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Background Acute coronary syndrome (ACS) in heart failure (HF) patients has not been well studied yet. Purpose The main aims of this study were to compare the characteristics and outcomes of Non-ST elevation ACS (NSTACS) in patients with and without prior HF, and to assess the GRACE risk score performance for risk stratification in both groups. Methods All consecutive patients (n=5661) admitted due to a NSTACS from November'2003 to November'2017 in two Spanish hospitals were retrospectively analysed. Patients were divided according to prior HF. As GRACE score predicts mortality in 6 months, logistic regression models were used to predict mortality in both groups. The different aspects of model performance were studied, including calibration and discrimination. Results Killip class, GRACE and CRUSADE scores were higher in HF-patients compared to patients without prior HF. Also, HF-patients had more complications (major bleeding, worsening HF, acute kidney injury) and higher mortality. Discrimination capacity of GRACE score to predict mortality at 6 months was slightly higher in non-HF patients (AUC 83.9% [81.6–86.2]) than in HF-patients [AUC 77.0% [70.1–83.8]) (Figure 1). The risk score calibration was acceptable for both groups [Brier scores were 0.139 (c-AUC 0,77) for HF-patients, and 0.046 (c-AUC 0.839) for non-HF patients]. Finally, HF-patients with lower GRACE scores had a higher predicted mortality than non-HF patients (Table 1). Conclusions We showed the potential utility of GRACE risk score in HF-patients admitted with NSTACS, expanding the indication of GRACE risk score for HF-patients as well. In fact, GRACE risk score not only keeps its accuracy, but it is even more robust in HF-patients than in non-HF patients. Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

Introduction and purpose Pump thrombosis (PT) is a serious left ventricular assist device (LVAD) complication, though there are no guidelines regarding its treatment. We have adopted a strategy of intravenous anticoagulation as the initial treatment strategy in these patients. Methods All consecutive patients who received a HeartWare LVAD from July-2009 to January-2018 were retrospectively analyzed. Patients developing a PT were selected, and treatment, outcomes and complications were recorded. Results 197 patients underwent HVAD, and 49 developed PT. All the patients were initially treated medically, though during the first PT 26.5% of the patients needed surgery [VAD exchange (n=6), transplant (n=6), or decommissioning (n=1)]. The overall survival at 1 year was 63.3%. Patients were treated predominantly with either intravenous heparin or bivalirudin. There were no significant differences neither in complications nor in survival between the 2 treatments (Figure 1); however, patients treated with bivalirudin during the first PT episode had less subsequent re-thrombosis episodes (18.2% vs 57.7%, p Table 1. Comparison of baseline characteristics and outcomes between Heparin and Bivalirudin Heparin (n=26) Bivalirudin (n=11) p-value Male, gender n (%) 20 (76.9) 9 (81.8) 1.00 Age when implant (years) 48±11.8 49.8±11.4 0.67 AF n (%) 9 (34.6) 6 (54.5) 0.50 Diagnosis: Dilated cardiomyopathy n (%) 13 (50) 7 (63.6) Ischemic heart disease n (%) 12 (46.2) 3 (27.3) Congenital heart disease n (%) 1 (3.8) 1 (9) 0.50 Thrombolysis (+ alteplase) n (%) 19 (73.1) 4 (36.4) 0.08 Treatment duration (days) 11.5±7.2 15.3±6.5 0.15 % Time in range 36.3±7.1 59.7±4.2 0.009 Hospitalisation (days) 19.1±16.4 31.9±18.2 0.06 Complications: Ischemic Stroke n (%) 2 (7.7) 4 (36.4) 0.09 Intracraneal bleeding n (%) 2 (7.7) 0 (0) 0.88 Gastrointestinal bleeding n (%) 1 (3.8) 0 (0) 1.00 Serious bleeding n (%) 5 (19.2) 0 (0) 0.29 Any bleeding n (%) 7 (26.9) 2 (18.2) 0.88 LDH Baseline 271.7±79.3 221.6±41.3 0.10 Admision 727.8±448.2 517.5±171.3 0.21 Maximum 827.1±424.7 1217.6±1004 0.03 Discharge 334.9±135.9 308.6±111.8 0.70 Time to normalisation (days) 10.2±4.5 17.2±2.6 0.004 Outcomes: Transplant (total) n (%) 7 (26.9) 2 (18.2) 0.88 VAD Exchange (total) n (%) 8 (30.8) 4 (36.4) 1.00 Mortality at 2 years n (%) 15 (57.7) 5 (45.4) 0.831 Rethrombosis: Rethrombosis n (%) 15 (57.7) 2 (18.2) 0.03 Number of episodes of rethrombosis 0.15 +1 n=6 n=1 +2 n=4 n=1 +3 n=4 n=0 +4 n=1 n=0 Figure 1 Conclusion VAD thrombosis is a serious life threatening complication, though an initial strategy with enhanced intravenous anticoagulation is an acceptable strategy with either intravenous heparin or bivalirudin. Acknowledgement/Funding N. Bouzas-Cruz would like to thank the Spanish Society of Cardiology (Sociedad Española de Cardiología), for her research grant and fellowship.

