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Funding Acknowledgements Type of funding sources: None. Introduction Acute kidney injury (AKI) in patients with myocardial infarction (MI) is associated with higher morbidity and mortality and a higher incidence of MACE. The cardiorenal syndrome is a disorder between the heart and the kidney, where the primary dysfunction of one organ results in secondary dysfunction and damage to the other. There are multiple mechanisms involved in its pathogenesis, related to hemodynamic changes that lead to venous congestion, greater volume overload, and impaired renal function. Echocardiographic parameters of congestion have been related to AKI in MI. Our objective was to assess hydration estimated by bioimpedance analysis (BIA) as a marker of congestion and its association with AKI. Methods Observational study in patients admitted to a CCU for MI and treated with PCI. Body composition was assessed with tetrapolar bioimpedance analysis obtained at 50 kHz. AKI was defined as a 1.5-fold increase in serum creatinine from baseline level within 24–48 hours. Mayor adverse cardiovascular events (MACE) during hospitalization were defined as type IV infarction, heart failure, stroke, or death. Results A total of 94 patients were included. The median age was 58 years (IQR 53 – 63), and 89% were male. 53% had STEMI, 32% hypertension, 23% diabetes, and the median creatinine on admission was 0.9 mg/dl (IQR 0.75 – 1.05). AKI occurred in 9 patients (9.7%). Patients with AKI had a higher incidence of MACE (66.7% versus 29.8%, p = 0.02). Total body water (TBW) was higher on admission in patients who suffered AKI, compared to those who did not (76.8% versus 75.5%, p = 0.0008). There was no significant difference in TBW between patients who developed heart failure compared to those who did not (75.3% versus 75.8%, p = 0.39). Conclusion Among patients with MI undergoing PCI, hydration status estimated by BIA, as a noninvasive parameter to estimate congestion, was associated with a higher risk of developing AKI.

Funding Acknowledgements Type of funding sources: None. Introduction Obesity is a cardiovascular risk factor, but several studies have shown the protective effects of higher body mass index (BMI) in myocardial infarction (MI) patients. This phenomenon is denominated "obesity paradox", that is, there is a lower incidence of events in obese patients after an acute episode. However, we must not forget that the BMI has several limitations for classifying obesity. The aim of our study was to evaluate the associations of obesity and fat mass percentage measured by bioimpedance analysis (BIA) with events in patients with MI and treated with PCI. Methods Observational study in patients admitted to a CCU for MI and treated with PCI. Body composition was assessed with tetrapolar BIA obtained at 50 kHz. Obesity was defined as a BMI greater than 30 kg/m2 and increased fat mass as a fat percentage greater than 25% in men and 35% in women. Major adverse cardiovascular events (MACE) during hospitalization were defined as type IV infarction (Third Universal Definition), heart failure, stroke, or death. Results A total of 94 patients were included. The median age was 58 years (IQR 53 – 63), and 89% were male. Most of them presented with STEMI (53%), 32% had hypertension, 23% had diabetes, and the median creatinine on admission was 0.9 mg/dl (IQR 0.75 – 1.05). Body measurement showed that 30 (31.9%) had normal weight and fat mass, 30 (31.9%) had obesity and increased fat mass, 26 (27.7%) had normal weight and increased fat, and 8 (8.5%) had obesity with normal fat mass. There was a positive and significant correlation between BMI and fat mass (figure 1). A total of 31 patients (33.3%) had a MACE during hospitalization. Patients with MACE had lower BMI than patients that did not suffer MACE (28.31 ± 4.42 kg/m2 versus 30.57 ± 7.01 kg/m2 , p = 0.04). On the other hand, fat mass was similar between patients with and without MACE (27.23 ± 6.19% versus 28.19 ± 8.01%, p = 0.53). Obese patients had a lower incidence of MACE than patients with a normal weight (21.1% versus 41.8%, p = 0.037), but there was no significant difference when comparing patients according to fat mass. Conclusion Although the occurrence of MACE in the short term after a MI was associated with lower BMI, this was not determined by a lesser amount of body fat. This adds to the evidence that the obesity paradox is not related to fat mass but is probably generated by the shortcomings of the BMI as a surrogate for body composition.

