Abstracts Programme

Abstract

1423: CCS and Survival by Study Study(NYHA III only) Year(start) N CCS improvedat 6 mo CCS unchangedat 6 mo CCS worsenedat 6 mo %Death at12 mo in CCSimproved at 6 mon %Death at12 mo in CCS unchanged at6 mo %Death at 12 mo in CCS worsened at 6 mo MIRACLE 1999 211 64.9% 18.0% 17.1% 4.0% 0.0% 8.3% MIRACLE ICD 1999 165 52.7% 15.8% 31.5% 2.4% 3.9% 16.2% Marquis 2003 225 69.3% 15.6% 15.1% 3.2% 3.0% 16.7% Prospect 2004 449 68.8% 14.7% 16.5% 2.3% 6.1% 9.3% AdaptivCRT 2009 453 74.2% 13.3% 12.6% 1.0% 2.9% 17.1% Attain Performa 2013 721 79.9% 4.7% 15.4% 2.1% 5.9% 5.0% Attain Stability Quad* 2017 189 74.6% 7.4% 18.0% — — — *12 month results pending, will be available at time of presentation. Purpose: The purpose of this study was to determine predictors of exercise capacity in terms of peak VO2 per kilogram (pVO2/kg), assessed by cardiopulmonary exercise test (CPET). Methods: Data of all adult patients, who received a MCS in the University Medical Center Utrecht (UMCU, The Netherlands) between 2006-2018 and underwent CPET 6 months postoperatively were included. Data consisted of baseline characteristics, CPET and echocardiographic results at 6 months. IBM SPSS Statics 25 was used for linear regression analysis to search for predictive factors for pVO2/kg. Results: 147 patients (102 (69%) male, mean age 50.6±11.9 years) underwent a CPET at 6 months after MCS implantation (table 1). Factors most associated with pVO2/kg were age and percentage of maximal predicted heart rate (=220-age); F(2,43)=17, p<0.001, R2=0.664. Both factors added significantly to the prediction (p<0.001). All other variables, including echocardiographic RV-function and left ventricular dimensions, were not associated with pVO2/kg. Conclusion: Age and percentage of maximal predicted heart rate are significant predictors for pVO2/kg. This supports the importance of maximal heart rate with regard to maximal exercise capacity in MCS support. 1425 Continuous-flow ventricular assist device to small left ventricle: Is it nightmare? M Minoru Ono1; K Nawata1; O Kinoshita1; S Shimada1; M Ando1; T Inoue1; E Amiya1; M Hatano1; I Komuro1 1University of Tokyo, Department of Cardiac Surgery and Cardiology, Tokyo, Japan Objectives: Continuous-flow ventricular assist device (cf-VAD) implantation results have been improving. Small ventricle may pose serious problem. We sought to examine whether small LV is a hurdle for cf-VAD implantation using contemporary devices. Patients and methods: Consecutive 146 patients were implanted with cf-VAD for bridge to transplantation, which is only an indication for use in Japan. Ninety-four axial-flow and 52 centrifugal-flow pumps were implanted. There were 38 females (26%) with an average age of 40.4 years. Follow-up rate was 100%. Small LV was defined as end-diastolic dimension (LVEDD) less than 55mm, and small indexed LVEDD (I-EDD: LVEDD divided by body surface area) was defined as < 35. Observed and event-free survivals were calculated and compared by Kaplan-Meier method with log-rank test. Results: One, 2, 3 and 4-year survivals were 92.3%, 88.9%, 86.6% and 84.8%. Survival of small LV group (n = 24) or small I-EDD group (n = 28) was comparable to the counterpart. Cerebrovascular event-free survival in these small LV groups was also not significantly different from the counterparts. Pump thrombosis was only 4 cases (2.7%) in the whole cohort. Conclusion: Small LV did not affect the long-term survival or adverse events of cf-VAD patients by using contemporary devises. 1426 The detrimental effect of right atrial pacing on left atrial function and clinical outcome in cardiac resynchronization therapy. P Pieter Martens1; S Deferm1; M Dupont1; W Mullens1 1Hospital Oost-Limburg (ZOL), Cardiology, Genk, Belgium BACKGROUND: Data on the effects of right atrial (RA)-pacing on left atrial (LA) synchronicity, function and structure after cardiac resynchronization therapy (CRT) are scarce. OBJECTIVE To assess the impact of RA-pacing on LA-physiology and clinical outcome. METHODSThe effect of RA-pacing on LA-function, morphology and synchronicity was assessed in a prospective imaging cohort of HF-patients in sinus rhythm with guideline indication for CRT. Additionally in a retrospective outcome cohort of consecutive HF-patients undergoing CRT-implantation the relation of RA-pacing was assessed with various outcome endpoints. High versus low atrial pacing burden was defined as atrial pacing above or below 50% in both cohorts. RESULTS Thirty-six patients were included in the imaging cohort (age=68±11years). Six-months after CRT, patients with high RA-pacing burden showed less improvement in LA-maximum volume, minimum volume and total emptying-fraction (p<0.05). Peak atrial longitudinal strain, reservoir and booster strain-rate but not conduit strain-rate improved after CRT in patients with low RA-pacing burden and worsened in patients with high RA-pacing burden (p<0.05 for all). A high RA-pacing burden induced significant