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Background: Previous studies using intracoronary imaging have found associations between coronary plaque morphology and MACE, but are limited in clinical translation due to their invasive nature. CTCA is an alternative, non-invasive modality that also allows plaque characterisa-tion. We performed a meta-analysis assessing the association between plaque characteristics and MACE in stable patients undergoing CTCA. Method(s): Digital databases were systematically searched until October 2016. Outcomes were regarded as trial-specific definitions of MACE, with plaque on CTCA classified as calcified, non-calcified (NCP) or mixed. High risk plaque (HRP) included spotty calcification (SC), low-attenuation plaque (LAP), positive remodelling (PR) and napkin-ring sign (NRS). Random effects modelling was used and results are reported as pooled hazard ratio (HR) with 95% confidence intervals (95% CI). Heterogeneity was measured with I2 statistic. Result(s): Nineteen studies with 19,943 subjects were identified, with 7 studies (n = 7,348) evaluating specific HRP features. Mean follow-up ranged from 1.5-8 years with 1,048 total MACE. The pooled HR for the presence of plaque-type on MACE was 1.27 (95% CI 1.17-1.38, p< 0.001) I2 = 86%. Mixed plaque demonstrated the highest risk plaque-type, HR 1.42 (95% CI 1.16-1.68, p< 0.001) followed by NCP 1.29 (95% CI 1.10-1.48, P < 0.001) and calcified plaque 1.18 (95% CI 1.06-1.31, P < 0.001), all I2 > 75%. Individual HRP components demonstrated higher MACE risk: LAP 3.21 (95% CI 2.02-5.10, p< 0.001) I2 =26%; PR 3.22 (95% CI 1.74-5.94, p< 0.001) I2 = 69%; SC 2.26 (95% CI 1.26-4.04, P = 0.006) I2=0%; NRS 5.06 (95% CI 3.23-7.94, P < 0.001), I2 = 0%. Conclusion(s): CTCA-derived plaque morphology is associated with future prognosis, with the strongest association seen with HRP features.

Background: Epicardial adipose tissue (EAT) is hypothesised to alter atherosclerotic plaque composition, with potential development of high-risk plaques (HRP). EAT may be measured by volumetric assessment (EAT-v) or linear thickness (EAT-t). We performed a random effects metaanalysis to assess the association of EAT with HRP, and whether this association is dependent on the measurement method used. Methods and Results: Electronic databases were systematically searched until October 2016. Studies reporting HRP by computed tomography or intracoronary imaging, and studies measuring EAT-v or EAT-t were included. Odds ratios (OR) were extracted from multivariable models reporting the association of EAT with HRP and are described as pooled estimates with 95% confidence intervals (CI). Analysis was stratified by EAT measurement method. Nine studies (n = 3,772 patients) were included with 7 measuring EAT-v and 2 EAT-t. Increasing EAT was significantly associated with the presence of HRP, OR 1.20 (95% CI 1.08-1.34, p<0.001). EAT-v was associated with HRP, OR 1.19 (95% CI 1.06-1.33, p< 0.001), however EAT-t was not, OR 2.77 (95% CI 0.40-19.0, P = 0.3). Patients with HRP had higher EAT-v than those without: weighted mean difference 28.32 mL (95% CI 18.8-37.84mL, p< 0.001). Estimates remained significant when adjusted for small-study effect bias, OR 1.13 (95% CI 1.03-1.28, P = 0.04). Conclusion(s): Increasing EAT is associated with the presence of HRP. The association is present when EAT-v is quantified but not with EAT-t. Further evaluation is needed to assess whether EAT may be a potential therapeutic target for novel pharmaceutical agents. [Figure Presented].

Background: Epicardial adipose tissue (EAT) has the potential to influence myocardial systolic and diastolic function or myocardial geometry, through paracrine or mechanical effects. We performed a systematic review to examine the association between full volume EAT and markers of myocardial function and geometry. Methods and Results: PubMed, Medline and Embase were searched from inception to October 2016. Studies were included only if complete EAT volume or mass was reported and related to a measure of myocardial function and/or geometry by univariable or multivariable analysis. Metaanalysis and meta-regression was to evaluate the weighted mean difference (WMD) of EAT in patients with and without diastolic dysfunction (DD). There were 21 studies included in the analysis which showed a significant correlation with increasing EAT and presence of DD, mean e' and E/e' but not E/A ratio, independent of adiposity measures. There was a greater EAT in patients with DD, WMD 24.43 mL (95%CI 18.5-30.4, P < 0.001) and meta-regression confirmed the association of increasing EAT with DD (Figure). A significant association was identified between EAT and increasing left ventricular mass, however the reported independence of this effect from other adiposity measures was inconsistent. EAT appeared to correlate inversely with left ventricular ejection fraction (LVEF), however the association with LVEF or other systolic parameters was not independent of other variables. [Figure Presented] Conclusion(s): There is a signal of an association between EAT and diastolic function as well as chamber size but not systolic function. Prospective and rigorous study is necessary to confirm this association and evaluate changes resultant from intervention.

