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Background Echocardiography provides complex data on cardiac function that can be integrated into patterns of dysfunction related to the severity of cardiac disease. The aim of this study was to demonstrate the feasibility of applying machine learning (ML) to automate the integration of echocardiographic data from the whole cardiac cycle and to automatically recognize patterns in velocity profiles and deformation curves, allowing the identification of functional phenotypes. Methods Echocardiography was performed in 189 clinically managed patients with hypertension and 97 healthy individuals without hypertension. Speckle-tracking analysis of the left ventricle and atrium was performed, and deformation curves were extracted. Aortic and mitral blood pool pulsed-wave Doppler and mitral annular tissue pulsed-wave Doppler velocity profiles were obtained. These whole–cardiac cycle deformation and velocity curves were used as ML input. Unsupervised ML was used to create a representation of patients with hypertension in a virtual space in which patients are positioned on the basis of the similarity of their integrated whole–cardiac cycle echocardiography data. Regression methods were used to explore patterns of echocardiographic traces within this virtual ML-derived space, while clustering was used to define phenogroups. Results The algorithm captured different patterns in tissue and blood-pool velocity and deformation profiles and integrated the findings, yielding phenotypes related to normal cardiac function and others to advanced remodeling associated with pressure overload in hypertension. The addition of individuals without hypertension into the ML-derived space confirmed the interpretation of normal and remodeled phenotypes. Conclusions ML-based pattern recognition is feasible from echocardiographic data obtained during the whole cardiac cycle. Automated algorithms can consistently capture patterns in velocity and deformation data and, on the basis of these patterns, group patients into interpretable, clinically comprehensive phenogroups that describe structural and functional remodeling. Automated pattern recognition may potentially aid interpretation of imaging data and diagnostic accuracy.

Basal septal hypertrophy (BSH) is commonly seen in patients with systemic hypertension and has been associated with increased afterload. The impact of localized hypertrophy on left ventricular (LV) and left atrial (LA) function is still unclear. Our aim is to investigate if BSH is a marker of a more pronounced impact of hypertension on cardiac function in the early stages of hypertensive heart disease. An echocardiogram was performed in 163 well-controlled hypertensive patients and 22 healthy individuals. BSH was defined by a basal-to-mid septal thickness ratio ≥1.4. LV dimensions and mass were evaluated. LV global and regional deformation was assessed by 2-dimensional (2D) speckle tracking echocardiography, and LV diastolic function by 2D and Doppler imaging. LA function was evaluated with phasic volume indices calculated from 2D and 3-dimensional volumes, as well as speckle tracking echocardiography. The population was 54% men, mean age 57 (53 to 60) years. BSH was seen in 20% (n = 32) of the hypertensive cohort. Patients with BSH showed decreased regional LV systolic deformation, impaired LV relaxation with a higher proportion of indeterminate LV diastolic function, and LA functional impairment defined by a reduction of reservoir strain and a change in LA functional dynamics. In conclusion, in well-controlled hypertension impairment of LV and LA function is present in patients with early LV remodeling and localized hypertrophy. BSH might be useful as an early marker of the burden of hypertensive heart disease. This work was supported by Horizon 2020 European Commission Project H2020-MSCA-ITN- 2016 (764738), Grant from Fundacio La Marato de TV3 (040310, Exp 2015.40.30), and from Fondo de Investigaciones Sanitarias - Instituto de Salud Carlos III (PI17/ 01131).

Despite the rapid development of emerging imaging technologies, left ventricular ejection fraction represents the cornerstone of diagnosis, choice of treatment, and prognosis in heart failure. However, true myocardial function often remains underestimated or overestimated in different conditions underlying this heterogeneous syndrome. Changes in left ventricular size and left ventricular ejection fraction, termed reverse remodeling, are among the main goals of treatment in heart failure, aimed at halting or attenuating disease progression. The lack of effective therapeutic approaches in nearly one-half of the heart failure population highlights the need for integrating novel echocardiographic measures to better understand the underlying pathophysiologic mechanisms.

