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Background Right ventricular (RV) performance is key in the management of patients with severe tricuspid regurgitation (TR); detection of RV dysfunction is crucial to identify on time patients that benefit from valve intervention. Conventional parameters of RV function by 2D echocardiography are influenced by changes on preload conditions and can remain unaffected until late stages of the disease. The right atrium (RA) has an important role in modulating RV filling and RA performance is impaired in severe TR. Potentially, an index that combines RV and RA function may reflect a broader view of the effects of severe TR in right heart function. Purpose 1) to evaluate the clinical utility of combining RV and RA strain for prediction of CV outcomes and 2) to design a novel index by Speckle-tracking echocardiography (STREI index) that integrates RA and RV information Methods Consecutive patients with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Consecutive control subjects and patients with permanent atrial fibrillation (AF) were included for comparison. Reservoir RA strain (RASr) and RV-free wall longitudinal strain (RV-FWLS) analysis were performed using novel, automated 2D strain analytical software (AutoStrain, Philips Medical Systems the EPIQ system, Figure 1). Novel STREI index was calculated with the formula: [2 × RV-FWLS] + RASr in absolute numbers. A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. The interobserver variability of RA strain was assessed in 30 randomly selected subjects (20 TR+5 AF+5 controls). Results A total of 176 patients with severe TR, 20 AF patients and 20 controls subjects were included in this study. Patients with TR showed lower STREI values compared to controls and to AF patients (TR vs. controls vs. AF: 55±18 vs. 116±12 vs. 70±13, p Conclusion STREI index is a feasible and reproducible new parameter of RV performance that independently predicts outcomes in patients with severe TR. Randomized studies should confirm its potential to identify those patients that benefit from earlier valve interventions. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto Carlos III

Background Optimal management of severe tricuspid regurgitation (TR) remains controversial. While right ventricular systolic function is an established prognostic marker of outcomes, the potential role of right atrial (RA) function is unknown. Purpose This study was aimed to describe RA function by 2D speckle tracking echocardiography (STE) in severe TR and to evaluate its potential association with cardiovascular outcomes Methods Consecutive patients with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Consecutive control subjects and patients with permanent atrial fibrillation (AF) were included for comparison. RA function was measured with 2D-STE and 3 components of RA function were calculated: reservoir (RASr), conduit (RAScd) and contractile (RASct) RA values using an automatic 2D strain analytical software (AutoStrain, Philips Medical Systems the EPIQ system, Figure 1). A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. The interobserver variability of RA strain was assessed in 30 randomly selected subjects (20 TR+5 AF+5 controls). Results A total of 176 patients with severe TR, 20 AF patients and 20 controls subjects were included in this study. Patients with at least severe TR showed lower RASr and RAScd compared to controls and to AF patients (Figure 1 and Table 1, p Conclusions Evaluation of RA function by 2D-STE is feasible, reproducible and is an independent predictor of heart failure and all-cause mortality in patients with at least severe TR. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): INSTITUTO CARLOS III

Background The COVID-19 pandemic has collapsed the health system, making it necessary to identify factors that help to predict and stratify the risk of patients on admission. Many factors have been used in clinical practice, but the scientific evidence available to date is limited. Purpose The objective of this study was to identify clinical and analytical predictors of 30-day mortality in SARS-CoV- 2 infection. Methods A total of 1708 consecutive patients hospitalized in our centre between 18th and 23rd March 2020 and 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Cox regression analysis was performed to assess whether sex and race, smoking habit, chronic kidney disease, D-dimer, heart disease (defined as a history of acute myocardial infarction, heart failure, atrial fibrillation) and troponin at admission (cTnI levels greater than the 99th percentile of a healthy population) were related to the 30-day mortality of these patients. Results Baseline characteristic are shown in the table 1. Median hospital length of stay was 9 days (IQR 5 to 16). A total of 338 patients (19.8%) died within 30 days and 153 (9.0%) were admitted to the ICU. Furthermore, 52.1% of patients developed ARDS and 9.3% required non-invasive ventilation. A troponin at admission greater than the 99th percentile of a healthy population (HR 1.9, 95% CI 1.4–2.5, p Conclusions At admission time, troponin values and patient comorbidity (Charlson Comorbidity Index ≥4) can be useful as prognostic markers of SARS-CoV-2 infection. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Hospital Ramon y Cajal

Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry and position of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detect subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in consecutive patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (S') and with STE derived automatic peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system (Philips Medical Systems, Andover, Massachusetts). A combined endpoint of hospital admission due to right heart failure or cardiovascular mortality was defined. Results A total of 130 patients were included (mean age was 75±17 years, 69% females, 93% in NYHA I/II). According to etiology, 14% were primary TR and 86% were functional (49% due to corrected left valve disease and 37% due to tricuspid annulus dilatation). Mean values of RV function parameters are shown in the table. During a mean follow up of 18±8 months, n=39 patients (30%) reached the combined endpoint. Patients with events showed impaired RV GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes (p>0.05 for all). Conclusion In patients with severe TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters should be included in the serial evaluation of these patients. Funding Acknowledgement Type of funding sources: None. RV parameters

Background Recent studies suggest a higher mortality rate because of COVID-19 in patients with previous cardiac conditions compared to those without. Given the limited resources of intensive care units (ICU) during the pandemic outbreak, this fact has important implications. Purpose The main purpose of this study was to compare the 30-day mortality of the COVID-19 infection in patients with and without previous cardiac conditions. The secondary end point was to assess the differences in clinical severity of the infection (as development of Acute Respiratory Distress Syndrome – ARDS) and ICU admission amongst these patients. Methods A total of 1708 consecutive patients were prospectively included. The inclusion criteria were: a confirmed positive diagnosis of COVID-19 infection by PCR and being admitted to our centre between 18th and 23rd March 2020 and 22nd August and 9th January 2021. Patients were classified in two groups according to the presence of previous cardiac conditions (defined as previous history of myocardial infarction, heart failure and atrial fibrillation). Other comorbidities were extensively explored and Charlson Comorbidity Index was calculated. A propensity-score matching was performed and 145 patients with previous cardiac conditions were matched with 145 patients without. Results The group of patients with a previous cardiac condition included 421 patients (24.6%). The crude analysis showed a higher 30-day mortality rate among patients with previous cardiac affections (35.6% vs. 14.6%, p Conclusions Patients with a personal history of previous cardiac conditions were less likely to be admitted to the ICU. However, our results show that when comparing cohorts with similar comorbidity burden, a previous cardiopathy “per se” does not significantly increase the risk of death in patients with a concomitant COVID infection. Funding Acknowledgement Type of funding sources: None. Mortality unmatched vs matched cohort