intra-atrial dyssynchrony (maximum-opposing-wall-delay; 44±13msec vs 97±17msec, p=0.022) (see figure). A total of 569-patients were included in the outcome-cohort. After covariate adjustment, a high RA-pacing burden was associated with LV-reverse remodeling (β=0.146,95%CI= [3.101;14.374],p=0.002), and new-onset or recurrence of atrial fibrillation (AF; 41% vs. 22% at median 31 [22-44] months follow-up; p<0.001). There was no difference in time to first HF-hospitalization or all-cause mortality (p=0.185) after covariate adjustment. However in a recurrent event analysis, heart failure readmission were more common in patients exposed to a high RA-pacing burden (p=0.002). CONCLUSIONSRA-pacing in CRT patients negatively influences LA-morphology, function and synchronicity, which is associated with worse clinical outcome including diminished LVreverse remodeling, increased risk for new-onset or recurrent AF and heart failure readmission. Strategies reducing RA-pacing burden might be warranted. effect of RA pacing on LA-function 1428 Consequences of a revised heart allocation system on the cost effectiveness of cardiac transplantation in the united states: game theory based insights M Mitchell Saltzberg1 1Medical College of Wisconsin, Comprehensive Heart Failure and Transplant Program, Milwaukee, United States of America Purpose: Heart transplantation (HT) is a cost-effective (CE) therapy for end stage Heart Failure. A new US organ allocation system expands the listing statuses © 2019 The Authors European Journal of Heart Failure © 2019 European Society of Cardiology, 21 (Suppl. S1), 5–592 350 Rapid Fire 5 Non-pharmacological treatments: beyond conventional and favors short-term, mechanical circulatory support (MCS) therapies and greater regional organ sharing with longer ischemic times and reduced survival. Methods: CE (Quality adjusted life year (QALY) and Cost for Year of Life Expectancy (LE)) of HT was evaluated using a decision-tree model populated with local and published clinical probability, LE and Cost data. Sensitivity analyses was performed to assess the impact of changing clinical practices. Data are expressed in inflation adjusted 2018 USD and costs are discounted at 3%. A Willingness to Pay (WTP) threshold of $50,000 was considered acceptable. Results: CE of HT is $75,751.88/QALY and $61,914.18/LE based on 79 % MCS use pre-HT and 21% short-term (ST) MCS use assuming a procurement radius (PR) of 350-miles. Varying % ST MCS (Fixed PR) from 5-79% negatively impacted CE; $57,239.12 $163,299.40/QALY and $46,717.69-$183,819.12/LE. Increasing PR (<100 miles, 100-350 miles, 351-500 miles and > 500 miles) adversely impacted CE; $75,751.88$78,548.65/QALY and $61,914.18-$64,200.06/LE. Assuming longer ischemic times (< 3.49 hours, 3.5-4.9 hours and> 5.5 hours) reduce post-HT survival (-1.4 yrs for 3.5-4.9 hrs and 2.8 yrs for > 5.5 hrs), CE was negatively impacted: $75,751.88 (<3.49 hrs), $97,604.57 (3.5-5.5 hrs) and $137,177.02/QALY (>5.5 hrs); $61,914.18/LE (<3.49 hrs), $80,971.59/LE (3.5-5.5 hrs); and $116,977.76/LE (>5.5 hrs). Varying % ST MCS use (5%-79%) with a worst case ischemic time (4.9 hrs) significantly worsened CE; $76,925.93 -$219,268.68/QALY and $63,680.29 $183,819.12/LE. Sensitivity analysis (Monte Carlo) confirmed a WTP of >$70,000 to render HT more cost-effective. Conclusion: HT is a cost-effective strategy. CE of HT will be adversely impacted with the revised allocation system due primarily to increased ST MCS use, increased PR, longer ischemic times and secondary reduced post HT survival. It will be increasingly important to monitor CE as HT programs adjust to the new allocation system. 1429 Identifying urinary microRNAs for heart allograft rejection monitoring using small RNA sequencing Pilot results J Novak1; T Machackova2; T Novakova3; J Godava3; P Hude3; V Zampachova4; J Oppelt2; P Nemec5; H Bedanova5; O Slaby2; J Bienertova-Vasku1; J Krejci3; L Spinarova3 1Masaryk University, Department of Pathological Physiology, Brno, Czechia; 2Masaryk University, Central European Institute of Technology, Brno, Czechia; 3St. Anne’s University Hospital, Department of Cardiovascular Diseases, Brno, Czechia; 4St. Anne’s University Hospital, Department of Pathology, Brno, Czechia; 5Centre of Cardiovascular Surgery and Organ Transplantation, Brno, Czechia Funding Acknowledgements: Supported by Ministry of Health of the Czech Republic, grant nr. 16-30537A. All rights reserved. Introduction: Heart failure (HF) represents one of the leading causes of death in the developed countries and heart transplantation (HT) is the only solution for patients with terminal refractory HF. Patients after HT are at risk of acute cellular rejection (ACR) potentially causing graft damage and failure. Diagnostics of ACR is based on histopathologic evaluation of endomyocardial biopsies (EMB) as no non-invasive biomarker has been found yet. microRNAs (miRNAs, miRs) are tiny non-coding RNA molecules involved in post-transcriptional regulation of gene