coefficient (ICC), respectively. Results Seventy-two percent were male and average age was 63±20 years. Linear correlation of RVGLS, RVFWLS and LAGS measurements with both methods reached statistical significance (table). This correlation was stronger and more reliable in the case of the LAGS. The attached figure shows the correlation between the different software in both groups. Conclusions AutoSTRAIN Tomtec automatic measurement method had higher reliability and correlation comparing to manual measurements performed by QLAB 10.7, especially in LA measurements. The obtained results, the application speed and the less operator's dependence of this automatic software support its routine use for RV and LA strain quantification. Funding Acknowledgement Type of funding sources: None. Correlation and reproducibility resultsLinear regression lines

Abstract Background and objectives Low-flow low-gradient (LFLG) aortic stenosis portends bad prognosis in different series. The objective of this study was to evaluate the evolution of this entity in our country. Methods We included 1394 consecutive patients evaluated between 2008-2016 with severe AS (AVA <1 cm²) and ejection fraction> 50% from 14 Spanish centres. The results (aortic valve intervention and mortality) were compared using the Kaplan-Meier survival analysis. Results Three groups based on gradient and flow status were established (high gradient: HG, normal flow under gradient: NFLG, low gradient low flow: LFLG). No significant demographic or clinical differences between groups were observed. After a follow-up of 61.52 months (IQR 43.5-86.5), 551 (73.8%) HG, 268 (35.4%) with NFLG and 81 (57.9%) LFLG received intervention, with a later surgery/TAVI indication in the LFLG group compared with HG group (p = 0.001) (Figure 1). The analysis of the Kaplan-Meier mortality curves showed no significant differences. Conclusions Patients with LFLG aortic stenosis with normal ejection fraction received less and later aortic valve intervention than the HG group with no significant differences in mortality. Abstract P754 Figure. Time to surgery

Abstract Introduction Pulmonary hypertension (PH) is defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, measured by right heart catheterization (RHC). Purpose To describe classical and myocardial deformation echocardiographic parameters in patients with established PH and to identify prognostic variables Methods We prospectively enrolled 76 patients with mPAP ≥25 mmHg undergoing RHC between 2017 and 2018. All subjects underwent transthoracic echocardiography (TTE) according to the latest ASE/EACVI guidelines the same day of the RHC. Strain analysis was carried out by speckle-tracking echocardiography (QLAB 10.7, Philips). Clinical events during the follow-up were: acute heart failure hospitalization, cardiac transplant and all-cause mortality. Results Mean age was 59±12, 43.4% were women and 49 patients (64.5%) belonged to group 2 of PH. The median follow-up was 288 (ICR 92–534) days. Total number of events was 42 (55.3%, 9 deaths). Variables associated to events are shown in Table 1. All classic LV and RV systolic function and strain parameters were associated with a worse prognosis, being free-wall RV longitudinal strain (RVLS) the only one that remained as a prognostic factor in mutivariate analysis. Other variables associated with a worse prognosis were PCP>15 mmHg and NT-proBNP>1800, the latter being independent predictor of events. The attached figure shows event-free survival curves for the global population divided according to whether or not they belong to group II PH. Conclusions Our data highlight the prognostic value of free-wall RVLS and NT-proBNP in patients with established PH. NT-ProBNP was only useful in group II PH while free-wall RVLS identified patients with a higher risk of events in both groups, mainly in patients with heart disease Free event survival Curves Funding Acknowledgement Type of funding source: None

Heart involvement in systemic light-chain amyloidosis (ALCAM) confers an ominous prognosis. New treatments, including Bortezomib (BOR), achieved better prognosis by increasing the patients with cardiac response (CarR). Traditionally, CarR has been defined by a >30% decrease in NTproBNP. Recent research suggest that echocardiography (Echo) could provide new cardiac response criteria with additional prognostic value. Our aim was to evaluate the usefulness of Echo CarR criteria.

