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Introduction Previous studies have found sex differences in implantable cardiac defibrillator (ICD) implantation counseling, especially in primary prevention. Possible explanations to this phenomenon have been described: under-representation of women in clinical trials, patient's preferences, lower overall sudden cardiac death risk in women compared to men, higher prevalence of non-ischemic dilated cardiomyopathy (DCM) in women and better response to cardiac resynchronization therapy in this population. Nevertheless, this gap appears to narrow in most recent registries. Purpose Our aim is to asses if there is still sex discrimination in ICD counseling by comparing ICD implantation between men and women. Methods A single-centre retrospective registry of 160 patients with a reduced left ventricle ejection fraction (LVEF ≤35%) found in a routine transthoracic echocardiogram (TTE) from January 2019 to June 2020. Inclusion and exclusion flow chart is described in Picture 1. Data collected included demographic, clinical and echocardiographic characteristics. Date of heart disease diagnosis, earliest date of LVEF ≤35% diagnosis (with TTE or cardiac magnetic resonance) and date of death when applicable were recorded. Cardiac resynchronization devices with ICD function were also considered for the analysis. In ICD carriers, implantation date and type of prevention for indication were collected. ICD implants and deaths up to December 31, 2020 were included for the analysis. Results Basal characteristics are described in Picture 2. The mean age was 67.5 years and 24.4% of the population were women. Ischemic etiology was the most frequent etiology in the overall population and in the male group. In women, DCM was the most common etiology. Sixty-eight patients carried an ICD. No significant differences between both sexes, neither globally nor according to the implant indication (primary vs. secondary prevention) were observed. In the subgroup analysis of patients with ICD, there were no significant differences in the number of devices between men and women, neither in ischemic or non-ischemic etiology. In primary prevention, there was a non-significant trend towards earlier implantation of the device in women (1.4 years vs 3.4 years, p=0.008) since the diagnosis of LVEF ≤35%. In patients without ICD (n=92), the mean age was significantly higher (72.5 years vs. 60.8 years, p Conclusions Despite under representation of women in pur population, we could not find differences in ICD implantation decision based on gender, even considering differences in underlying cardiomyopathy. There was no delay in implantation depending on sex, and even the trend was towards earlier implantation in women. Funding Acknowledgement Type of funding sources: None. Inclusion and exclusion flow chartBasal characteristics

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

Funding Acknowledgements Type of funding sources: None. Introduction The most frequent complications of atrial fibrillation (AF) ablation procedures are those related to the vascular access site, which are associated with increased morbidity and length of hospital stay. Purpose: To assess the safety and efficacy of venous access site closure with a suture-mediated vascular closure device (SVD), as well as the feasibility of early mobilization and same-day discharge protocol after AF ablation procedures. Methods: We conducted a retrospective analysis of all consecutive AF ablation patients in whom a SVD was employed to achieve hemostasis after each venous puncture. The ablation was performed under conscious sedation, using 7 to 12-F introducer sheaths. Anticoagulation was uninterrupted but for the last dose prior to the procedure. Intraprocedural heparin was not reversed. Groin ultrasound was performed in the first 10 patients with adequate SVD deployment. Three conditions were required for the same-day discharge protocol application: 1) uncomplicated procedure, 2) successful SVD deployment and 3) adequate recovery. Recovery followed a three-phase protocol: bed rest (two hours), sitting (one hour) and ambulation. Follow-up included phone call and clinical examination. Patients were offered contact to the electrophysiologist if needed. Results: 63 ablation procedures with SVD closure were performed from May 2019 to October 2020, with a total of 132 access sites analysed. Patient characteristics are shown in the table. The SVD was successfully deployed in 125 (94.7%) and hemostasis immediately achieved. In the remaining 5.3%, failure was attributed to a deficient technique, which missed to advance the knot to the vein. First 10 patients were ultrasound evaluated 24 hours later (no early discharge), showing total absence of complications. 35 subsequent patients (55.6% of the remaining 53) were discharged the same day without ultrasound control. The remaining 18 stayed overnight for reasons not related to the access site (hemodynamic surveillance, initiation of antiarrhythmic drugs or loss of phrenic capture), allowing in any case early mobilization (three hours after the procedure). Mean follow-up was 272 ± 160 days, with no adverse events recorded. Conclusion: SVD are safe and effective in achieving rapid hemostasis, making the early mobilization and same-day discharge protocol after AF ablation feasible in selected patients. Age 63 (57-71) Male 46 (73%) Body mass index (kg/m²) 27,5 (24,2-31,6) Previous anticoagulation- Vitamin K antagonist- Direct oral anticoagulation 50 (79,4%)14 (28%)36 (72%)

