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Funding Acknowledgements Type of funding sources: None. Background. Transcatheter aortic valve replacement (TAVR) prostheses have better hemodynamics compared to surgical prostheses, with lower incidence of prosthesis-patient mismatch (PPM). Nonetheless, this complication is neither rare nor benign in the expanding population of TAVR patients (pts). Data regarding the effect of TAVR PPM on cardiac function is scarce. Our aim was to determine the short-term impact of PPM on left atrium (LA) function in patients undergoing transfemoral TAVR. Methods. One hundred forty-three consecutive pts (76.3 ± 7.5 yrs, 74 men) considered to be at high risk for SAVR were enrolled and examined before and 30 days after TAVR. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for LA and left ventricular (LV) strain analysis. Longitudinal LA strain parameters were assessed from the apical 4-chamber view. Peak values of global longitudinal LA strain (LAε) and LA systolic strain rate (SSr, reservoir function) and early diastolic strain rate (ESr, conduit function) were measured in all. Contractile LA function (late diastolic strain rate, ASr) was assessed in patients in sinus rhythm (106 pts). Results. Fifty-five pts (38%) had PPM (defined as an indexed effective orifice area, EOA ≤0.85 cm2/m2). Most of these pts (71%) had moderate PPM (indexed EOA between 0.65 and 0.85 cm2/m2). No significant differences in age (76.4 ± 8.1 vs 76.3 ± 7.2 yrs, p = 0.9), gender (p = 0.2), body surface area (p = 0.8), body mass index (p = 0.2) and the presence of cardiovascular risk factors (p > 0.2 for all) were observed between pts with and without PPM. The severity of post-TAVR aortic regurgitation was mild in 92 pts (64%) and moderate in 12 pts (8%) without any significant difference between pts with and without PPM. The post-TAVR prevalence of ³moderate mitral regurgitation was not different between the two groups (p = 0.40). After TAVR, there were no significant differences in terms of indexed LV mass, volumes, ejection fraction (p > 0.5 for all). LV global longitudinal strain was also similar between groups (-13.7 ± 4.3 vs -14 ± 3.6%, p = 0.7). Although LA volumes were similar between patients with and without PPM (47.8 ± 12.4 vs 49.3 ± 20.3 ml/m2, p = 0.6), in the mismatch-group we found a significantly reduced systolic global LA strain (12.7 ± 6.2 vs 15.9 ± 7.9%, p = 0.009) and impaired LA contractile function (ASr: -1.0 ± 0.4 vs -1.2 ± 0.5, p = 0.03). Parameters of LV diastolic function were also worse in the mismatch-group, with an E/e’sep ratio of 22 ± 10 vs 17 ± 7, p = 0.01. Conclusions. In our study group TAVR was associated with an incidence of PPM of 38%. The short-term follow-up of these patients revealed a significantly impaired LA function and increased LV filling pressure in patients with PPM compared to those without PPM. To our knowledge, this is the first report about the effect of PPM on the LA global and contractile function.

