Introduction Persistent dyspnea in patients who have suffered from COVID-19 disease has become a constant in cardiology in recent months. Healther workers have been one of the population groups mainly affected during the pandemic. Chronic involvement by COVID-19 infection, such as dyspnea, is frequent, and so far, of unknown mechanism. CardioPulmonary Exercise Test (CPET) is currently the gold standard technique in the differential diagnosis of dyspnea. Therefore, CPET could be useful in the evaluation of patients after infection by the SARS-COV2 virus; a role still unknown in this context. Objective Evaluate the parameters obtained in CPET in patients who had suffered from COVID-19 disease and who presented persistent dyspnea. Methods We conducted a single-center and prospective study that included healthcare workers who suffered from COVID-19 disease with mild-moderate intensity symptoms, without the need for hospitalization, between March-December 2020 and who presented dyspnea on exertion at least 3 months after infection, in the absence of structural heart disease. An echo was performed, and a baseline spirometry followed by a CPET. Some of the variables collected such as VO2, OUES and PulseO2 have been quantified as a percentage (%) of the predicted according to predicted equations. Results 64 healthy patients with an active baseline life (without exertional dyspnea prior to infection) were included. 7 patients were excluded for presenting previously unknown structural heart disease. Of the 57 patients (Figure 1), more than half had a functional capacity lower than predicted (50th percentile), highlighting, among the cardiovascular response variables, a peak VO2 of 79% (SD: 14.0%) of the predicted, denoting slightly depressed functional capacity. In addition, in this subgroup, a VO2 at the level of the first ventilatory threshold (VT1) of 51.1% (SD: 4.2%) is observed over the predicted value -value that is considered in the lower limits of normality-; and a PulseO2 (systolic volume reflex) and an OUES in normal ranges with respect to those predicted. In the total of the 57 patients, no alterations were observed in the ventilatory efficiency parameters with effort, nor in the baseline spirometry, nor in the breathing reserve (BR), nor in final oxygen saturation (SatO2). Conclusion CPET has made it possible to identify that more than half of the patients show a deterioration -at least slight- in functional capacity (the majority of which are women) reaffirming the value of this test. The combination of this pattern that we observed in our serie is usually seen in patients with physical deconditioning and/or obesity, and is secondary to alterations in the peripheral use of oxygen, mainly at the muscular level. Based on this, a direct or indirect potential myopathic effect of the virus cannot be ruled out as responsible for the deterioration of the functional class of patients after COVID-19 disease. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Introduction Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) have a prevalence of 5 to 6% of acute myocardial infarction (AMI).  The management of MINOCA in routine clinical practice is not standardized. There are patients who are admitted with elevated markers of myocardial damage, without meeting the MINOCA criteria.  Diagnostic and therapeutic approaches vary between patients and hospitals and that has an impact on the prognosis. Objetives The objective of our study is to determine the handling differences of the patients depending if it is used "MINOCA working diagnosis" or not and the usefulness of cardiac resonance (CMR). Methods Retrospective observational cohort study conducted in patients with elevated markers of myocardial damage between January 2017 and December 2019. Patients with stable coronary artery disease, unstable angina pectoris, a history of revascularization, type 4/5 MI and patients with documented arrhythmic were excluded. CMR was performed on an Avanto Siemens 1.5T. Results 174 patients with troponin I elevation with no exclusion criteria, were included in the study. 118 patients were included as MINOCA working diagnosis and 56 were included in the non-MINOCA group. The mean age of patients included in MINOCA was 63.6 ± 15,4 while the mean age of the non-MINOCA patients was 41.0 ± 19 (P < 0,05). There were more woman on MINOCA group (52,5% vs 19,6%, p < 0,05). Patients with MINOCA had lower peak troponin values (5,1 ± 9,3 vs 9,7 ± 10,9, p < 0,05) and more cardiovascular risk factors. The percentages of atrial fibrillation were also higher in this group (19,5%, p < 0,05). 96,4% of non-MINOCA (p < 0,05). The most frequent symptoms in the MINOCA group was typical angina (73.7%) and atypical angina (15.3%), however, in the non-MINOCA was pericarditis (37.5 %) and atypical chest pain (17.9%) (p <0.05).  The reason for requesting RMC in the non-MINOCA group is mainly myocarditis (37,5%), followed by cardiorrespiratory arrest (3,8%) (p < 0,05). In the MINOCA group, CMR was performed in 41,5%: acute infarction was diagnosed in 14,3%, acute myocarditis in 36,7%, Takotsubo syndrome in 26,5%, cardiomyopathy in 10,2% and normal in 6,1%. In 6,1% the diagnosis was not reached. Nevertheless, in the other group, CMR was perfomed in 96,4%. The main diagnostic was acute myocarditis (61,8%). 