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Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Sociedad Española de Cardiología. Background Left bundle branch block (LBBB) has been commonly associated with adverse cardiovascular (CV) events, but the effect of an isolated LBBB on maximal functional capacity is not well characterized. Purpose To evaluate maximal functional capacity in adults with isolated LBBB and compare it to healthy population-derived predicted values (adjusted for sex, age, weight, and height). Methods This descriptive pilot study included subjects with isolated LBBB derived from outpatient clinics of two academic hospitals. All subjects underwent maximal cardiopulmonary exercise testing (CPET) and a Global Physical Activity Questionnaire (GPAQ). The primary endpoint was to evaluate maximal functional capacity according to population-derived predicted values of peak oxygen consumption (peakVO2): pp-peakVO2. The secondary endpoint was to evaluate adverse CV events (CV deaths or hospitalizations) at follow-up. Results A total of 27 (18 women and 9 men) participants were included. The median (interquartile range) age of the sample and time to screening from the first LBBB diagnosis were 62 (51-71) and 3.4 (1.1-8.4) years, respectively. The results of the GPAQ score showed that 19 patients were highly active, and 8 were moderately active. The median of peakVO2 and pp-peakVO2 were 19.3 (15-22.5) mL/kg/min and 88 (79.3-104.4) %, respectively. There were no adverse CV events at a median follow-up after CPET of 3.1 (2.7-3.4) years. Conclusion In this pilot study, adults with isolated LBBB showed reduced maximal functional capacity, despite the absence of cardiac disease and a baseline moderate to highly active lifestyle.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Sociedad Española de Cardiología. Background Fatigue and exercise intolerance are the most common symptoms in patients with long COVID. Purpose This study aimed to evaluate whether a home-based inspiratory muscle training (IMT) program improves maximal functional capacity in patients long COVID after a previous admission due to SARS-CoV-2 pneumonia. Methods This study was a single-centre, blinded assessor, randomised controlled trial. Twenty-six patients with long COVID and a previous admission due to SARS-CoV-2 pneumonia were randomly assigned to receive either a 12-week program of IMT or usual care alone. The physiotherapist and participants were not blinded. Patients allocated to the IMT arm were instructed to train at home twice daily using a threshold inspiratory muscle trainer and to maintain diaphragmatic breathing during the training session. The usual care arm received no intervention. The primary endpoint was changes in peak oxygen consumption (peakVO2). Secondary endpoints were changes in quality of life (QoL), ventilatory efficiency and chronotropic response during exercise (evaluated by chronotropic index-CIx- formula). We used linear mixed regression analysis for evaluating changes in primary and secondary endpoints. Results The median (interquartile range) age of the sample and time to first visit after discharge were 52 (42-59) years and 405 (301-435) days, respectively. A total of 11 (42.3%) were female. At baseline, the median of peakVO2, ventilatory efficiency and CIx were 17.4 (15.6-21.1) mL/kg/min, 29 (24.5-33.3), and 0.64 (0.54-0.87), respectively. The IMT arm improved their peakVO2 significantly compared to usual care (+Δ 4.46 mL/kg/min, 95% CI 3.10 to 5.81; p Conclusion In long COVID patients with a previous admission due to SARS-CoV-2 pneumonia, IMT was associated with marked improvement in exercise capacity and QoL.