Background Despite improvements in cancer management, cancer treatment related cardiac dysfunction (CTRCD) is a growing medical problem that impact cancer patients' prognosis, especially when it leads to early interruptions of effective anticancer therapies. Heart failure (HF) therapies are recommended in patients who develop symptomatic CTRCD or asymptomatic decrease in left ventricular ejection fraction (LVEF). However, the beneficial effect of sodium-glucose co-transporter 2 (SGLT2) inhibitors was not prospectively tested in patients with cancer and CTRCD Purpose EMPACARD-treatment is a prospective registry aiming at evaluating the usefulness of empagliflozin on left ventricular remodelling in patients with metastatic breast cancer and refractory CTRCD. Methods Metastatic breast cancer patients, who develop refractory CTRCD during or after anthracycline chemotherapy and/or HER2 targeted therapies were prospectively included in our study and treated with empagliflozin 10mg/day on top of their current HF therapies. Refractory CTRCD was defined as symptomatic HF in patients treated with optimal doses of neurohormonal HF therapies, including sacubitril/valsartan. Clinical and echocardiographic variables were analysed to determine the potential benefits of empagliflozin on left ventricular remodelling (LVEF and left ventricular diastolic diameter (LVDD)), NT-proBNP levels, NHYA class and 6 minutes walking test (6MWT). The median follow-up was 6 months. Continuous variables were summarized as medians with interquartile ranges (IQR) and compared with Wilcoxon's test for paired samples. Categorical values were expressed as percentages and compared with the chi-squared test. Statistical significance was considered with a p-value of less than 0.05. All analyses were performed with R version 4.1.1. Results 19 metastatic breast cancer patients were included. Baseline characteristics and HF treatments are described in table 1. One patient received a heart transplant, and there were no deaths. At 6 months follow up LVEF significantly improved from 30% (IQR 27.5–32) to 38% (IQR (33.5–39), (p Conclusions Guideline-based HF therapy, including empagliflozin improves LV remodelling in patients with cancer and refractory CTRCD. Empagliflozin might be a promising treatment option in patients with refractory CTRCD Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Introduction Despite recent advances, acute heart failure poses a therapeutic challenge due to its high morbidity and mortality both in the short and long term. Particularly, right ventricle failure is associated with worst outcomes. Levosimendan has emerged as an option and its use is the object of ongoing investigation. Its mechanism of action relies both on troponin C calcium sensitization to improve contractility and ATP-dependent potassium channels activation of promoting vasodilation. These actions cause well-established effects on the function of the left ventricle and systemic circulation, but little is known of the role of the right ventricle. We aimed to compare the outcomes of patients who received levosimendan regarding the presence of right ventricular failure. Methods Single-center retrospective study, including all hospitalized adult patients that received levosimendan for acute heart failure from 2011 to 2020. Cardiac surgery patients were excluded. Right heart failure was assessed by echocardiography and categorized as normal or mildly, moderately, or severely reduced. Acute kidney injury was defined as a creatinine increase of ≥ 50% or ≥ 0.3 mg/dl from its baseline. Results A total of 52 patients were included for analysis. Their basal characteristics are described in table 1. All 3 patients (5.8%) that died during hospitalization showed right ventricular dysfunction. Acute kidney injury was more common in patients with right ventricular dysfunction (36.4% versus 10.5%, p = 0.04), as can be seen in figure 1. There were 9 cases of hypotension (17.3%), with no significant differences between groups. Conclusion In patients, hospitalized with acute heart failure who received levosimendan, right ventricle failure with associated with worst outcomes, particularly with acute kidney injury.

Background The Anti-Her 2 (AH2) drugs [trastuzumab (T.) and ertuzumab (P.)] are essential components in HER2 + Breast Cancer treatment. Although these kinds of therapies represent a breakthrough in different studies, a group of patients (p.) presented left ventricular dysfunction (LVD) in the follow-up. The vast majority recovered the left ventricular ejection fraction (LVEF) after withdrawal of treatment. We analysed prospectively a group of p. who presented a LVD after AH2 treatment. We propose that the early treatment with beta-blockers (BB), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), aldosterone antagonist (AA); could help an early recovery of LVEF and allow the reintroduction of the AH2 therapy without a new risk of LVD. Methods We evaluated 587 consecutive p. with HER2+ breast cancer who received T. alone or with P. from January 2017 to August 2018. We evaluated LVEF with ultrasonography (US.) before treatment (t). 43 p. had developed LVD and started t. with BB [Carvedilol (C.], ACEI [Enalapril (E.)] or ARB [Valsartan (V.)], AA [eplerenone (EP.)] at the moment of HF diagnosis and kept under t. after LVEF recovery. AH2 therapies were reintroduced when the patients improved their LVEF. Follow-up was with US.: 30 days, 60 days, 3 and 6 months (m.). We used SPSS for the statistical analysis. Results 43 p. aged 54 +/- 8, 100% female. Risk Factors: arterial hypertension 10 p., diabetes 5 p, dyslipidemia 6 p., smoking 9 p. Previous oncological therapies: doxorubicin - cyclophosphamide 22 p., paclitaxel 22 p. Median of the basal LVEF was 61.4 % and at HF diagnosis was 39.3 %. Patient's New York Heart Association (NYHA) at diagnosis moment class was: I 15 %, II 60% and III 25%. All of the p. stopped the AH2 therapy. HF t. was: C 42 patients, E 33 patients, V. 10 patients and EP. 42 patients. LVEF recovery at 30 days was 81.39 % of p, at 60 days 95.34 %, at 3 and 6 m 97.67 %. When p. recuperated the LVEF we restarted the AH2 therapy. No patients had a new LVD at 3 m. and 6 m.. Patient's NYHA class at 6 m was: I 30%, II 25% and asymptomatic 45%. Conclusions While the LVD related with AH2 therapies is a real problem in HER2+ breast cancer patients’ care, a timely diagnosis and t. with therapies for HF can allow LVEF recovery and specific oncological therapy continuance. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.