The idea of coronary microcirculation playing a role in the pathophysiology of heart failure dates from decades ago, with authors hypothesizing that structural and functional alterations in the coronary microcirculation could potentially contribute to heart failure. It is known that in a wide range of primary cardiomyopathies, from dilated to hypertrophic, there are pathological alterations in myocardial vasculature structure and function, playing a role in the clinical course of the disease. Needless to say, many patients with normal epicardial coronary arteries can suffer from coronary microvascular dysfunction, that could lead to a wide variety of clinical problems – from impaired functional capacity to stable and unstable angina, Takotsubo syndrome, myocardial infarction with normal coronary arteries and can also end up with either acute or chronic heart failure. Furthermore, nowadays, it has been recognized that pathophysiology of the heart failure with preserved ejection fraction (HFpEF) is mainly due to the myocardial microcirculatory impairment. In heart failure with reduced ejection fraction (HFrEF) neurohumoral mechanisms affecting the peripheral vasculature have been identified as important factors in the development and progression of heart failure, leading to unfavourable remodelling, and thus some of them being important treatment targets. Among many new clinical scenarios where both myocardial and peripheral microcirculation play an important role, raising field of implantable continuous flow assist devices opens many questions and implies better understanding of their effects of microcirculation, as they usually lead to the improvement of end organ dysfunction caused by previous heart failure, which is probably through the positive effects of peripheral microcirculation.

Introduction: Data on heart transplant (HTx) patients and infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are very limited. There is significant heterogeneity in the clinical presentation. 1 Immunosuppression-related issues are of the main concern because of an increased risk for viral replication and superimposed infections. There is no evidence-based recommendation for the management of these patients. Some authors suggest modification in immunosuppression, i.e. discontinuation of mycophenolate mofetil (MMF) and calcineurin inhibitor (CNI) reduction in patients with more severe clinical presentation.2 Patients and Methods: This is a case series of 5 HTx recipients from our center who tested positive for COVID-19 infection and were treated in different COVID-19 specialized units. Results: There were 4 male and one female patients, 62-75 years old. Four of them were symptomatic and hospitalized, while one remained self-quarantined at home. The clinical presentation was mild to moderate, with symptoms including mild fever, dyspnea, and myalgia. X-ray signs of pneumonia were present in 3 patients, but none needed ICU care nor mechanical ventilation. Both a reduction of CNI dose with lower target serum concentration and MMF was discontinued in all patients. One patient was treated with hydroxychloroquine, one with remdesivir and one with steroid therapy. Antibiotics prophylaxis was administered in 2 patients. None of the patients experienced overt graft rejection and all patients have successfully recovered (Table 1). Conclusion: Lacking any evidence-based recommendation for the treatment of HTx patients infected with SARS-CoV-2, we are challenged to modify maintenance immunosuppression carefully balancing between the risk of uncontrolled viral replication with a superimposed infection on one side, and the increased risk of graft rejection on the other side. Further studies are needed to determine the optimal management of COVID-19 infection in these patients.

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients during cardiac arrest and cardiogenic shock and is associated with increased survival rate1. Since mortality on ECMO is still rather high, SAVE (Survival after Veno-Arterial ECMO) score can be used to predict survival from refractory cardiogenic shock requiring ECMO2. Patients and Methods: We performed a retrospective analysis of 121 patients (78% male) who underwent VA-ECMO implantation in our Department from January 2011 till November 2020 (Figure 1 and Table 1). Results: Median age was 58 years with 21% of patients older then 65 years. Median of ECMO duration was 6 days. The most common causes of cardiogenic shock were acute myocardial infarction and cardiomyopathy (53% and 37%, respectively) (Figure 2), and 37% patients were implanted during cardiopulmonary resuscitation (eCPR). Overall survival on ECMO support was 59%, but in patients after CPR only 34%. Furthermore, of all patients, 34% were successfuly weaned and the rest who survived continued on advanced heart failure therapies (Figure 3), but overall survival in follow-up was only 26%. Median SAVE score was -8 with significantly less negative values in patients younger than 65 and treated after 2015. Also, patients treated before 2015 had significantly higher values of creatinine, free hemoglobine and international normalized ratio (INR) and their survival rate was only 39%, in comparison to those who were implanted after 2015 whose survival rate was 62%.Conclusion: Although results with ECMO support in cardiogenic shock in our Department improved throughout 10-years experience, they still exhibit high long-term mortality. Our observations reinforce the need for thorough assessment of each ECMO candidate, especially in respect to patient’s age, end-organ failure and SAVE score as key steps to ensure optimal outcomes.