Background Transcatheter aortic valve implantation (TAVI) improves not only left heart remodeling but also has an upstream effect on the right ventricle and pulmonary vasculature. Right ventricle (RV) to pulmonary artery (PA) coupling, a parameter which integrates RV systolic performance at a given degree of afterload, was associated with all-cause mortality in these patients (pts). Our aim was to evaluate the short-term effect of TAVI on RV-PA coupling and the main determinants of RV-PA coupling in pts with aortic stenosis (AS) undergoing transfemoral TAVI. Methods We have prospectively enrolled 102 consecutive pts (76±8 years, 57 men) with severe AS undergoing TAVI. All pts underwent a comprehensive echocardiogram both before and 30 days after TAVI, including speckle tracking echocardiography (STE) for myocardial deformation analysis. Peak values of global longitudinal left ventricular strain (GLS), left atrial strain (LAε, reservoir function), and late diastolic LA strain rate (ASr, contractile function) were measured. The ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) was used as an estimate of RV-PA coupling. Results Compared with baseline, there was a significant increase in LV ejection fraction after TAVI (54±12% vs 50±13%, p=0.04), a significant reduction in LV mass (147±35 vs 171±44 g/m2, p Conclusions Our results confirm that relief of aortic valve obstruction by TAVI has beneficial effects on the RV-PA coupling, that occur early after intervention. This is accompanied by a significant improvement in LV and LA deformation. Moreover, there is a significant correlation between LA function and RV-PA coupling both before and after TAVI. Enhanced RV-PA coupling after TAVI is related to improved LA strain, suggesting the contribution of LA function in modulating right heart function in this setting. Funding Acknowledgement Type of funding source: None

Background Anemia is common in patients (pts) with severe aortic stenosis (AS). Untreated anemia and severe AS are individually associated with the development of heart failure, however data regarding the potential detrimental effect of anemia on left ventricular (LV) function and prognosis in pts with severe AS are controversial. Aim To investigate the impact of anemia on clinical status, echocardiographic parameters and prognosis in pts with severe AS and preserved LV ejection fraction (LVEF). Methods Consecutive patients with severe AS (aortic valve area [AVA] index ≤ 0.6 cm2/m2) and preserved LVEF (>50%) referred to our echocardiography laboratory were prospectively screened. All patients underwent complete clinical examination and comprehensive echocardiography, including speckle tracking-derived measurements of LV and left atrial (LA) strain. Baseline clinical variables included NYHA class, cardiac risk factors, haemoglobin (Hb) level and glomerular filtration rates (GFR, by MDRD formula). The definition of anemia was based on gender-specific cut-off values, as recommended by the WHO (Hb Results The study population included 264 patients (pts) (66 ± 11 yrs, 147 men). Anemia was present in 64 pts (24%). Aortic valve replacement (AVR) was performed in 151 pts. Dividing the study population into 2 groups, according to the presence/absence of anemia, no significant differences were found between groups regarding: age (p = 0.09), body surface area (p = 0.6), LVEF (62 ± 7 vs 63 ± 6%, p = 0.2), LV Global Longitudinal Strain (-15.2 ± 4 vs -14.7 ± 3 %, p = 0.4), LV mass index (p = 0.9), mean aortic gradient (p = 0.2) and indexed AVA (0.40 ± 0.09 vs 0.39 ± 0.09 cm2/m2, p = 0.6), or presence of significant coronary artery disease (p = 0.9). Compared to pts with normal Hb level, in pts with anemia NYHA class (p = 0.03), brain natriuretic peptide values (p = 0.004), lateral E/e’(16.2 ± 6.9 vs 13.7 ± 6.3, p = 0.01) and average E/e" ratio (15.9 ± 5.9 vs 14.1 ± 5.3, p = 0.03), LA volume index (54.3 ± 16.9 vs 45.0 ± 12.1 ml/m2, p Conclusions In our study including pts with severe AS and preserved LVEF, patients with baseline anemia presented worse functional status and LV diastolic dysfunction and increased 3-year all-cause mortality compared to those with normal Hb levels. However, in pts who underwent surgical AVR, there was no impact of baseline anemia on 3-year survival.