Objective: Determine the impact of transoesophageal echocardiography (TOE) guidance on outcomes in patients undergoing TAVR with the repositionable Lotus valve. Introduction: Early in the TAVR experience, the procedure was largely performed with TOE guidance. Given the repositionability of the Lotus valve, TOE guidance and therefore general anaesthesia may be avoided. Method(s): Consecutive patients undergoing TAVR (Lotus) were divided into 2 groups (TOE-guided and fluoroscopyguided procedure). Data was collected on baseline demographics, peri-procedural complications and 30-day followup. The association between the presence of aortic regurgitation (AR) at 1 month and fluoroscopy guidance was assessed with a logistic regression analysis. Associations with procedural mortality, rates of procedural stroke/myocardial infarction (MI), permanent pacemaker (PPM) requirement, acute kidney injury (AKI), length of stay and need for rehabilitation were also assessed. Result(s): There were no significant differences in baseline characteristics between TOE (n=75) and fluoroscopy-guided (n=28) procedures (mean age 83.3 vs 82.8y, p 0.7). Fluoroscopy guidance was not associated with AR at 1 month (OR 0.72, CI 0.3-1.9, p 0.5). There were no differences in procedural mortality (0 in both groups), stroke (0 in both groups), MI (0 in both groups), PPM requirement (25% in both groups) or AKI (21 vs 24%, 0.7). There was also no difference in length of stay (5 vs 6 days, p 0.7) or need for rehabilitation (28 vs 25%, p 0.7). Conclusion(s): In a cohort with a low volume of fluoroscopy guided Lotus TAVR procedures, there appears to be no difference in outcomes compared with TOE-guidance.

Background: Epicardial fat is considered a local promoter of coronary atherosclerosis and is associated with burden of coronary plaque and acute coronary syndromes. We sought to verify the association between epicardialfat- volume (EFV) and coronary artery stenosis assessed by computed-tomography. Method(s): Patients with suspected coronary artery disease undergoing 320-detector-row-computed-tomography-coronary- angiography (CTCA) at Monash HEART (2009-2012) were assessed for EFV and coronary stenosis. Epicardial fat was manually traced and automatically quantified by software that detects fat as voxels with Hounsfield-unit between -200 and -50. Coronary stenosis was qualitatively assessed by two, blinded experienced cardiologists. Univariate and multivariate binary-logistic-regression was performed. Only univariate predictors with p<0.25 were included in the multivariateanalysis. Statistical significance was defined as p<0.05. Result(s): We examined 92 patients (61.7+/-12.1 years, 60% male). Mean EFV in all patients was 86.4+/-38.7 ml. The intra and inter-observer variability was excellent; 2.7+/-1.8 ml (p=0.19) and 0.87+/-3.0 ml (p=0.78), respectively. EFV quantification took between 5-10 minutes. Patients with coronary stenosis (n=76) had higher EFV compared to patients with no coronary stenosis (90.1+/-4.5 vs. 67.5+/-7.5, p=0.032). Furthermore, patients with significant (>50%) stenosis (n=25) had higher EFV than patients with no significant (n=67) stenosis (107.6+/-7.3 ml vs. 78.1+/-4.4 ml, p=0.001). On univariate-analysis, age (p=0.17), obesity (p=0.6), hypertension (p=0.32), hyperlipidaemia (p-0.08) and diabetes (p=0.1) were not associated with significant coronary stenosis. On multivariate-analysis EFV was independently associated with significant coronary stenosis (p=0.003). Conclusion(s): EFV is independently associated with significant coronary artery stenosis. If confirmed in larger studies with long term outcomes, quantification and reporting of EFV on C

BACKGROUND: Epicardial fat is considered a local promoter of coronary atherosclerosis and is associated with burden of coronary plaque and acute-coronary- syndromes. We sought to verify the association between epicardial-fat-volume (EFV) and coronary-arterystenosis assessed by computed-tomography. METHOD(S): Patients with suspected coronary-artery-disease undergoing 320-detector-rowcomputed- tomography-coronary-angiography (CTCA) at MonashHeart (2009-2012) were assessed for EFV and coronary stenosis. Epicardial fat was manually traced and automatically quantified by software that detects fat as voxels with Hounsfield-unit between -200 and -50. Two, blinded experienced cardiologists qualitatively assessed coronary stenosis. Univariate and multivariate binary-logistic-regression was performed. Only univariate predictors with p<0.25 were included in the multivariate-analysis. Statistically significance was defined as p<0.05. RESULT(S): We examined 92 patients (61.7+/-12.1 years, 60% male). Mean EFV in all patients was 86.4+/-38.7 ml. The intra and interobserver variability was excellent; 2.7+/-1.8ml (p=0.19) and 0.87+/-3.0 ml (p=0.78) respectively. The mean duration for EFV quantification was between 5-10 minutes. Patients with coronary-stenosis (n=76) had higher EFV compared to patients with no coronary-stenosis (90.1+/-4.5 vs. 67.5+/-7.5, p=0.032). Furthermore, patients with significant (>50%) stenosis (n=25) had higher EFV than patients with no significant (n=67) stenosis (107.6+/-7.3ml vs. 78.1+/-4.4ml, p=0.001). On univariateanalysis, age (p=0.17), obesity (p=0.6), hypertension (p=0.32), hyperlipidaemia (p-0.08) and diabetes (p=0.1) were not associated with significant coronary-stenosis. On multivariate-analysis EFV was independently associated with significant coronary-stenosis (p=0.003). CONCLUSION(S): EFV is independently associated with significant coronary-artery-stenosis. If confirmed in larger studies with long term outcomes, quantification and reporting of