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Purpose is to evaluate the prognostic value of myocardial scar/fibrosis using cardiac magnetic resonance (CMR) in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM).Methods; 156 patients with either ICM or NICM underwent CMR with late gadolinium enhancement (LGE) sequences for assessment of left ventricular ejection fraction (EF), detection and quantification of any myocardial scar/fibrosis using three methods; a) manual, b) number of segments involved, c) percentage of scarred myocardium (segment based). Patients were followed up for at least 6 months for any clinical cardiac event.Results: Males were 56% (mean age 61 years), with minimal follow up (FU) of 6 months. Patients were divided into; group I; ICM (58%) and group II; NICM (36%). Clinical presentation was ranging from eventless (10%), chest pain (18%), heart failure (15%), hospitalization (35%), syncope (1%), ventricular tachycardia (Conclusion: Myocardial scar size is a strong predictor for the clinical outcome in both ICM and NICM. EF is less reliable to predict morbidity in cardiomyopathy patients. Segments dependent methods for quantification of myocardial scar is comparable to the manual LGE quantifications.

Introduction Incomplete rupture is a relatively uncommon type of free-wall rupture. It is found in 10% to 15% of total free-wall ruptures. Case report A 68-year-old male patient, heavy smoker, with medical history of diabetes mellitus and hypertension, had experienced an attack of acute retrosternal chest pain associated with dyspnea grade II-III one week before presentation. He presented to our facility complaining acute chest pain. Upon examination, the patient had stable vital signs and an unremarkable clinical examination except for distant heart sounds on auscultation. Electrocardiogram showed deep Q waves in V1 to V4 with residual ST segment elevation. Routine lab investigations were unremarkable including a negative troponin. A Chest X-ray showed an enlarged cardiac shadow. Echocardiography revealed a poor left ventricular systolic function due to an akinetic anterior wall and a dyskinetic apical cap containing a large highly mobile thread like mass which was suspected to be a thrombus. Coronary angiography revealed proximal 85% stenosis followed by mid segment total occlusion of the Left anterior descending (LAD) artery, proximal 75% stenosis of the left circumflex (LCX) artery and a tight lesion in the mid segment of the right coronary artery (RCA). The patient was diagnosed to have multi-vessel coronary artery disease and was maintained on medical treatment. Cardiac MRI was requested to detect myocardial viability before revascularization. Subsequently, cardiac magnetic resonance (CMR) revealed a dilated left ventricle with very poor systolic function, akinetic inferior wall, aneurysmally dilated apex and anterior wall with the same large highly mobile mass. Late gadolinium enhancement revealed scarred anterior, septal and inferior walls including all apical segments and surprisingly the mobile intra-ventricular mass also contained a scar tissue continuous with the anterior myocardial scar which means it is a part of the myocardium which was dissected or partially ruptured. Unfortunately, the patient suddenly experienced an attack of ventricular arrhythmia which was not resuscitated successfully. Conclusion Incomplete rupture is a rare type of free-wall rupture. It is thought that the infarcted myocardium wall is made weak in part by activation of metalloproteinases, which degrade the myocardial matrix. Structural weakness is associated with increased intra-cavitary pressure which predisposes the myocardial wall to rupture. Although Echocardiography is a good method of diagnosis but CMR is superior due to its high spatial resolution and good tissue characterization, plus the use of late gadolinium enhancement helps in identifying the location and the extent of prior infarctions guiding us to the next step in management. Abstract P868 Figure. Myocardial dissection with scarred flap

OnBehalf YIG-CVR Introduction Thromboembolic events or bleeding are by far the most frequent complications of prosthetic heart valves. Cerebrovascular stroke is one of the major thromboembolic complications of anticoagulation-related issues of prosthetic heart valves. Aim of the work To determine the pattern and risk factors of acute stroke in patients with prosthetic heart valves. Methods and Patients A retrospective single-center analysis of the database registry of consecutive acute stroke patients with mitral or aortic heart valve prostheses admitted to a tertiary care stroke specialized center from 01/01/2012 to 01/12/2017. All patients were examined by a certified neurologist and underwent a complete work-up evaluation (Computed Tomography or Magnetic Resonance Imaging, Carotid Doppler ultrasound examination, complete blood tests, and electrocardiogram) and a transthoracic echocardiography (TTE) examination as well as transesophageal echocardiography (TOE) if valve dysfunction or thrombosis were suspected. Results 214 patients with mitral or aortic valve prostheses were admitted by acute stroke in the duration from 01/01/2012 to 01/12/2017 with a mean age of 44 ± 15 years, 132 were males (61.7%) and 178 patients had mechanical valves (83.2%). 135 patients had mitral prosthesis (63.1%) and ischemic stroke was encountered in 151 patients (70.6%). Conclusion In a single center experience, mechanical prosthesis at the mitral valve position was associated with higher incidence of ischemic stroke. Proper close follow-up of INR levels as well as the surgical shift to biological instead of mechanical valve should decrease significantly the incidence of prosthetic valve related strokes. Baseline, clinical and other parameters Patients (n = 214) Age (years) 44 ± 15 Mechanical valve 178 (83.2%) Atrial Fibrillation 101 (47.2%) Rheumatic Heart Disease 175 (81.8%) Left ventricular ejection fraction (%) 54 ±13 Mitral Only 135 (63.1%) Aortic Only 51 (23.8%) Double Valve Prosthesis 28 (13.1%) Ischemic stroke 151 (70.6%) Hemorrhagic stroke 47 (22%) Both ischemic and hemorrhagic stroke 16 (7.4%) Data are represented as mean(±SD) or number (Percentage) Abstract P1521 Figure. Valve sites

Objectives We studied the progression of coronary atherosclerosis over time as detected by multidetector computed tomography (MDCT) in relation to risk factors and plaque composition. Background Studies using MDCT are limited to the assessment of the degree of stenosis without taking into consideration the plaque composition that is seen by MDCT. Methods This study included 200 patients, complaining of chest pain and referred to do 64/128-contrast–enhanced MDCT for the second time, and both studies were retrieved and evaluated for the presence of plaque, plaque type, vessel wall remodeling, percent area, and diameter stenosis and compared in both studies. Plaque progression over time and its association with risk factors were determined. Results We included 200 patients, and 348 plaques were detected by 64/128 MDCT. The duration between follow-up and baseline studies was 25.9 ± 19.2 month. In all, 200 plaques showed progression (57.47%), 122 were stable (35.06%), and 26 regressed (7.47%). In longitudinal regression analysis, the presence of history of diabetes mellitus and dyslipidemia and the absence of intraplaque calcium deposits were independently associated with plaque progression over time ( P < 0.0001). Conclusion Coronary plaque burden of patients with chest pain and no history of acute coronary syndrome significantly increased over time. Progression is dependent on plaque composition and cardiovascular risk factors. Larger studies and longer follow-up period are needed to confirm the determinant factors for plaque progression.