Background Deformation imaging represents a method of measuring myocardial function, including global longitudinal strain (GLS), peak atrial longitudinal strain (PALS) and radial strain. This study aimed to assess subclinical improvements in left ventricular function in patients undergoing transcatheter aortic valve implantation (TAVI) by comparing GLS, PALS and radial strain pre and post procedure. Methods We conducted a single site prospective observational study of 25 patients undergoing TAVI, comparing baseline and post-TAVI echocardiograms. Individual participants were assessed for differences in GLS, PALS and radial strain in addition to changes in left ventricular ejection fraction (LVEF) (%). Results Our results revealed a significant improvement in GLS (mean change pre-post of 2.14% [95% CI 1.08, 3.20] p = 0.0003) with no significant change in LVEF (0.96% [95% CI − 2.30, 4.22], p = 0.55). There was a statistically significant improvement in radial strain pre and post TAVI (mean 9.68% [95% CI 3.10, 16.25] p = 0.0058). There was positive trend towards improvements in PALS pre and post TAVI (mean change of 2.30% [95% CI − 0.19, 4.80] p = 0.068). Conclusion In patients undergoing TAVI, measuring GLS and radial strain provided statistically significant information regarding subclinical improvements in LV function, which may have prognostic implications. The incorporation of deformation imaging in addition to standard echocardiographic measurements may have an important role in guiding future management in patients undergoing TAVI and assessing response.

Background Optimisation of low-density lipoprotein cholesterol (LDL-C) targets is one component of cardiac rehabilitation (CR). The 2019 European Society of Cardiology (ESC) guidelines recommend lower LDL-C targets than those released in 2016. Aims To determine the proportion of patients who met 2019 LDL-C targets and compare these to international standards; examine the effect of the introduction of the recent ESC guidelines on target achievement. Examine the choice of lipid lowering therapy (LLT) used in our cohort. Methods Retrospective chart review of 163 patients who attended CR in 2019. Baseline LDL-C levels were calculated where applicable. Targets achieved were compared with the contemporary ESC guidance. Required LLT was estimated for those who were unable to meet their LDL-C target. Results Overall, 96/163 (59%) patients met their absolute LDL-C targets, which was favourable when compared to international standards. Fewer patients treated using the 2019 ESC guidelines met their absolute, (63% (70/112) vs. 51% (26/51)), or relative LDL-C 43% (22/51) targets. A high intensity statin was prescribed in 63% (89/163) of patients and only 9% (5/163) patients were prescribed ezetimibe therapy; increased use of these agents may have led to a further 20% (33/162) of patients meeting their LDL-C targets. 13% (22/163) of patients likely require PCSK9i therapy. Conclusions Patients may be more likely to meet LDL-C targets while enrolled in CR compared to standard care. Following the introduction of lower absolute LDL-C targets and additional > 50% LDL-C reduction from baseline requirement, fewer patients are meeting the LDL-C targets set out in the 2019 ESC dyslipidaemia guidelines. Additionally, many patients are not on maximum statin therapy, ezetimibe is under-prescribed, and a guideline-reimbursement gap exists for those who require PCSK9i therapy. Supplementary information The online version contains supplementary material available at 10.1007/s11845-021-02885-9.

lower among the CRY Clinic patient cohort (33% vs. 27%). Additionally, reported resistance exercise levels was lower (30%) than aerobic exercise (72%). This is despite resistance exercise being additionally beneficial for many cardiac conditions. During the period of data collection, access to gyms and group exercise was limited due to pandemic government restrictions that likely effected resistance exercise more than aerobic exercise. In fact, a significant increase in recreational walking during covid restrictions was previously reported. Exercise is often discussed during medical consultation but rarely prescribed. In our cohort only 0.5% of patients received an Ex Rx. The reported barriers to Ex Rx are lack of time, perceived lack of patient engagement, complex comorbidities and clinician education. Attempts were made in the form of education and resource provision to clinicians to challenge perceived barriers. Ex Rx are important in the CRY Clinic not only for the known benefits of PA but as inappropriate exercise can be harmful for some cardiac conditions. The Ex Rx enabled the benefit of PA to be gained by the safe promotion of appropriate exercise to such patients (figure 2). The introduction of this PA assessment and Ex Rx was a successful call to action to incorporate exercise as medicine to the CRY Clinic. 'Walking is a (wo)mans best medicine' (Hippocrates 460BC).

central death notification and publicly accessible online death notifications. Proximity from home address to the nearest PPCI centre was determined using Google Maps. Statistical analyses were performed using Stata. Results 7,486 STEMI patients were identified from January 2013 -March 2018. 6,612 were included in the analysis. Minimum follow up was 3 years, median follow up was 5.5 years. 4,040 received timely PPCI, 2,162 delayed PPCI, 335 t-PA. Baseline characteristics are shown in table 1. There was no difference in survival between the timely PPCI (84.7%) and t-PA groups (84.2%) (HR 0.93, 95%CI 0.71-1.25; Log-Rank p=0.62). There was increased mortality in the delayed PPCI (80.6%) in comparison with both timely PPCI (HR 1.5, 95%CI 1.16-1.49; Log-Rank p<0.000) and t-PA groups (HR 1.23, 95%CI 0.93-1.66; Log-Rank p=0.16), figure 1, 2. Conclusion Patients who were treated with a pharmaco-invasive strategy had lower all-cause mortality on long term follow up versus those who received PPCI outside of the target treatment window. Given the high proportion of patients who received delayed PPCI (33%), consideration should be given to expanding a pharmaco-invasive approach to patients who are unlikely to receive timely PPCI.

Introduction Coronary artery disease is a leading cause of mortality and morbidity worldwide. For those undergoing PCI, there are 20–30% with disease of the small coronary arteries on presentation [1]. Small coronary artery disease asserts a significant risk factor for adverse events. It is often diffuse and multi-vessel on presentation and confers higher rates of major adverse cardiac events, (MACE) and target lesion failure after intervention [2,3]. Best practice guidelines on the management of SvCAD interventions remain limited. Drug-eluting balloons are a novel therapy, which has shown promise in treating in-stent restenosis (ISR), however their use in small coronary arteries when compared to drug-eluting stents remains unclear. Purpose This systematic review and meta-analysis compare long-term outcomes (&gt;1 year), of drug-eluting balloons (DEB), vs. drug-eluting stents (DES), in the treatment of small coronary artery disease (&lt;3mm). Methods A systematic review was completed within PRISMA guidelines. The primary outcome was non-inferiority of DEB Vs. DES in major adverse cardiac events (MACE). Secondary outcomes include all-cause mortality, MI, vessel thrombosis, major bleeding and target vessel revascularization at one, two and three years follow-up. Two independent reviewers extracted data. All outcomes used the Mantel-Haenszel and Random effect model. Odds ratios (OR), were presented with a 95% confidence interval (CI). Result Of 4661 articles, four RCTs were included (1414 patients). DEB demonstrated reduced rates of non-fatal MI at one year, OR 0.44 (95% CI 0.2, 0.94) and Basket-2 small reported a significant reduction in two-year bleeding rates OR 0.3 (95% CI 0.1, 0.91). DEBs were non-inferior to DES for all other outcomes. Conclusion Long duration follow-up of DEB and DES use in small coronary arteries demonstrates DEB to be non-inferior to DES in all outcomes across all years of follow-up. There was a significant reduction in rates of non-fatal MI at one year in the DEB arm and a reduction in major bleeding episodes at two years in the Basket Small 2 trial. These data highlight the potential utility and long-term safety of novel DEBs in small coronary artery disease revascularization. Funding Acknowledgement Type of funding sources: None.