Background: Current guidelines recommend genetic counselling and testing in patients with familial non-ischemic idiopathic cardiomyopathies with hypertrophic, dilated, restrictive or arrhythmogenic phenotype.1, 2 We aimed to investigate genotype features of patients with non-ischemic cardiomyopathies in advanced stage of heart failure in University Hospital Centre Zagreb. Methods: Genetic testing (single variant and multiple variant testing) was performed in part using the in-house genetics laboratory, and also in a collaborating genetics laboratory in Helsinki, Finland (Blueprint Genetics). Pathogenic and likely pathogenic variants that established a molecular diagnosis were confirmed by Sanger sequencing. Results: From September 2016 to December 2020, we have performed genetic testing in 66 patients. Of this number, 14 patients (8 males, 41.5±14.3 years) had advanced heart failure as evidenced by either having undergone heart transplantation, mechanical circulatory support implantation, or were currently listed for heart transplantation. Before genetic testing, clinically observed phenotypes indicated dilated cardiomyopathy in 6 patients, restrictive cardiomyopathy in 6 patients, and arrhythmogenic cardiomyopathy in 2 patients. Diagnostic yield of the performed genetic tests was relatively high, only one test did not identify any mutations, and 4/14 identified mutations that can currently be classified only as variants of uncertain significance. Pathogenic and likely pathogenic mutations predominantly affected genes coding proteins of the sarcomere, cellular and nuclear membrane, or pathologic protein such as transthyretin (Table 1). Genetic testing lead to change in the clinically determined diagnosis in 4/14 patients. Results of genetic testing in this group of patients warranted further family clinical screening in all of the patients, and family genetic screening in 5 eligible patients. Conclusion: Genetic testing in our advanced heart failure population yields important information on etiology of the diseases, and indicates further family screening.

Background and aim In recent years, worse outcomes of female acute coronary syndrome (ACS) patients have been recognized. The aim was to explore gender differences in ACS in the Croatian branch of the ISACS-CT registry (NCT01218776). Methods From January 2012 to May 2018, 3066 ACS patients were enrolled; 50% (n=1539) presenting with STEMI, 35% (n=1071) with NSTEMI, and 15% (n=456) with unstable angina (UA). In-hospital mortality was defined as the primary endpoint. Results At admission women were older, more burdened with comorbidities, with a longer delay from symptom onset to admission (Figure 1), but without differences in signs and symptoms or Troponin T levels (p=0.166). During hospitalization, there were no gender difference in the administration of beta blockers, ACE inhibitors or statins in the first 24 hours. Coronary angiography was performed in a smaller percentage of female patients (86 vs. 92%, p6h (OR=1.61) were associated. At discharge, there were no gender differences in LV ejection fraction Conclusion The findings in the Croatian branch of the ISACS-CT registry demonstrate notable gender differences in ACS. Older age and a substantial burden of comorbidities represent strong influences on disease development, intervention choice and in-hospital mortality when treating women with ACS. Figure 1 Funding Acknowledgement Type of funding source: None

Background. Unlike lymphodepletion, a decrease in platelet count following induction immunosuppressive therapy with polyclonal rabbit antithymocyte globulin (rATG) is deemed as an adverse event. However, this phenomenon may represent a particular rATG antirejection mechanism. Methods. This retrospective single- center study included 156 patients who received a heart transplant (HTx) between 2010 and 2018. All patients received rATG induction therapy for 5 days. Absolute lymphocyte count (ALC) and platelet counts were assessed on days 0, 7, and 14 following HTx. The primary outcome of the study was the first occurrence of acute cellular rejection (ACR) defined as grade 1B within 24 months after HTx. Results. Both ALC and platelet counts decreased rapidly after induction. During the 24- month follow-up period, 17% of patients had ACR. Patients with ACR had significantly higher platelet count on day 7 (145 vs 104, P < 0.001) and higher ALC on day 14 (162 vs 130, P = 0.035) than those without rejection. Patients in the highest platelet count quartile showed more ACR (50% in quartile 4 vs 0% in quartile 1, P = 0.006) as well as a higher cumulative total rejection score. Univariate analysis showed that ACR was associated with platelet count on day 7, recipient age, and pretransplant cytomegalovirus IgG serology. In multivariable regression analysis, platelet count on day 7 was the most accurate predictor of ACR. Conclusions. Lower platelet count after induction with rATG is associated with less ACR. This suggests platelet involvement in antirejection mechanisms of rATG and a possible rationale for targeting platelets in future immunosuppressive strategies

