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Intramyocardial hemorrhage (IMH) is considered a marker of tissue damage severity in patients with reperfused ST-segment elevation myocardial infarction (STEMI) and has been associated with a poor prognosis despite successful revascularization of the culprit artery . We aim to study the impact of cardiovascular risk factors and treatment strategies on the presence of IMH studied with T2* -w cardiovascular magnetic resonance (CMR) in this clinical setting METHODS A prospective observational study including patients with repefused STEMI who underwent an MRI during the first week post-revascularization were conducted . The presence of IMH was analyzed in ECG triggered T2 * w sequences as presence of hipointensity area . Clinical data including cardiovascular risk factors and treatment strategies at cath lab were studied. RESULTS 94 patients with reperfused STEMI were included. Demographic data are shown at the the table. No significant association was observed between the presence of IMH and the different treatment strategies used. All data were introduced in a multivariate model including presence of thrombus, total ischemia time and culprit coronary artery. The analysis showed previous infarction as an independent risk factor (OR: 6 p = 0.03, CI: 1.1-29) while history of hypertension (OR: 0.9, p = 0.04, CI: 0.1- 0.9) and systolic blood pressure showed independent protective effect (OR: 0.3 p = 0.02 IC: 0.9-0.99.) CONCLUSIONS. 1. Previous infarction was shown to be an independent risk factor for IMH . 2. Arterial hypertension and systolic blood pressure showed a protective effect. Age (years) 62 ±13 Male sex 72 (77) Diabetes mellitus 32 (34) Hypertension 53 (56) Hyperlipidaemia 52 (55) Current or prior smoking 55 (58) Time to reperfusion 203 (142-300) Infarct-related artery LAD 38 (41) RCA 49 (52) Cx 7 (7) Infarct size (% LV mass) 18 ± 11 MO (% LV mass) 3.15 (1.44-5.48) Abstract P824 Figure. Intramyocardial hemorraghe T2* sequences

The prognostic impact of coronary revascularization in patients with stable angina is limited being reserved nowadays for patients with symptoms or severe ischemia in imaging tests. We propose to study the usefulness of stress CMR to assess the utility of coronary revascularization in patients with stable angina. Methods A retrospective cohort study was conducted including consecutive patients with inducible ischemia in dypiridamol stress CMR. Patients with acute coronary syndrome or severe valvular disease were excluded. The decision to revascularize after MRI was made by the responsible medical team following the guidelines of clinical practice. The presence of cardiovascular events (death, admission or need for new revascularization) was analyzed during follow-up. The stress cardiac MR imaging protocol included a baseline functional study (b-SSFP sequences) and after administration of 0.84 mg / kg IV dipyridamole, perfusion sequences (b-SSFP) obtained during the administration of IV gadolinium contrast and F-GRE viability sequences. Clinical data such as the severity of coronary involvement, the type of coronary revascularization and if it was complete as well as data derived from the baseline functional study of ventricular volumes, segmental contractility score, transmurality and extension of necrosis, extension of hypoperfusion and also number of segments with severe ischemia considering as such those segments with transmural hypoperfusion or stress-induced systolic dysfunction. Results We included 424 patients of mean age of 65+ 10 years, 182 (43%) of them had known coronary artery disease and 93 (20%) of them had pevious percutaneous revascularization. Thirty-five (8%) had left main disease and 176 (41%) multivessel disease. Twenty five patients had normal stroke volume (SV) and depressed left ventricle ejection fraction (LVEF) and 60p had normal LVEF and low SV . One hundred and seven patients of the total group were revascularized (2.5% surgically). Coronary revascularization showed a significant increase in survival only if it was complete (p Conclusions 1. SV is the most powerful predictor of events in patients with stable angina and ischemia in CRM dypiridamol stress test. 2. Patients with an SVi Abstract P359 Figure. Survival curves regarding SV

Los puentes miocardicos estan constituidos por haces de fibras musculares que recubren un trayecto variable de una arteria coronaria epicardica, siendo un hallazgo relativamente frecuente con una incidencia que varia en funcion del metodo de estudio utilizado (angiografico/autopsia). Aunque relacionados generalmente con un pronostico benigno, cursando en muchos casos de forma asintomatica y siendo su hallazgo casual, su presencia ha sido considerada tambien como causa de angina, arritmias malignas, infarto de miocardio y muerte subita. Su diagnostico se realiza in vivo por estudio angiografico, al comprobar una compresion sistolica de una arteria coronaria que desaparece durante la diastole. Presentamos el caso de un paciente con signos electrocardiograficos de isquemia severa en el territorio de la descendente anterior que fue valorado inicialmente como infarto de miocardio y tratado como tal. En su evolucion se constato la normalizacion del ECG sin desarrollo de nuevas ondas Q de necrosis y se confirmo mediante estudio angiohemodinamico la existencia de un puente muscular aislado sobre la arteria descendente anterior en su tercio medio, sin otras lesiones coronarias asociadas.

La endocarditis infecciosa precoz es una complicacion grave que se observa en el 3% de los pacientes portadores de protesis valvulares cardiacas y que sigue teniendo una mortalidad muy elevada. Aparece antes de los 12 meses del recambio valvular, es mas agresiva que la tardia, y esta producida fundamentalmente por estafilococos. Las manifestaciones clinicas estan relacionadas con la presencia de bacteriemias asociadas a signos de dehiscencia protesica. Presentamos un caso de endocarditis protesica precoz en posicion aortica complicada con insuficiencia aortica severa y fistula entre raiz aortica y auricula derecha, junto con alteracion electrocardiografica consistente en trastorno de la conduccion auriculoventricular e intraventricular.