Background Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is a significant cause of morbidity and mortality. While multiple predictors of early RHF have been described, information on late RHF is scarce. The aim of this study was to identify predictors of late RHF in LVAD patients. Methods A retrospective analysis of all adult patients who underwent HeartWare-VAD implantation for ischemic heart disease or non-ischemic dilated cardiomyopathy in a single centre was performed. Late RHF was defined as RHF requiring hospitalization and medical treatment after 30 days of LVAD implantation. Results A total of 16 (10.3%) patients from 156 implantations developed late RHF. Patients developing late RHF were older at time of surgery, 56.7±6.9 vs 49.5±12.5 years; p Multivariate Cox proportional-hazards analysis for late right heart failure Variable Hazard ratio 95% confidence interval P-value Tricuspid regurgitation- moderate or severe 5.50 1.34–22.58 0.02 Mitral regurgitation (discharge)- moderate or severe 3.54 1.14–11.02 0.03 Age 1.07 1.01–1.14 0.03 Right ventricular basal diameter 1.14 0.43–3.03 0.79 Right ventricular fractional area change 0.98 0.87–1.10 0.79 Multivariate analysis showing predictors of late right heart failure according to a multivariate model. Late RHF according to TR severity Conclusions Pre-operative significant tricuspid regurgitation and mitral regurgitation after implantation predict the occurrence of late RHF. Prospective studies are needed to determine whether tricuspid valve interventions may reduce late RHF.