Funding Acknowledgements Horizon 2020 European Commission Project MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310). Background and aim Localized basal septal hypertrophy (BSH) is a known marker of increased afterload and localized deformation impairment, and can be seen in one-fifth of patients with arterial hypertension. Although there is variability in the classification, BSH is mainly defined from ratios between several wall thickness measurements. We hypothesize that the curvature of the septum is reflective of localized hypertrophy and will be significantly increased in patients with BSH. Speckle tracking endocardial delineations of the left ventricle (LV) can be used to quantify curvature, with the potential to create a novel, semi-automatized parameter for recognition of patients with an increased impact of afterload on cardiac structure and function. Methods An echocardiogram was performed on a total of 149 patients with a diagnosis of long-standing hypertension, treated with at least one antihypertensive drug and on 19 healthy age and sex-matched controls. The interventricular septum thickness was measured at basal and mid-level in the parasternal long axis (PLAX) and 4-chamber (4C) views. BSH was identified from a two-part criterion: both a positive visual assessment of an abrupt change in septal thickness seen in the 4C or PLAX views and a basal to mid-septal ratio ≥ 1.4. A dedicated software for speckle tracking was used to trace the endocardial border of the LV in 4C and 3C view. In post-analysis, we quantified the maximal curvature of the antero- and inferoseptal segments from the exported myocardial contour. Curvature, measured in m-1, was defined as the reciprocal value of the radius of the circle fitted into the curve defined by three subsequent neighboring points in the myocardial contour. Curvature was considered negative if the curve was convex with respect to the LV long-axis. Results Using septal wall thickness measurements, 19% (n = 28) of hypertensive patients were classified as having BSH, whereas all healthy controls had normal geometry. Basal antero- and inferoseptal wall thickness was significantly increased in the BSH group, which was coupled with regional deformation impairment (basal inferoseptum, controls vs. non-BSH vs. BSH: 16.1 ± 2.33 vs. 15.14 ± 2.8 vs. 13.02 ± 2.98 %, p Conclusion Increased septal curvature is an easily quantifiable, single-value, semi-automated parameter reflective of localized thickening that could easily be incorporated into the output of the LV speckle tracking workflow, possibly aiding in the recognition of hypertensive patients in need of a closer clinical follow-up. Abstract P735 Figure 1

Background and aim The persistence of cardiovascular changes in fetal growth restriction (FGR) has been demonstrated from prenatal to preadolescent age, supporting the hypothesis of primary cardiac programming in FGR and the association between low birth weight and cardiovascular risk in adulthood. The aim was to follow-up the FGR cohort and explore the cardiac function and shape in adolescence. Methods FGR was defined by estimated fetal weight and birth weight below the 10th centile, while the control group consisted of normally grown fetuses with birth weight above the 10thcentile. The patients were followed from preadolescence (8–12 years of age) to adolescence (12–17 years of age) with 2-D echocardiography and deformation imaging. The adolescent participants underwent a cardiopulmonary exercise test, where echocardiography was performed at peak exercise. Sphericity index was calculated as the ratio of the LV apex-to-base length and LV basal diameter, measured in 4-chambre view. Results The cohort included 56 participants: individuals with FGR (n=22) and controls (n=34). The mean follow-up was 4.4±0.5 years. The preadolescent FGR cohort was younger (10 vs. 11 years, p=0.004), of shorter height, and lower body weight. In FGR, the trend in smaller LV end-diastolic volumes (LVEDV) was paired with a shorter apex-to-base length (63 vs. 68 mm, p=0.006), and a significantly more spherical LV (1.9 vs 2.0, p=0.004). While the LV ejection fraction was preserved, the LV global longitudinal strain (GLS) was reduced (21.21 vs 22.45%, p=0.001) and the relaxation time impaired. In the follow-up adolescent cohort, there were no differences in height, weight, LV dimensions, LV sphericity, LV GLS or relaxation time. During the follow-up period, the FGR cohort had a significantly higher increase in weight (40 vs. 31%, p=0.016) and BMI (18 vs. 11%, p=0.008). The same was seen in cardiac dimensions, showing a higher increase in LVEDV (35 vs. 27%, p=0.049) and the LV base-to-apex length (24 vs. 17%, p Conclusion The results suggest changes in cardiac shape and function, described in individuals with FGR in prenatal and preadolescent age, seem to be ameliorated in adolescence related to compensatory growth as compared to healthy controls. These findings offer novel information in the research of elevated cardiovascular risk in adults with FGR. Figure 1 Funding Acknowledgement Type of funding source: None

