Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact. Currently, various guidelines and recommendations have been published about chronic coronary syndromes (CCS). According to the recent European Society of Cardiology guidelines on chronic coronary syndrome, a multimodal imaging approach is strongly recommended in the evaluation of patients with suspected CAD. Today, in the current practice, non-invasive imaging methods can assess coronary anatomy through coronary computed tomography angiography (CCTA) and/or inducible myocardial ischemia through functional stress testing (stress echocardiography, cardiac magnetic resonance imaging, single photon emission computed tomography—SPECT, or positron emission tomography—PET). However, recent trials (ISCHEMIA and REVIVED) have cast doubt on the previous conception of the management of patients with CCS, and nowadays it is essential to understand the limitations and strengths of each imaging method and, specifically, when to choose a functional approach focused on the ischemia versus a coronary anatomy-based one. Finally, the concept of a pathophysiology-driven treatment of these patients emerged as an important goal of multimodal imaging, integrating ‘anatomical’ and ‘functional’ information. The present review aims to provide an overview of non-invasive imaging modalities for the comprehensive management of CCS patients.

Ventricular sensing by an LV lead is feasible in transvenous devices. Sensing programmability is an unmet need: to fix RV lead sensing issues in cardiac resynchronization therapy (CRT) recipients at no risk of infection (no pocket opening); to avoid interaction with the tricuspid valve; to avoid lead redundancy in the vasculature. Moreover, it will be mandatory owing to the loss of lead interchangeability due to the adoption of DF-4 and quadripolar leads.

Funding Acknowledgements Type of funding sources: None. Background The diagnostic and prognostic evaluation of acute myocarditis remains still challenging. Particularly, acute atrial involvement could be underdiagnosed due to its limited evaluation by cardiac magnetic resonance (CMR) and the lack of sensitive basic echocardiographic indices. Purpose Our aim was to assess left atrial strain in a cohort of patients with diagnosis of acute myocarditis, and its correlation with incident cardiovascular events at follow up. Methods 30 patients with acute myocarditis diagnosed by CMR, performed within one week from admission, according to Lake-Louise criteria were retrospectively included. Patients with poor acoustic window or missing data related to hospitalization or follow-up were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. Clinical endpoints were the development of all-cause or cardiovascular death, cardiovascular hospitalization (including heart failure, major arrhythmias, acute coronary syndromes), atrial fibrillation or ventricular arrhythmias onset. Results The study cohort, composed of 30 patients with acute myocarditis (mean age 38 ±15 years, 33% (n = 10) female), showed raised C-reactive protein and cardiac troponin at admission, beside a mild reduction of left ventricular ejection fraction (Fig.1). Left ventricular strain was preserved in the majority of patients (57%, n = 17) or mildly reduced, while left atrial strain was significantly reduced (Table 1). At CMR, 57% (n = 17) of patients presented myocardial edema and 70% (n = 21) presented late gadolinium enhancement.  Over a mean follow up of 2.3 ± 1.9 years, 5 patients had hospitalizations for cardiovascular reasons, one of whom for heart failure, 3 patients developed atrial fibrillation, 5 patients developed ventricular arrhythmias. Patients with cardiovascular events showed lower left atrial strain than those without events (Fig.2); global atrial reservoir strain reached a statistically significant difference in patients with incident atrial fibrillation vs those without (p = 0.02). Conclusions our findings suggest that patients with acute myocarditis may have a subtle atrial involvement which could be detected by speckle tracking echocardiography. Moreover, lower values of left atrial strain may characterize patients at higher risk of incident atrial fibrillation during follow-up. Abstract Figure. Fig.1  Abstract Figure. Fig.2

Funding Acknowledgements Type of funding sources: None. Introduction Optimal venous access is crucial in successful cardiac device implantation. Most commonly used accesses are subclavian or axillary vein puncture and cephalic vein cutdown. The extrathoracic access has the advantage of reducing the risk of pneumothorax and lead disfunction; thus, this approach is recommended as the first choice approach. Purpose The aim of our retrospective registry was to evaluate the incidence of long-term device complications (pneumothorax, lead rupture or displacement, hematoma, infection or bleeding) with different venous approaches in four high-volume centers in Italy. Methods We collected data from implantation and device complications during follow up using available electronic records from each center. Results We included 4443 patients, mean age 73±11 years. Median follow up was 118 months (IC range 59-198 months). The incidence of any complication was 7.7 %, without difference between intrathoracic and extrathoracic access (7.8% vs 7.7% respectively, p=0.70). However, lead rupture was more frequent in the intrathoracic group (5.3% vs 1.4%, p=0.04). Conclusion In experienced, high-volume centers, the use of intrathoracic vein puncture in the case of unsuitable extrathoracic access may represent a safe alternative of venous access in patients undergoing cardiac device implantation, although associated with a higher occurrence of lead rupture.