68 Rare heart involvement of a systemic vasculitis: cardiac mass in wegener syndrome {#article-title-2} Wegener's granulomatosis (WG) is one of the small vessel vasculitides. The percentage of cases that involve the heart is unknown, but cardiac manifestations are rare. We report a patient with WG with a mass. A 60-year-old woman presented to hospital with monomorphic ventricular tachycardia (VT). She had history of atrial fibrillation, with normal TTE. A TTE was performed that revealed a mitral mass attached to the mitral posterior leaflet. The mass had no contrast capture and she had moderate mitral regurgitation (MR) and good biventricular function. A 2D TOE demonstrated a mass in atrioventricular junction sized 20x18mm, with similary echodensity to the miocardium and well-defined edges (Image1) and significant MR secondary to displacement of the posterior leaflet. Coronary angiography showed normal epicardial coronary. VT were not induced on electrophysiological study. From her blood tests MPO-ANCA antibody were elevated. Cardiac-MRI confirmed the presence of an atrioventricular junction mass (Image2). T2-weighted imaging demonstrated the mass to be hyperintense with respect to the surrounding myocardium (Image3). The patient had involvement of other organs (nose, renal,…). The patient was treated with corticosteroids and cyclophosphamide. A TTE performed after the beginning of the immunosuppressive therapy showed that the cardiac mass had disappeared. It is very unusual cardiac involvement of the WG. In cases of heart mass we'd not only think of thrombus, myxoma or other tumors. We don't forget other etiologies such as inflammatory masses. This mass was correctly diagnosed with imaging techniques and C-MRI was especially helpful. We underline that cardiac mass in WG can be successfully treated by immunosuppressive therapy, so that surgical approach could be avoided in selected patients. ![Figure][1] Figure # 69 A dancing tumor in the heart {#article-title-3} A 53-year-old woman presented with fatigue and dyspnea on exertion. She had received hysterectomy because of a large uterine leiomyoma 9 years previously. Thereafter, she had undergone multiple wedge resections for recurrent pulmonary nodules in both lungs (Figure1 right upper panelA) since 5 years after the hysterectomy. The pathology of the resected nodules showed metastatic leiomyomas. A MRI of chest revealed a filling defect (Figure 1 left upper panel) in right atrium (RA) during regular post-operative follow-up. A transthoracic echocardiography showed a serpentine mass floating between RA and right ventricle (RV). A transesophageal echocardiography depicted that the tumor mass originated from inferior vena cave (IVC), extended into RA, and moved back and forth through the tricuspid valve into RV during cardiac cycle (Figure 1 right lower panel). A computed tomography (CT) of abdomen showed a right pelvic tumor with extension to IVC (Figure 1 left lower panel). The patient received two-stage operation for both intracardiac and pelvic tumors. The pathologic report disclosed leiomyomas. The postoperative period was uncomplicated and uneventful. This concluded an intravenous leiomyomatosis with pulmonary metastases. ![Figure 1][1] Figure 1 # 70 A giant myxoma of the left atrium involving the entirety of fossa ovalis in an oligosymptomatic patient. {#article-title-4} The Case: We present a case of a 60 years old woman with mild and atypical symptoms, which orientated to thinking to a pneumonitis or bronchial asthma. The appearance of pulmonary edema and enlarged heart size at chest-X-ray determined a couple of cardiologic exams (ECG, transthoracic echocardiography) which came to obiectivate, as the main cause of the symptoms, the existence of a GIANT left atrial mixoma (6x4 cm) which was attached to entirety of fossa ovalis, with a clear diastolic prolapse into the mitral valve annulus. The tumor was resected en bloc with the interatrial septum. An atrial septal defect was created during the resection and safely repaired by bovine pericardial patch. Surgical intervention lead to healing of the patient. Conclusion: The clinical presentation of the atrial myxoma is variable. Usually there is a classic triad of symptoms: (1) symptoms of mitral valve obstruction; (2) symptoms of embolism; (3) constitutional symptoms and laboratory abnormalities. Patients with LA myxoma simulate clinically mitral stenosis whereas patients with RA and RV myxomas present with features of right heart failure. Angina pectoris may be the first manifestation of myxoma. In most part of cases symptoms are mild or/and atypical. Even patients with LARGE myxomas may be oligosymptomatic and an high index of suspicion is essential for the diagnosis. Echocardiography is the ideal tool for diagnosis as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity. ![Figure][1] Figure # 71 Massive calcification involving a left ventricular false tendon {#article-title-5} We report the case of a 70-year-old man with cardiovascular risk factors and a history of a heart murmur diagnosed during infancy, presenting with worsening exertional dyspnea. The physical examination showed a slow-rising carotid pulse, a grade III/VI systolic murmur and crepitant rales at pulmonary auscultation. Laboratory evaluation revealed a normal complete blood count, renal function, ionized calcium and phosphate and a plasmatic brain natriuretic peptide level of 2500 pg/ml. Echocardiographic evaluation showed concentric left ventricular (LV) hypertrophy with preserved ejection fraction, mild diastolic dysfunction and a severe aortic valve stenosis (valve area of 0.6 cm2/m2). Calcified masses were also observed at the mid-LV cavity on 2D and 3D echo (Panels A and B, arrows), which