Funding Acknowledgements Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310) Background and aim Non-invasive left ventricular (LV) pressure estimates and speckle-tracking deformation curves can be used to quantify an index of myocardial work (MWI) which may offer insight into the early changes and work distribution in hypertension (HTN) and mitral regurgitation (MR) – cardiac diseases related to pressure and volume overload. The aim is to assess segmental strain and MW indices in patients with HTN, MR, and in healthy controls. Methods An echocardiogram was performed in 73 participants: 31 patients with a diagnosis of long-standing HTN with signs of LV hypertrophy, 22 patients with MR without hypertension, and 20 healthy age- and sex-matched controls. LV speckle-tracking was performed in 4C, 2C, and 3C apical views. MWI was calculated between mitral valve closing and opening. Average regional values of strain and MW indices were calculated by averaging the 4C, 3C, and 2C basal, mid, and apical segments, as based on the 18-segment model of the LV. Total MW per minute (MWI/min) was calculated by multiplying global MWI by the heart rate. Results LV ejection fraction and global longitudinal strain (GLS) were preserved and similar in all groups (GLS, controls vs. mild/moderate MR vs. severe MR vs. HTN: -21.28 ± 2.36 vs. -21.30 ± 1.49 vs. -20.93 ± 2.46 vs. -20.93 ± 2.46, p = 0.602). MR was classified as mild or moderate in 45% (n = 10) and severe in 55% (n = 12). A strong trend of higher global MWI (controls vs. mild/moderate MR vs. severe MR vs. HTN: 2098 ± 373 vs. 2036 ± 341 vs. 2237 ± 351 vs. 2297 ± 427 mmHg%, p = 0.171), as well as MWI/min could be noted in patients with hypertension and severe MR. Averaged regional deformation values showed a gradient increasing from base to apex in all groups, significantly more pronounced in the HTN patients. This deformation pattern was reflected in myocardial work distribution. In HTN, the basal region performed a lower percentage of total work, with the apex performing an increased workload. In the MR subgroups, the work was distributed similarly to the healthy controls Results are shown in Figure 1. Conclusion Non-invasive pressure strain relations offer additional information on cardiac function in HTN and MR with preserved LVEF and GLS. In HTN, MW is elevated and redistributed in the LV with an apex-to-base gradient signaling an apical compensation of basal impairment in the setting of increased afterload. Mild and moderate MR is associated with a compensated state of normal global MWI and work distribution, however, MWI/min in severe MR reveals an overall increase in workload - potentially predicting further LV remodeling in these patients over time. Abstract 155 Figure 1

Brojna klinička istraživanja dokazala su jasne koristi tjelesne aktivnosti za kardiovaskularno, ali i opće zdravlje svakoga čovjeka. Tjelesna aktivnost izaziva fiziološki odgovor organizma koji dovodi do različitih prilagodba pojedinih organskih sustava, a primjer jedne od njih jest i sportsko srce – benigni i reverzibilni odgovor kardiovaskularnog sustava na ponavljanu i intenzivnu tjelesnu aktivnost. Neke bolesti miokarda mogu dijeliti slične elektrokardiografske, ehokardiografske i druge karakteristike sa sportskim srcem. Pravodobno prepoznavanje takvih bolesti ključno je za zaštitu zdravlja svih koji se bave intenzivnijom tjelesnom aktivnosti rekreativno ili profesionalno., Numerous clinical studies have demonstrated obvious benefits of physical activity for cardiovascular, as well as general health of every human being. Physical activity induces a physiological response resulting in different adaptations of individual organ systems. One of such adaptations is the athlete's heart representing a benign and reversible reaction of the cardiovascular system to repeated and intensive physical activity. Some of the myocardial diseases may share electrocardiographic, echocardiographic and other features similar to those of the athlete's heart. Timely recognition of such diseases is crucial to the health of everyone who is engaged in a more intensive physical activity, either recreationally or professionally.

