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Introduction Running the marathon may be followed by post-exercise “cardiac fatigue” manifesting as transient right ventricular (RV) systolic and diastolic impairment. It is the thin-walled RV that is predominantly affected by the exercise-induced overload, with little if any, impact on the left ventricle (LV) [1]. The 2-D echocardiographic (ECHO) assessment of RV is challenging and may be incomplete since conventional measures reflect only the longitudinal motion (displacement of tricuspid annulus towards the apex) [2]. The mechanics of RV can be separated into two more components, anteroposterior (stretching RV wall by contracting septum) and radial (internal relocation of the RV free wall) [2]. The significance and relative contribution of motion components to global RV function may not be equal, and their interplay can vary depending on concomitant diseases [3]. Purpose We aimed to analyse the pathophysiology of RV exhaustion associated with a marathon run with 3-D ECHO, which allows precise estimation of all RV motion components and their contribution to RV global function. Methods The study included 34 healthy males (mean age of 40±8 years), amateurs, who finished the marathon in northern Poland. The 3-D ECHO was performed 2 weeks before (stage I), at the marathon finish line (stage II) and 2 weeks after the competition (stage III). According to the ReVISION method (Right ventricular separate wall motion quantification) the global RV function was decomposed to longitudinal (L_), anteroposterior (AP_) and radial (R_) [3]. By dividing componential ejection fractions (EF) with global RV EF, L_EFi, AP_EFi, and R_EFi ratios were obtained. Results When comparing results from stage I and III there were no significant differences (Table 1). The analysis revealed post-run decline in RV EF with no changes in LV EF. The quantification of the RV motion components showed reduction in R_EF after the marathon with no changes in AP_EF or L_EF. The relative contribution of componential EF to global RV function were permanent and was not influenced by the competition. Conclusions Marathon run resulted in transient RV dysfunction arising from decline in radial shortening. Noteworthy, the componential interplay between wall motion compartments was preserved in pre- and post-run assessment. The ReVISION method enables the comprehensive analysis of the competing RV. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The study was supported by the project POWR.03.05.00-00-z082/18 co-financed by the European Union through the European Social Fund under the Operational Programme Knowledge Education Development 2014–2020

Introduction The long-term endurance training is associated with an increased risk of both right (RV) and left ventricular (LV) dysfunction. However, males and females exhibit different cardiac adaptation to exercise. The aim of our study was to evaluate three-dimensional (3D) echocardiographic parameters of ventricular function before and after the marathon in male and female amateur athletes, and compare them between sexes. Methods The study included 40 male (39±8 years) and 27 female (40±7 years) amateur athletes. Echocardiography was performed 2–3 weeks before (Stage 1) and immediately after (Stage 2) the marathon run. RV and LV area and function were assessed using standard and 3D echocardiography. Results After the marathon, there was a significant increase in the RV size (indexed RV end-diastolic volume, 51.1±12.0 vs. 59.0±9.1 ml/m2, p=0.003 in males; 48.8±11.0 vs. 60.0±11.1 ml/m2, p Conclusions In both male and female amateur athletes, marathon running resulted in RV dilatation and reduction in function, with concomitant decrease in LV dimensions. However, 3D analysis revealed that strenuous exercise alters LV systolic function to a greater degree in men relative to women. Funding Acknowledgement Type of funding sources: None.

Background/Introduction Postprocedural radial artery occlusion (RAO) is still the Achilles' heel of conventional transradial approach (cTRA) as it limits its reuse for future coronary procedures. A distal transradial access (dTRA) via the anatomical snuffbox has been proposed as an alternative. It is hypothesised that dTRA may reduce the incidence of RAO. Purpose To assess whether routine dTRA reduce the risk of RAO in consecutive patients undergoing coronary angiography or intervention, in comparison with cTRA. Methods Out of 465 subjects, 400 patients were included in a prospective, single-center, randomized (1:1) study. Hemodynamic instability, ST-elevation myocardial infarction, forearm artery occlusion or prior radial access failure were the exclusion criteria. Ultrasound-guided follow-up was obtained after 1 day and 60 days to evaluate the incidence of acute and late RAO. Results Baseline characteristics of patients were matched. Results are presented in table 1. Conclusion(s) The incidence of postprocedural acute and late RAO after routine dTRA and cTRA is low and occur with similar frequency when evaluated by ultrasound. Funding Acknowledgement Type of funding sources: None. Table 1