Funding Acknowledgements Type of funding sources: None. BACKGROUND Adequate measurement of the QT interval is of paramount importance in order to identify patients at higher risk for ventricular arrhythmias. Previous studies have described different methods to estimate baseline QT in patients with left bundle branch block (LBBB). However, the evidence regarding the assessment of QT interval in the setting of right bundle branch block (RBBB) is scarce. PURPOSE We aimed to analyze the feasibility and accuracy of the different formulas described for LBBB in the estimation of the QT interval in RBBB. METHODS We enrolled patients who underwent left sided electrophysiologic procedures. All patients were in sinus rhythm and had narrow QRS. Pacing was performed from the left atrial appendage for baseline measurements, and from the left aspect of the interventricular septum (selective capture of the left bundle was attempted) to measure RBBB QT and QRS. Pacing cycle length was 800 ms or slightly below patients´ intrinsic rhythm at both locations. Measurements were performed manually (using digital calipers) according to current recommendations and corrected using Bazett. Validated formulas for LBBB QT considered are described in table 1. RESULTS 50 patients (42 cryoballoon pulmonary veins isolation (PVI), 4 radiofrequency PVI, 4 concealed left accessory pathways). 70% were male. Mean age was 62 ± 11 years old. Left ventricle ejection fraction was 58 ± 10%. 66% and 60% of the patients were taking betablockers and antiarrhythmic drugs, respectively. Mean pacing cycle length was 707 ± 99 ms. Baseline measurements: QRS 95 ± 10, QT 391 ± 36, QTc 467 ± 39 ms. RBBB measurements: QRS 165 ± 21, QT 448 ± 46, QTc 531 ± 52 ms. Correlations between baseline and estimated QTc were good for all the formulas (table 1). Reliability analysis showed that both Yankelson and Wang methods had the highest intraclass correlation coefficients (ICC) when trying to estimate baseline QTc. CONCLUSIONS Previously described formulas for LBBB exhibit marked differences regarding reliability in the estimation of QTc interval in the setting of RBBB. According to our results, Yankelson’s method shows the most consistent agreement when estimating baseline QTc interval in patients with RBBB. Table 1.LBBB METHODFormula to estimate baseline QTcPearson’s R correlation coefficientCI (95%)Intraclass correlation coefficientCI (95%)YankelsonQTc - QRS + 95 (m) or 88 (f)0.805(0.632-0.977)0.882(0.788-0.934)Bogossian**QT - (QRS/2)0.813(0.644-0.982)0.756(-0.127-0.919)Wang**QT - (0.86*QRS - 71)0.801(0.627-0.974)0.834(0.465-0.930)Tang-Rabkin0.945*QTcRabkin - 260.722(0.521-0.923)0.711(0.019-0.885)RautaharjuQT - 155*(60/heart rate - 1) - 0.93*(QRS - 139) - 22 (m) or - 34 (f)0.780(0.599-0.961)0.105(-0.017-0.381)**Bogossian and Wang required additional HR correction (Bazett). Abstract Figure 1. Bland-Altman

Funding Acknowledgements Type of funding sources: None. Introduction Primary prevention of sudden cardiac death is the main indication for ICD implantation, mainly based on left ventricular ejection fraction (LVEF). Gender differences in the diagnosis and treatment of some cardiology conditions such as myocardial infarction have been previously established. Purpose We aim to analyze differences in prognostic variables that could justify gender differences in the non-prescription of an ICD for primary prevention. Methods A retrospective selection of patients from our center during 2019 with ventricular systolic dysfunction (LVED ≤35% in an echocardiogram) was made. We included patients at least one month after an acute myocardial infarction and with optimal medical treatment without an ICD. Death was considered during the year 2019. Results We initially selected 325 patients with ventricular dysfunction, of wich 175 fulfilled the inclusion criteria (67.4% men and 32.6% women). ICD indication was considered in 47 patients out of the 175 selected (29.7% among men and 21.1% among women, p = 0.7; 70.3% among men and 78.9% among women, p= 0.30 for non-prescription). The index left ventricle end-diastolic volume (iLVEDV) was significantly worse in males. Females were older and had lower LVEF. Conclusion Although it is a unicenter study and we have only performed univariate comparisons, without considering confounding factors, we found no significant gender differences in prognostic variables that could justify differences in the non-prescription of an ICD for primary prevention. Results Variable Men Women p-value Age (years) 74.53 ± 0.11 79.52 ± 0.15