Background: A new hemodynamic environment is set up after heart transplantation (HTx).1, 2 Our aim was to assess changes in diastolic function of the left (LV) and right (RV) ventricle in HTx patients (Pts) during the 1st year and the influence of donor age, graft ischemic time (GIT) and acute right ventricular failure (ARVF). Patients and Methods: In 55 “healthy” HTx Pts echo was performed 1- and 12 months after HTx. Data on mitral valve (MV) E- (Ew) and A-wave velocity (Aw), MV and tricuspid (TV) E/A ratio, MV and TV E’ and A’ by tissue Doppler, septal E/E’, pulmonary vein diastolic velocity (PVd), systolic pulmonary pressure (sPAP), left atrial indexed volume (LAVI), right atrial pressure (RAP) were collected. Results: Ew significantly decreases during the 1st year (0.80 vs. 0.73 m/s ; p=0.036) as well as E/E’ (11.5 vs. 9.1 ; p=0.009), PVd (0.67 vs. 0.55 m/s ; p mean of 41 years) caused initially lower MV-E’ (r=-0.390, p=0.010) and higher sPAP (r=0.285 ; p=0.045). GIT had no influence on diastolic parameters. ARVF significantly correlated with lower TV-A’ acutely and after 1 year (ARVF 5 vs. no-ARVF 8 cm/s ; r=-0.600, p= 0.011) and higher RAP (r=0.414, p=0.003). Conclusion: During the 1st postransplant year there is improvement in LA diastolic function with better early passive LV filling and reduction in PAH, without change in active filling phase or LA volume. In Pts with significant PAH mean E/E’ ratio within 1st month was 14, but after a year in Pts with persistent PAH it declines to only 10, preserving the higher E/A ratio. Higher donor age could impair the early LV ventricular filling with a trend toward more PAH but MV-E’ improves with time. ARVF reduces active RV filling (TV-A’) throughout the 1st year. GIT does not have influence on diastole.

Background: Decrease in platelet count following the induction with polyclonal anti-thymocyte globulin (ATG) is deemed as an adverse event, while decrease in lymphocyte count represents a therapeutic goal1. Still, the effect on platelets may represent an important part of ATG anti-rejection mechanisms. Patients and Methods: This was a retrospective single-center study of consecutive HTx (heart transplantation) patients (pts) from February 2010 to February 2018 in University Hospital Centre Zagreb. All pts received rATG (Thymoglobulin®) 1.5 mg/kg daily during the first 5 days. Complete blood count with differential was assessed on days 0, 7 and 14 after HTx. The incidence of cellular-mediated rejection (ACR) was monitored for two years after HTx. ACR was classified according to ISHLT classification from 1990 and expressed as ACR of grade 1B or higher (≥1B). Results: A total of 159 pts were transplanted. Median age was 55 years (IQR, 47-62 years), 76% were male. A total of 27 pts (17 %) experienced ACR ≥1B during 24 months. Pts with ACR of grade ≥1B had higher platelet count on day 7 (145 vs 104 x 103/μL, p

Background and Aim: The relevance of dual antiplatelet therapy (DAPT) in acute ST-segment eleva-tion myocardial infarction (STEMI) is well-established (aspirin and P2Y12 inhibitors).1 The role of gly-coprotein (GP) IIb/IIIa inhibitors in clinical practice is not completely defined. Administration in the event of thrombotic complications is considered reasonable, although there is no evidence for routine use in primary percutaneous coronary intervention (pPCI). The aim was to analyze early outcomes of STEMI patients (pts) in the Croatian branch of the ISACS-CT (International Registry of Acute Coronary Syndromes in Transitional Countries) registry, depending on received antiaggregation therapy.Patients and Methods: Data were gathered retrospectively from pts hospitalized between January 2012 to October 2017. The study included 2503 pts with acute coronary syndrome, from which 48.9% (n=1224) were diagnosed with STEMI. The patients were divided into 4 groups depending on adminis-tered antiaggregation therapy.Results: For 7.8% (n=96) pts antiaggregation therapy data were missing, and 5.8% (n=71) were not treat-ed with DAPT. Remaining 1057 (86.4%) pts were analyzed. Aspirin was administered in 95% of pts in the first 24 hours. 41.9% (n=443) of pts were additionally treated with clopidogrel, 16.1% (n=170) with tica-grelor, 28.6% (n=302) with clopidogrel and eptifibatide, and 13.4% (n=142) with ticagrelor and eptifibatide (Table 1). The groups did not differ in comorbidities, while pts receiving eptifibatide had lower systolic blood pressure on admission. Patients treated with eptifibatide were more frequently male, smokers, of younger age, had more thrombotic complications seen on coronary angiography (predominantly distal embolisation and “no-reflow” phenomenon) and lower in-hospital mortality. In a multivariable regression model adjusted for age, gender, hypertension, diabetes, and pPCI, increasing age (OR=1.1), diabetes (OR=1.9) and pPCI (OR=0.5) remained relevant to in-hospital mortality.Conclusion: STEMI patients that are young, male and smokers are more frequently treated with epti-fibatide, likely due to a higher burden of thrombotic complications. Unlike the choice of antiaggrega-tion therapy, increasing age, diabetes and non-invasive management of STEMI were associated with in-hospital mortality.