Background Pulmonary hypertension constitutes a rare disease characterized by a severe development and a high risk of premature death. One of its main clinical types is pulmonary arterial hypertension (PAH), in which the highest percentage of patients are affected by idiopathic PAH. The pathogenesis of this disease has not completely been discovered and elucidated so far, and non-specific clinical symptoms make the diagnosis of PAH a serious problem. Currently, PAH is confirmed with invasive examination based on right heart catheterization. Purpose The main aim of the study was to evaluate and compare both plasma and urine fingerprints of PAH patients and control group with the use of an untargeted metabolomics approach. The study also focused on correlation analysis between the observed metabolic changes and the clinical parameters to select specific indicators of PAH disease. Methods An untargeted metabolomics approach was applied to the plasma and urine samples with the use of gas chromatography coupled to triple quadrupole mass spectrometry (GC-QqQ/MS) and advanced statistical tests were applied to evaluate the potential metabolic indicators of PAH. The PAH patients (n=40) and healthy controls (n=39) were matched for age, sex, BMI and included in the study. The obtained raw datasets were properly processed (data deconvolution, signal correction using QCSVR method and PQN normalization) and subsequently subjected to uni- and multivariate statistical tests (Student's t-test, Welch's test, U Mann-Whitney test, PCA and OPLS-DA). The identification of the statistically significant metabolites was performed using universal libraries, such as: Fiehn's and NIST11. Results The statistically significant metabolites (n=10 and 11 for urine and plasma samples, respectively)originate from various biochemical pathways associated with the carbohydrate, amino acid, lipid, fatty acid and pyrimidine metabolism. The metabolic changes observed in the urine samples of PAH patients (compared to the control group) included different concentrations in: threonic acid, hippuric acid, acetic acid, sorbitol, butanoic acid and propionic acid. The metabolic alterations in the plasma samples covered changes in the levels of valine, leucine, lactic acid, hydroxybutanoic acid, nonanoic acid, cholesterol and octadecanoic acid. Metabolites representing the highest correlation with mean pulmonary arterial pressure include, for instance: propionic acid (r=0.85), valine (r=0.75) and lactic acid (r=0.63) Conclusions The observed metabolic changes are related to various biological processes that are disturbed in the course of PAH, namely: proliferation of pulmonary vascular cells or the functions of cardiomyocytes and the right ventricle of the heart. The obtained results confirmed the potential of a metabolomics approach to uncover and explain the underlying molecular mechanisms of PAH. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and High Education of Poland

Introduction Endurance athletes have an increased risk of atrial remodeling and atrial arrhythmias. However, data regarding atrial adaptation to physical exercise in non-elite athletes are limited. We aimed to assess exercise-induced alternations in atrial morphology and function in male and female amateur marathon runners, using real-time three-dimensional (3D) echocardiography. Methods The study group consisted of 40 male (39±8 years) and 27 female (40±7 years) amateur athletes. 3D echocardiography was performed 2–3 weeks before (Stage 1) and immediately after (Stage 2) the marathon run. Right (RA) and left atrial (LA) remodeling was assessed by volumetric measures, total ejection fraction (EF) and volume (EV). Speckle tracking was used to determine the temporal evaluation of atrial function by strain analysis. Results The main results are presented in Table 1. At rest, male athletes demonstrated greater RA size and decreased RA contractility, as assessed by EF and atrial strains, in comparison to females. At Stage 1, LA morphology and function did not differ significantly between genders. After the marathon, a remarkable increase in RA maximal volume (RAVmax, 32.9±8.6 vs. 36.4±8.2 ml/m2, p=0.016) and RAEF (49.5±9.7 vs. 57.3±9.2%, p=0.002) was observed only in female athletes (p Conclusions In amateur athletes, marathon running promotes biatrial remodelling with significant gender discrepancies. Females are more susceptible to exercise-induced morphological and functional changes of RA, while postrace alternations in males concern principally LA. 3D echocardiography of the atria is a useful indicator of exercise capacity, not only in elite, but also in amateur athletes. Funding Acknowledgement Type of funding sources: None.

Background/Introduction Conventional transradial approach (c-TRA) at the wrist is considered as the default strategy for catheter-based procedures providing less serious access-related complications and better patients' comfort than transfemoral route. A novel distal transradial artery approach (d-TRA) via the anatomical snuffbox has been proposed recently as an noteworthy alternative. It is hypothesised that d-TRA may provide additional benefits without losing the efficacy of c-TRA. Purpose To assess consecutive patients' comfort undergoing coronary angiography or intervention by novel d-TRA in comparison with c-TRA. Methods In a span of 4 months, out of 465 caucasian subjects, 400 patients were included in a prospective, single-center, randomized (1:1) distAl vs traditioNal Transradial Access for coRonary procEdures Study (ANTARES). Hemodynamic instability, ST-elevation myocardial infarction, forearm artery occlusion or prior radial access failure were the exclusion criteria. An artery was punctured with anterior wall modified Seldinger technique, and standard 5F or 6F vascular sheaths were used. Pain/discomfort when access gaining, radial spasm, early (within 24 hours) postprocedural local neuropathy (thumb numbness) were the analyzed parameters determining patients' comfort in both groups. Results Baseline characteristics of patients were matched. Conclusion(s) Coronary procedures performed in consecutive patients via novel d-TRA are associated with worse patient's comfort determined by higer rate of radial spasm and early postprocedural local neuropathy, and greater pain/discomfort when access gaining, in comparison with c-TRA. Funding Acknowledgement Type of funding source: None