Analizar la evolución de pacientes con disfunción ventricular grave precondicionados con levosimendán antes de la cirugía cardíaca. Material y métodos: Entre noviembre de 2005 - enero de 2012 se operaron 48 pacientes con edad media de 69 ± 9 años (rango 40–83 años). La fracción de eyección del ventrículo izquierdo (FEVI) preoperatoria fue de 29 ± 6% (rango 15–39). El EuroSCORE logístico y el Parsonnet fueron de 9,7 ± 4% y 20,8 ± 15%, respectivamente. Todos fueron pretratados des-de 12 h antes de la cirugía con levosimendán a dosis de mantenimiento (0,05 mg/kg/min, sin bolus previo). Los procedimientos realizados fueron: revascularización coronaria (40%), reemplazo valvular mitral (21%) y aórtico (19%), procedimientos combinados (19%). Se empleó ecocardiografía transesofágica intraoperatoria y el sistema VIGILEO® para montorizar la FEVI y el gasto cardíaco. Resultados: El seguimiento medio fue de 28 meses. No hubo complicaciones mayores durante la administración del fármaco. La FEVI y el gasto cardíaco se incrementaron de forma significativa en el momento de la esternotomía y al salir de bomba con respecto al valor preoperatorio. Para salir de circulación extracorpórea se asoció noradrenalina en todos los casos y balón de contrapulsación del 33%. La mortalidad hospitalaria fue del 4,7% (n = 2). El tiempo medio de extubación y de unidad de cuidados intensivos (UCI) fue de 8 ± 5 h y de 3,7 ± 1 días, respectivamente. Conclusiones: El precondicionamiento con levosimendán en pacientes de alto riesgo por disfunción ventricular parece seguro, mejora la función cardíaca periprocedimiento y favorece una buena evolución postoperatoria.

Background: Remote ischemic preconditioning (remote IPC) induced by short non-deleterious ischemic episodes prior to an index ischemic event is known to protect the heart from lethal myocardial ischemia-reperfusion (I/R) injury.Although demonstrated to be effective across almost all species, the underlying signaling pathways and specifically a role for nitric oxide (NO) remain poorly understood.We and others recently showed that brief episodes of limb I/R via blood pressure cuff in-/deflations increases endothelial NO synthase (eNOS) activity with a subsequent formation of NO, nitroso species (RNO) and nitrite.Nitrite, in turn, has been shown to protect the myocardium from lethal ischemia-reperfusion when activated by the heme globin myoglobin (Mb).We therefore hypothesized that remote IPC initiates the release of NO species in an eNOS-dependent manner, and that Mb is required to reduce this endogenously formed species to NO to protect the myocardium.Methods and Results: This study was conducted using a mouse model of remote IPC followed by open-chest I/R via reversible ligation of the left coronary artery in vivo.Four cycles of remote IPC consisting of 5 minutes of hindlimb ischemia followed by 5 minutes of reperfusion, checked by laser Doppler perfusion imaging, caused a release of NO, RNO and nitrite into the circulation.Remote IPC furthermore stimulated a post-translational modification of mitochondrial complex I by S-nitrosation and a subsequent decrease in reactive oxygen species in the reperfused myocardium.This finally caused a reduction in myocardial infarct size per area at risk from 36±2% to 17±1% in wild-types (n=5,p<0.0001).Targeted disruption of endothelial nitric oxide synthase in eNOS-/-mice impaired the release of NO species during remote IPC and completely abolished the beneficial effects on myocardial necrosis (control vs. remote IPC: 45±3% vs. 41±3%, p=n.s.).Finally, in Mb-deficient mice (Mb-/-) remote IPC caused an increase in NO species, but was without effects on infarct size (control vs. remote IPC: 31±1% vs. 35±2% p=n.s.).All values are means±SEM. Conclusion:A concerted action between vascular and myocardial signaling pathways is involved in the NO triggered protection from remote ischemic preconditioning.While eNOS is essentially required for the formation of circulation NO species as triggering mechanisms, Mb in the heart is required for the activation of nitrite to nitric oxide leading to protection of the myocardium at risk.