Background: Decrease in platelet count following the induction with polyclonal anti-thymocyte globu- lin (ATG) is deemed as an adverse event, while decrease in lymphocyte count represents a therapeutic goal1. Still, the effect on platelets may represent an important part of ATG anti- rejection mechanisms. Patients and Methods: This was a retrospective single-center study of consecutive HTx (heart trans- plantation) patients (pts) from February 2010 to February 2018 in University Hospital Centre Zagreb. All pts received rATG (Thymoglobulin®) 1.5 mg/kg daily during the first 5 days. Complete blood count with differential was assessed on days 0, 7 and 14 after HTx. The incidence of cellular-mediated rejection (ACR) was monitored for two years after HTx. ACR was classified according to ISHLT classification from 1990 and expressed as ACR of grade 1B or higher (≥1B). Results: A total of 159 pts were transplanted. Median age was 55 years (IQR, 47-62 years), 76% were male. A total of 27 pts (17 %) experi- enced ACR ≥1B during 24 months. Pts with ACR of grade ≥1B had higher platelet count on day 7 (145 vs 104 x 103/μL, p

Cardiac transplantation is a method of choice in the treatment of patients with end-stage heart failure (HF) whose life expectancy, despite the optimal medical therapy is less than one year. Number of patiences with diabetes are increasing at alarming rates. Some studies have shown an increased risk of post-transplant infection, transplanted organ rejection, renal failure and mortality in diabetic recipients. A 38-year-old African American male patient with end-stage ischemic biventricular cardiomyopathy and diabetes mellitus type 1 with moderate chronic renal failure, was transplanted in August 2014. A few days following the transplantation his renal function continued to deteriorate and chronic haemodialysis was initiated. During the next four years, the regular heart biopsies showed no signs of acute cellular or humoral rejection and echocardiography showed normal graft function. In February 2018 the patient was listed for kidney transplantation. In April 2018 the patient presented with septic shock. Due to the severe eosinophilia combined with culture-negative severe sepsis, complete viral and parasitic serology was performed. All tests came back negative. Bone marrow aspiration showed only eosinophilia. Due to the sepsis of unknown origin, the patient was treated with broad-spectrum antibiotic therapy without an effective response to applied therapy. Despite of the all intensive care treatment, the patient died. Autopsy showed a pancarditis possibly caused by Trypanosoma cruzi or Toxoplasma gondii. In conclusion, cardiac transplantation can be performed in diabetic patients with chronic renal failure, but with significantly increased risk for further renal deterioration and even the need for chronic haemodialysis.