determined turbulent flow depicted by colour Doppler (Panel C). Steady-state free-precession cine cardiac magnetic resonance (CMR) confirmed the presence of a membrane with transverse arrangement, suggestive of an anomalous band abnormally thickened and calcified (Panels D and E, arrowheads). This non-obstructive structure was connected with the anterolateral papillary muscle and with the lateral wall of the left ventricle by multiple fibrous filaments The presence of fibrosis was excluded by late gadolinium enhancement CMR. LV false tendons are fibromuscular structures of varying length and thickness that traverse the ventricular cavity and are accepted as anatomic variants. Calcium deposits in the heart are common in older persons and have been described in association with coronary artery disease, dilated cardiomyopathy, aorto-mitral valvular disease and renal disease. We report a case of massive left ventricular false tendon calcification associated with aortic valve calcification and stenosis. ![Figure][1] Figure # 72 Mediastinal mass in a young patient with a history of heart transplantation {#article-title-6} A 37-year-old man with a history of heart transplantation three years ago was referred to our Cardiac Image Unit for evaluation of a mediastinal mass. The patient complained of diffuse abdominal pain with dyspepsia and abdominal magnetic resonance imaging (MRI) showed multiples space-occupying lesions in the liver with normal fine-needle aspiration biopsy. Echocardiography showed a paracardial mass with preserved systolic function and absence of valvular disease. Subsequently, cardiac MRI was indicated showing a polylobulated mass adjacent to the left atrium and atrioventricular groove (7.8x3.4x4.0 cm diameter). The mass was characterized by an intermediate intensity on T1-weighted turbo spin echo (TSE) sequence, it was hyperintense on T2-weighted TSE sequence (not suppressed with fat-saturation techniques) and it had a heterogeneous contrast uptake, all of which suggest malignancy (most likely lymphoma). A whole body positron emission tomography/computed tomography (PET/CT) was performed confirming a left paracardial hypodense irregular mass, predominantly solid and hypermetabolic (SUV max. 17.8 g/ml) with ametabolic areas consistent with central necrotic tissue. Moreover, multiples hypermetabolic well-defined masses suggestive of liver metastatic lesions were observed. Then, a new fine-needle aspiration biopsy of the liver confirmed the presence of a diffuse large B-cell lymphoma. The treatment included reduction of immunosuppression therapy and R-CHOP chemotherapy every 21 days. Lymphoproliferative syndrome is the most common neoplastic complication after skin and cervix cancer in patients undergoing solid organ transplantation and can reach up to 15% during the first year. This case highlights the value of cardiac magnetic resonance and PET/CT in the assessment of a paracardial mass. ![Figure][1] Figure [1]: pending:yes

Objective To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). Design A single-center retrospective case–control study was carried out. Setting Coronary Care Unit. Patients Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). Variables Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. Results Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38–3.11; p = 0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4–10.6; p = 0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2–9.1; p = 0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2–8.1; p = 0.018) were the only variables independently associated to increased 30-day mortality. Conclusion In our “real life” experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.

This paper aims to study the predictive potential of the stage of change, type of treatment followed and other variables regarding adherence to therapy.A longitudinal and multicentre study has been carried out in three drug-addiction treatment centres within the Valencia Region, Spain. The sample included 172 alcohol-addicted clients (152 men and 20 women). Adherence to treatment was measured at one, 3, 6, 9, 12, 18, and 24 months.The most successful variable predicting treatment adherence is the type of program followed associated to all the time cutoffs. The fact of attending the centre with some relative or friend is a sign of potential adherence to treatment at the 3 and 6 months. The longer the withdrawal period previous to treatment, the greater the chances of adherence at the 6, 9 and 12 months of treatment.Those variables directly associated with treatment are potentially better predictors of adherence than the stage of change. We have found it necessary to assess it throughout the therapeutic process.

Tomando como marco de referencia el modelo transteorico de cambio de Prochaska y DiClemente, el objetivo del presente estudio es evaluar el estadio de cambio en el que se ubican 317 heroinomanos (250 varones y 67 mujeres), utilizando una entrevista semiestructurada. Ademas, se estudia el poder predictivo del estadio de cambio, las variables sociodemograficas, toxicologicas y los tipos de tratamiento relacionados con la adherencia al mes, tres, seis, nueve y doce meses. Los resultados obtenidos indican que el estadio de cambio no es una potente variable predictora de la adherencia al tratamiento, ya que solamente se muestra estadisticamente significativa al mes y a los 3 meses; otras variables estudiadas, sin embargo, si predicen adherencia durante todos los cortes temporales medidos: edad y tipo de tratamiento que inicia. Por otra parte, y en menor medida, los tratamientos anteriores, el tiempo maximo de abstinencia previa y el tipo de acompanamiento, tienden a predecir adherencia en los ultimos cortes temporales.