The usefulness of local collagenase in therapeutic approaches to solid tumors has been tested recently. In this study, we evaluate the safety and efficacy of intraperitoneal collagenase associated or not to mitomycin for treatment of colorectal peritoneal metastases in an experimental rat model. Using a fixed-dose procedure, we found that a dose of collagenase of 37 IU/mL administered for 15 min with a hyperthermia pump at 37.5 °C, both in isolation or associated to sequential treatment with intraperitoneal mitomycin, led to a macroscopic decrease in tumor volume as evaluated by the modified peritoneal cancer index (mPCI). Concerning the safety of the procedure, the animals showed no physiological or behavioral disorders during 8 weeks of follow-up. Local treatment for peritoneal metastases of colorectal origin with intraperitoneal collagenase has proved safe and effective in an experimental murine model. Therefore, the stroma-first approach by enzymatic breakdown of collagen from the tumor's extracellular matrix provides a new therapeutic target for colorectal peritoneal metastases.

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

Introduction Lung transplantation (LT) often requires extracorporeal life support with extracorporeal membrane oxygenation (ECMO) because of several complications (included acute heart failure) during the intervention. Data on predictors of intraoperative ECMO use in these patients are scarce but it is an interesting topic because ECMO support has been linked to worse outcomes after LT. Purpose The main aim of our study is to assess which pre-surgical characteristics of right ventricular (RV) function and data from right heart catheterization (RHC) could help us to anticipate the need of ECMO in LT. Methods We conducted a retrospective observational study of all patients who underwent LT at our institution along 2018. We analysed data from echocardiogram (ECO) and RHC. All subjects underwent transthoracic echocardiography (TTE) according to the latest ASE/EACVI guidelines. Strain analysis was carried out by speckle-tracking echocardiography (QLAB 10.7, Philips). Results We included all 47 patients who underwent LT from January to December of 2018. They were middle age patients (52±11.8 years old) 51.1% men, 61.7% smokers (other cardiovascular risks: diabetes mellitus (8.5%), hypertension (23.4%) or dyslipidaemia (27.7%)). 24 (51%) of them needed intraoperative ECMO. 21 patients (45%) were evaluated by RHC before LT and ECO quality was good enough to evaluate different data in 41 patients (87%). Variables related to ECMO requirement vs non-ECMO use were: mean pulmonary artery pressure (23.1±7.3 vs 16.67±4.9 mmHg, p=0.027), mean transpulonary gradient (16.9±6.6 vs 8.9±3.6 mmHg, p=0.027) and diastolic transpulmonary gradient (9.8±8.1 vs 2.3±4.7 mmHg, p=0.002) from RHC and RV mid cavity diameter (3.4±0.8 vs 2.8±0.6 mm, p=0.001) from ECO. Besides this, free-wall RV longitudinal strain (FWRVLS) showed a tendency to be lower in patients who required ECMO (17.3±4.5% in vs 21.4±4.5%, p=0.072). Conclusion According to our results, RV mid cavity diameter measured by ECO and mean pulmonary artery pressure, mean and diastolic pulmonary gradients measured by RHC are useful tools to predict which patients could require ECMO during LT. FWRVLS showed an interesting tendency of lower values of it in LT using ECMO. This exploratory finding opens an important investigation line about a parameter which could help us to identify patients with subclinical right ventricle dysfunction. ROC curve Funding Acknowledgement Type of funding source: None

Biofouling is a problem well known to manufacturers and researchers in various fields of knowledge (i.e. heat transfer, marine engineering, desalination of sea water and the offshore industry. One of the deepest impacts, both economic and operational, is on industrial equipment that uses sea water for cooling purposes, this is associated with power generation technologies; and can include loss of the equipment's design parameters, implications regarding total loss of efficiency and an increase in unscheduled maintenance actions, both corrective and preventative, that are established in the operation and maintenance (OM physical treatment and chemical treatment. The present research has developed treatment of a chemical nature by applying two different chemical compounds (chain quaternary ammonium and propylene glycol), both of which are environmentally friendly. The use of quaternary ammonium compounds (QAC) had not been researched enough at the time that the investigation into biofouling and propylene glycol was carried out, and had never been tested on this type of equipment. The research undertaken aims to clarify which compound is capable of eliminating biofouling and return the conditions of the exchanger tube back to those of the clean tube, and to find out what dosage should be applied to maintain these conditions over a long period of time. The experiment was conducted on two different physical surfaces, AISI316Ti and AISI316L in a pilot plant located at the Nautical School of the University of Cantabria (Spain), under the supervision of the Department of Science and Technology of Navigation and Marine Construction. A toxicological study has also been carried out on fish (Scophthalthmus Maximus) in accordance with the directive of the Paris Commission (PARCOM) with the purpose of verifying that each chemical compound used was not harmful to the marine environment.