Background and Aim: There are still wide knowledge gaps in myocardial infarction with non-obstructive coronary arteries (MINOCA) - a heterogeneous entity seen in 1-10% of patients with acute coronary syndrome (ACS)1. The aim is to determine characteristics of MINOCA in the Croatian branch of the ISACS-CT registry, and compare them to age- and gender-matched patients with unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI). Patients and Methods: The study included 2487 patients with ACS. MINOCA was defined by simultaneous cardiac troponin levels >0.014 ng/L, symptoms of ischemia or significant ST-T changes in the ECG, and an absence of coronary artery stenosis of ≥ 50% on angiography. Age and gender-matching was performed from the remaining cohort by randomly sampling patients from the UA, STEMI and NSTEMI subgroups, based on the mean age ± 5 years and the gender ratio of the MINOCA group. Results: MINOCA was seen in 2.5% (n=63) of the cohort, initially categorized as UA (37%), NSTEMI (48%) and STEMI (16%). Median age was 62 (53, 71) years, 56% male. After age- and gender-matching, there were 36 UA (10% of the UA cohort), 135 NSTEMI (15%) and 198 STEMI (16%) patients in the ACS control subgroups. MINOCA patients had a lower prevalence of diabetes, hypertension, dyslipidemia, chronic kidney disease and tobacco use as compared to UA and NSTEMI. MINOCA patients used less antiplatelets, beta-blockers and statins before hospitalization. MINOCA and STEMI subgroups had a high incidence of chest pain symptoms and a short time from symptom onset to hospitalization. In the first 24h of hospitalization, less MINOCA patients were treated with antiplatelets and statins, and at discharge, they were less frequently prescribed with antiplatelet drugs compared to UA and NSTEMI (Table 1). Inhospital mortality was low, with no deaths in MINOCA and UA patients, and 2 and 3 deaths in NSTEMI and STEMI, respectively. Conclusion: MINOCA patients are mainly categorized as UA and NSTEMI at presentation, but have less comorbidities, more pronounced symptoms of typical chest pain, a shorter time from symptoms to hospitalization, lower levels of statin and antiaggregation prescription at admission, and antiaggregation at discharge. In-hospital mortality confirms MINOCA as low risk, however, long-term registry follow-up is needed to learn about longer term outcomes.

Background: The number of transplant patients of childbearing age has increased. Decisions regarding the pregnancy management are challenging. Close monitoring includes screening for complications including rejection, graft dysfunction, and infection. First pregnancy in a post-cardiac transplant patient was reported in 1988 in a female patient who conceived less than 2 years post-transplant. Since then, there are many case reports that have demonstrated successful pregnancies in solid organ transplant recipients.1-3 Case report: We present a case of 42-years-old female patient who underwent heart transplant 2016. In 2018 the patient expressed wishes for pregnancy and childbirth. A multidisciplinary team of cardiologists and gynecologists was formed and preconception and genetic counseling given. Before pregnancy we adjusted standard immunosuppressant therapy – mycophenolate mofetil was excluded, prednisone was continued in dose of 5 mg daily, and tacrolimus titrated to achieve concentration of 10-15 ng/ml. One month later, myocardial biopsy excluded graft rejection and 6 months later patient conceived naturally. Graft function was assessed by regular monthly NT-proBNP check. Echocardiography performed at 4th and 35th week of pregnancy showed normal graft function. In 36th week of pregnancy patient was admitted to our Department due to renal failure and hyperkalemia and was treated conservatively. Due to labor contractions on the 7th day of hospitalization, urgent caesarean section was performed in general anesthesia. Our patient gave birth to a healthy male newborn, without postpartal complications. Standard immunosuppressant therapy with mycophenolate mofetil, tacrolimus and prednisone was introduced immediately after birth. Repeated myocardial biopsy performed in the follow-up showed no signs of graft rejection. Conclusion: Pregnancy and childbirth in post-cardiac transplant patient is feasible and should be managed by multidisciplinary team of healthcare providers.

Background: Women have poorer outcomes in acute coronary syndrome (ACS) due to older age, comorbidities, atypical presentation and delay in admission.1 The aim is to consider gender differences in outcomes in the Croatian Branch of the ISACS-CT registry. Methods: From January 2012 to February 2017, 1808 patients were enrolled in the Croatian branch of the registry, 46% (n=844) presenting with acute ST segment elevation acute myocardial infarction (STEMI), 35% (n=637) with non-ST segment elevation myocardial infarction (NSTEMI) and 18% (n=327) with unstable angina. Sex ratio, male to female, was 2.2:1, the median age 65 (57-75) years. In-hospital mortality was defined as the primary outcome. Results: There was no sex difference in type of ACS at admission. Women were significantly older, generally more burdened with comorbidities and arrived to the hospital with more delay from symptom onset (women vs. men: in the first 2 h - 19% vs. 24%, p=0.02 ; in the first 6 h - 49% vs. 58%, p