Funding Acknowledgements Type of funding sources: None. Dilated cardiomyopathy (DCM) is a complex myocardial disease, with a high burden of symptoms and decreased life expectancy. Mitral regurgitation (MR) is a frequent comorbid condition and it is thought that it deteriorates left ventricle (LV) volume and ejection fraction. Guideline directed medical therapy for heart failure improves myocardial function and decreases morbidity and mortality, and there is ongoing interest in the application of novel percutaneous techniques like mitral edge-to-edge repair or resynchronization therapy in order to decrease cardiovascular events (CVE). Our objective was to analyze if MR is associated with late gadolinium enhancement (LGE), left ventricle (LV) or right ventricle (RV) dysfunction and cardiovascular events in patients with DCM. A retrospective, case control study was designed including 173 patients (mean age 60 years, 73% males, 36% dyslipemia, 30% diabetes, 20% hypertension, 8% current smokers) with diagnosis of DCM and cardiac magnetic resonance study in our center between 2014-2020 according to the latest European Society of Cardiology (ESC) definition and the latest updated position paper. Clinical data, use of guideline directed medical therapy and devices, cardiac imaging tests, mortality and CVE were collected and analyzed. Mitral regurgitation was calculated on CMR and was included if it was more than mild. After a mean follow up of 18 months, 53 patients (30%) suffered a CVE (16% heart failure, 14% incident arrythmia, 0,5% stroke 8% death). Patients with MR (n= 48; 28%) had worse LV ejection fraction (-4,8% mean; p=,02), worse RV ejection fraction (-5,5% mean; p=,03), more hospitalizations due to heart failure (OR 1,78; p=,01), had a trend toward increased mortality although it was not statistically significant (p=,01) and a trend towards late gadolinium enhancement (p,13). There was no association with incident arrythmias (p=,5) or stroke (p=,9) In multivariate analyses (log regression, multiple linear regression) MR was maintained as an independent predictor of worse RV ejection fraction (mean -3,9%; p=,03), and hospitalization for heart failure (OR 3,8; p=,043). There was also a trend toward increased mortality (p=,1) in our population. Figure. In patients with DCM, MR is associated with decreased LV and RV ejection fraction, hospitalization due to heart failure and has a tendency to be associated with mortality. Specific treatment for mitral regurgitation, including percutaneous edge-to-edge repair or surgery according to current guidelines, might decrease the severity of MR in these patients and that could lead to an improved prognosis and less morbidity. Further studies should review the impact of an interventional strategy in mitral regurgitation in patients with DCM. Abstract Figure. Mitral regurgitation in DCM: prognosis.
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): University Hospital of Salamanca - contract (CM19/00055) supported by the Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund "Investing in your future"). Background/Introduction Percutaneous coronary intervention (PCI) is the last remaining revascularization option in high risk (HR) patients affected by complex coronary artery disease not suitable for surgery. Elective mechanical circulatory support (MCS) could be necessary to keep hemodynamics during these procedures. In this context, selection of the patients balancing the risk-benefit is a challenge. Purpose Analyse the factors related to mortality in patients who underwent elective HR-PCI with MCS: veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella CP® or percutaneous heart pump (PHP). Methods The study is a retrospective single centre registry, including all elective MCS implants for HR-PCI in a referral hospital. All of them were previously discussed in clinical session, deciding this modality of intervention by the Heart Team. Univariate analysis of variables related to discharge survival was performed using SPSS Statistics. Results Twenty-seven patients underwent supported elective HR-PCI from 2013 to Sep-2021 (Figure 1). They were patients with low LVEF, high percentage of admission for ACS or HF, high coronary anatomy complexity (mean syntax score 31.4±9.5), and high surgical risk (mean STS morbidity-mortality score 24.17±16.0). In 88.9% of the patients, the circulatory support device was removed after completing the procedure, remaining in the rest due to persistent instability. The main access site was femoral, using axillary arterial access when the iliofemoral arteries were not suitable. Endotracheal intubation was needed in 29.6% of patients. Deaths during the admission (14.8%) were not directly related with the procedure but with posterior complications (alveolar haemorrhage, multiorgan failure, refractory heart failure and sepsis). Variables related to mortality were concomitant more than mild valvular heart disease; higher creatinine serum levels and lower pH before the procedure; axillary access and need for endotracheal intubation during or after the intervention; periprocedural mayor and minor bleeding and postprocedural critical care infections (Figure 1). We did not find other differences in terms of baseline characteristics, complexity of revascularization, type of support or development of complications. In the follow-up (median 4.8 [29.7] months) 70.4% of patients remain alive after the intervention (Figure 2). Conclusion Temporary MCS used prophylactically in elective high-risk PCI appeared feasible and safe in the real-world setting and could be an alternative for patients dismissed for surgery because of high-risk. Moreover, we found some prognostic variables related to discharge survival to help clinicians with the selection of the most appropriate patients. Randomized studies are required to determine a better selection of cases according to risk-benefit
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