Background Transcatheter aortic valve replacement (TAVR) reverses LV remodeling and improves overall cardiac function, but data regarding its effect on left atrial (LA) function is scarce. Our aim was to evaluate the short-term effect of TAVR on LA myocardial deformation parameters and the relationship between the improvement of LA function and baseline echocardiographic parameters. Methods Fourty-eight consecutive pts (75 ± 6 yrs, 28 men) considered to be at increased risk for surgical aortic valve replacement were enrolled and examined before and 30 days after TAVR. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for deformation analysis. Longitudinal LA strain parameters were assessed from the apical 4-chamber view. Peak values of global longitudinal LA strain (LAε) and LA systolic strain rate (SSr, reservoir function) and early diastolic strain rate (ESr, conduit function) were measured in all. Contractile LA function (late diastolic strain rate, ASr) was assessed in patients in sinus rhythm (39 pts). Results Compared with baseline, the mean indexed LV mass was significantly reduced after TAVR (141 ± 26 vs 160 ± 37 g/m2, p = 0.009) but the mean increase in LVEF was not statistically significant (51 ± 14% vs 47 ± 15%, p = 0.2). There was a significant reduction in systolic pulmonary pressure after TAVR (34 ± 12 vs 42 ± 13, p = 0.004). Although there was no significant decrease in indexed LA volume (51 ± 22 vs 56 ± 20 ml/m2, p = 0.3), the contractile LA function significantly improved 30-days after TAVR (mean ASr, -1.1 ± 0.5 vs -0.8 ± 0.4 %, p = 0.02). There was a tendency of improvement in global longitudinal LA strain (15 ± 7 vs 12 ± 6%, p = 0.06) and global longitudinal LV strain (-13 ± 4 vs -11 ± 5%, p = 0.06) as well. Parameters of LV diastolic function, including TDI derived e’ and E/e’ ratios were not significantly improved 30 days after TAVI. While LA volumes and function parameters were not significantly different between genders at baseline, the improvement of LA function was more frequently found in male pts (p = 0.05). There were no significant correlations between the improvement of LA function parameters and baseline echocardiographic parameters in our study group. The only predictor of LA booster function improvement was the baseline value of ASr (p = 0.01). Conclusions TAVR is associated with a significant recovery of LA function as assessed by STE, suggesting a reverse cavity remodeling. This was accompanied by a significant reduction in LV mass and systolic pulmonary pressure. Men seem to show a more significant improvement in LA contractile function, suggesting a gender-related LA response to chronic afterload reduction.

We present the case of a 55-year old woman with an unremarkable past medical history, allergic to eggs and cinnamon and without any clinical complaints, who presented for a routine ECG prior to a dental implant procedure. The ECG revealed signs of left ventricular (LV) hypertrophy with deep negative T waves in V2-V6 (Figure) suggesting apical hypertrophic cardiomyopathy. Her physical exam was unremarkable and a transthoracic echocardiography (TTE) was ordered. The TTE revealed normal LV dimensions, a normal global systolic function of both ventricles, but most remarkably, an isoechoic mass that occupied the whole apex and one third of the LV cavity (Figure), with a maximum thickness of 22 mm and a 2 mm hyperechogenic lining towards the LV, all these findings being suggestive of Loeffler endocarditis. The routine laboratory tests showed (apart from a slightly increased LDL-cholesterol and normal BNP values) hypereosinophilia: more than 10% of the white blood count. Chest X-Ray and the abdominal scan showed no signs of pulmonary or hepatic infiltration. Cardiac magnetic resonance imaging was scheduled, but the patient has claustrophobia and was unable to perform the exam. The aetiological workup included the investigation of allergic, hematologic, as well as parasitic causes of the hypereosinophilic syndrome. Consequently, serological tests for Coxiella, Chlamydia, Echinococcus and Toxocara were all performed. The IgG antibodies for Toxocara canii were found in a very high level, indicating a chronic parasitic infection as a possible cause of the hypereosinophilic syndrome. The hematologic exams were all within normal limits. The endomyocardial biopsy, the gold standard for diagnosis could not be performed for technical reasons. The first step in the management of hypereosinophilia (HE) is stopping exposure to the trigger, as well as specific treatment- albendazole. The patient received oral anticoagulant treatment in order to prevent thromboembolic complications, which are frequently reported in this clinical setting. Loeffler’s endocarditis is usually a late cardiac manifestation of the HE syndrome. This is a rare and surprising case of an incidental imaging diagnosis in a totally asymptomatic patient after a routine ECG that was suggestive of hypertrophic cardiomyopathy. The challenge consisted in finding the cause of HE in order to attempt an aetiological treatment. Although the allergic and parasitic causes were most likely, considering the patient’s history, a hematologic malignancy had to be excluded. HE associated with toxocariasis rarely causes cardiac manifestations, but it should not be excluded when the patient has a history of canine exposure. The most fearsome complication in this case is the embolization of the eosinophilic mass, but the prompt management and routine follow-up allow the prevention of a thromboembolic event. Abstract P681 Figure. ECG and TTE apical views