Introduction Left Ventricular Assist Devices (LVAD) improve survival and functional capacity in patients with advanced heart failure (HF). However, there are potential complications. Purpose We sought to determine parameters of exercise intolerance in a group of patients with the HeartWare LVAD (HVAD) compared to a group of HF patients. Methods This was a single-centre parallel prospective group-study. Briefly, echocardiograms, right heart catheterisation (RHC) and cardiopulmonary exercise tests were performed in forty-two patients admitted for a heart transplant assessment between August2017 and October2018.Of them 20 belonged to the HVAD group and 22 to the HF group. Results In our study, HVAD patients had a better exercise capacity than HF patients, although no significant differences were noted (14.0±5.0 ml/kg/min vs 11.3±3.9 ml/kg/min, p=0.06). To determine exercise tolerance, both HVAD and HF groups were subdivided into 2 groups based on the median peak exercise oxygen consumption (peakVO2) for that group. The table shows the comparison between preserved and non-preserved exercise tolerance in HF and HVADpatients. First of all, in the HVADgroup, all resting RHC pressures were significantly lower in the preserved exercise capacity group. However, in HFpatients there were no statistically significant differences between both subgroups in right-sided pressures, but Thermodilution exercise-induced change in cardiac output (ΔCO) and cardiac index (ΔCI) was significantly higher in the patients with preserved exercise tolerance. Secondly, in the HVADgroup the right ventricle was significantly larger in the reduced exercise tolerance subgroup. Moreover, patients with lower peak VO2 had more significant tricuspid regurgitation. Nevertheless, in HFpatients none of the echocardiographic parameters were related to the exercise capacity. HF HVAD > Median Peak V02 < Median Peak V02 p > Median Peak V02 < Median Peak V02 p Thermodilution CO, l/min: • Rest 4.3±1.0 4.4±1.8 0.82 4.8±0.8 4.2±1.2 0.21 • Exercise 5.6±1.7 4.8±1.8 0.36 7.1±3.2 4.8±0.8 0.05 • ΔCO 1.26±1.0 0.26±0.7 0.02 2.2±2.5 0.4±0.7 0.05 Right Atrium pressure, mmHg 7.0±4.5 6.8±4.10 0.92 4.3±3.2 10.6±6.40 0.02 Mean Pulmonary Artery pressure, mmHg 26.4±12.6 26.5±10.9 0.97 16.8±5.4 30.5±12.5 0.01 Tricuspid Regurgitation, n (%): • None 1 (9) 1 (9) 1 (12) 0 (0) • Mild 7 (64) 8 (73) 7 (88) 4 (44) • Moderate 2 (18) 0 (0) 0 (0) 4 (44) • Severe 1 (9) 2 (18) 0.36 0 (0) 1 (12) 0.03 Right Ventricle Basal Diastolic Diameter, cm 4.0±1.0 4.1±1.0 0.83 3.7±0.5 4.4±0.5 0.02 Conclusion Right-sided parameters in the echocardiogram and RHC pressures discriminate between preserved and non-preserved exercise capacity in HVADpatients, but not in HFpatients. In these last patients only ΔCO and ΔCI were statistically correlated with peak exercise oxygen consumption Acknowledgement/Funding N. Bouzas-Cruz would like to thank the Spanish Society of Cardiology (Sociedad Española de Cardiología), for her research grant and fellowship

Purpose Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is a significant cause of morbidity and mortality. Multiple factors have been identified in order to predict early RHF, though information is scarce regarding late RHF. The aim of this study was to analyse and identify predictors of late RHF in LVAD patients. Methods A retrospective analysis of adult patients who underwent HeartWare-VAD implantation from 2009 to 2017 in a single-centre was performed. Late RHF was defined as RHF after 30 days of implantation requiring hospital admission. Clinical data, echocardiographic and haemodynamic parameters before implantation, data regarding the early post-operative phase and echocardiographic parameters at discharge were analysed. Results A total of 22 (10.7%) patients from 206 implantations developed late RHF during follow-up. Time to first RHF admission was 202.5 (IQR 130-682) days. Patients presenting with late RHF had a higher incidence of pre-operative significant tricuspid regurgitation (p Conclusion Late RHF was more prevalent in patients with dilated cardiomyopathy or congenital heart disease, and is not predicted by early RHF. Significant tricuspid regurgitation at discharge post-implantation predicted the occurrence of late RHF. Prospective studies are needed to determine whether tricuspid valve interventions may reduce late RHF.

Introduction: Obesity is considered a global epidemic, with alarming prevalence and incidence. The aim was to investigate the relationship between obesity (in terms of body mass index, BMI) and the prognosis of patients with acute coronary syndrome (ACS). Methods: We studied a total of 3436 consecutive ACS patients. This cohort was divided into 4 groups according to BMI: normal weight (BMI 25 kg/m2 had higher mortality (8.0% vs 4.9%, P = 0.002), in both NSTEMI (8.5% vs. 5, 7, p = 0.024) and STEMI (6.8% vs 3.2%, p = 0.017). For the different BMI groups, patients with BMI between 30 and 35 kg/m2 were those with lower mortality, with statistically significant differences compared to patients with normal weight (3.2% vs. 8.0%, p