65% of patients underwent both RMC and coronary angiography. Definitive diagnosis at the time of discharge was acute infarction (40,8%), Takotsubo syndrome (24,6%) and acute myocarditis (15,3%) in MINOCA patients. In the other group, acute myocarditis (60,7%) and Takotsubo syndrome (12,5%). Conclusions In our study, we confirm that the use of MINOCA as a "working diagnosis" allows us a global and standardized handling of this patient profile, and consequently, there was a diagnostic trend towards requiring more RMC. The most patients were included in non-MINOCA group because a high clinical suspicion of acute myocarditis.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Primary Investigator funded Department of Internal Medicine Funded Background Acute coronary syndrome or "Heart Attack" is a medical emergency that takes the world by storm. Closely linked to this is a sedentary lifestyle that ls known by most to increase its likelihood. Unfamiliar to the majority is a tool called "International Physical Activity Questionnaire (IPAQ)" that can measure the level of activity to low, moderate and high intensity.  Purpose In this study, the IPAQ will be utilized to determine the association of level of physical activity with outcomes of acute coronary syndrome through 30 days major adverse cardiovascular events (MACE). This can contribute to the knowledge of predicting likelihood of MACE after coronary syndromes and help discern aggressiveness of treatment. Methods This is a single - center prospective cohort study that was performed in a tertiary hospital. The participants included patients with ages 30 to 69 admitted with a diagnosis of acute coronary syndrome from September 2020 to November 2020.  T - Test and Odds Ratio were employed to compute for likelihood of MACE 30 days after acute coronary syndrome. Results A total of 33 participants were included with mean age of 61 years. Fifty five percent were female. Majority of the patients were overweight with hypertension as the most common co morbidity. Among the participants, 36% (12) have low physical activity and 64% (21) have moderate to high physical activity. Upon follow up of participants, low physical activity showed  significantly higher incidence of MACE (58%) versus moderate-high level of physical activity (24%).  The odds ratio for low level of physical activity is 4.5 with 95% confidence interval (0.975 - 20.806)  and 0.25 for moderate to high physical activity. Conclusion Analysis of the results revealed that low level of physical activity resulted with twice the proportion of 30- day MACE as compared to moderate-high activity.  Association of level of physical activity with outcomes of ACS showed a 4.5 times more likelihood of developing MACE after 30 days for low level of physical activity. Association of Activity to Risk of MACE Odds 95% CI P-value Level of physical Acitivty Lower Limit Upper Limit Low 4.504 0.975 20.806 0.054 Moderate to High 0.251 0.056 1.134 0.072

Funding Acknowledgements Type of funding sources: None. Introduction An increase it is being seen in patients who are referred for consultation due to dyspnea persistent after having overcome COVID19. The cause for this sequel is still not entirely clear, but our group has observed -in another study- that the consumption of oxygen (VO2) determined by cardiopulmonar exercise test (CPET) in these patients is low with respect to its predicted (p50). The objective of the present work was to demonstrate this hypothesis against to a control group with similar characteristics, who have not suffered from COVID19. Methods We conducted a prospective study with military personnel who are part of a corps of army elite. All subjects have performed the same training daily during the last 2 years. They were divided into 3 groups: the first (G1) made up of those who had not suffered from the COVID19 disease; a second group (G2) that had suffered from it, but did not report impairment of functional class (CF); and a third group (G3) who maintained dyspnea persistent 3 months after suffering from the disease. Analytical with NT-proBNP, echocardiogram, basal spirometry, and CPET were performed. None required hospital admission. Results 36 subjects were included, distributed as follows: G1 (n = 14), G2 (n = 15), G3 (n = 7). The 3 groups had a similar age and BMI. None of the subjects presented alterations in baseline spirometry, neither structural heart disease in the echo, and nor relevant analytical alterations, being NT-proBNP less than 125 pg/ml in all of them. In relation to the response variables cardiovascular, statistical differences (p = 0.03) were observed in peak oxygen consumption predicted among the three groups (% predicted peak VO2), being significantly lower in the G3 subjects. In addition, a trend was observed -in absolute values- of peak VO2 to be lower in G3 -not significant probably due to the small sample size-. They were not objectified significant differences in PulseO2, nor in OUES. No patient presented alterations in the ventilatory efficiency parameters, or in final BR. Conclusions In our sample, patients who remained with persistent dyspnea after COVID-19, have a lower functional capacity compared to healthy subjects of the same characteristics, and with respect to subjects who after COVID19 do not present any symptoms. This subjective deterioration of the FC can be objectively quantified using CPET, thus reaffirming its value in this context.