Funding Acknowledgements Type of funding sources: None. Introduction A coronary artery calcium (CAC) score of more than 100 places the 10-year cardiovascular risk above 7.5%, justifying the initiation of pharmacological measures in primary prevention. Purpose The present study explores the level of implementation of a primary prevention strategy after CAC score in patients without obstructive coronary disease. Methods The study cohort included all patients from the health area of our city (Galicia, Spain) who underwent a coronary computed tomography (CT) scan between July 2021 and February 2022. Subjects with obstructive coronary disease (CADRADS 3 or higher), atrial fibrillation patients and inconclusive studies were excluded. The final population of the study consisted of 209 patients. The sample was classified according to Agatston Score into three groups: no calcification (CAC=0), non-significant (CAC 1-100), and significant calcification (CAC >101). Multinomial and binomial logistic regression were performed to identify the predictors associated with the prescription of statin and aspirin, respectively. Results 41 patients (19.62%) had significant calcification (CAC >101). Of those, 16 (39.02%) started aspirin and 21 (51.22%) started statin (Figure 1). The CAC score allowed to increase the percentage of patients who benefited from lipid-lowering treatment, from 31.70% to 82.92% (Figure 2). Significant differences were observed in the proportion of patients who initiated aspirin and statins according to the degree of coronary calcification (Chi2 18.76; p=0.000), (Chi2 48.42; p=0.000) respectively. After multivariate adjustment, a CAC score >100 (OR 5.88 (2.29-15.07; p=0.000) and the presence of vulnerable plaque (OR 6.78 (1.01-47.46; p=0.050) were the only predictos which led clinicians to start antiplatelet therapy. Neither age, nor SIS (segment involvement score) were associated. Regarding to lipid-lowering therapy, CAC score 1-100 (OR 5.87 (1.68-20.51; p=0.006) and CAC score >100 (OR 30.78 (5.08-186.47; p=0.000) were independently associated with statin prescription. Conclusions The use of coronary CT allows optimization of the therapeutic strategy in primary prevention, increasing the percentage of patients who may benefit from statins. In this setting, aspirin is little established in our cohort. Therefore, we should transmit to the clinician the possibility of starting antiplatelet therapy, individualizing the indication.

Funding Acknowledgements Type of funding sources: None. Background Multiparametric cardiac magnetic resonance (CMR) evaluation with modified Lake Louise criteria (mLLC) is the gold standard non-invasive test for the diagnosis of acute myocarditis. Although CMR in the follow-up may inform of edema resolution and myocardial fibrosis there is a lack of consensus on the optimal time interval to perform it and the clinical and prognostic differences between patients with complete resolution and those who present late gadolinium enhancement (LGE) persistence. Purpose To describe the clinical profile, CMR findings, early CMR follow-up and clinical events in patients with acute myocarditis focusing on the differences between patients who present complete LGE resolution versus patients with LGE persistence. Methods All patients who underwent a CMR for a suspected myocarditis during a period of 1 year from June 2021 to June 2022 were retrospectively evaluated. Those with a confirmed myocarditis by mLLC and a follow-up CMR were included. Electronic medical records were analyzed to collect data on baseline clinical variables, CMR features and follow-up events. Follow-up CMR was performed on follow-up based on clinician’s criteria. Results A total of 27 patients fulfilled mLLC for myocarditis during the period of study and had a follow-up CMR. The mean time to first CMR control was 186 +/- 95 days (6,2 months). Of those 23 (85.2%) presented persistent LGE enhancement and 4 of them presented a complete resolution of LGE. There were no statistically significant differences between groups although patients with complete LGE resolution tend to be younger. There were no differences between groups in terms of LVEF and RVEF. Patients with persistent LGE in the follow-up tend to have higher edema and LGE extension during the acute myocarditis episode, being the LGE difference statistically significant. In the follow up CMR almost all patients presented edema resolution and although the majority of patients (85.2%) presented LGE persistence they presented a trend to a decrease of affected segments (4.4 to 3.1 after mean time of 6 months). There were no differences in clinical events between groups in terms of death, admissions, ventricular arrhythmias and new episodes of myocarditis, patients with persistent LGE tend to have more visits for unresolved chest pain. Conclusions The majority of patients with a confirmed acute myocarditis had edema resolution and LGE persistence after 6 months. There were no differences in clinical events during follow-up. Follow up CMR before 6 months can prove resolving edema but LGE persistance is common. Further studies are needed to define the optimal interval to perform CMR after the index event.

Introduction Clinical decision-making on anticoagulation in chronic kidney disease (CKD) patients with atrial fibrillation (AF) is challenging. Current strategies are based on small observational studies with conflicting results. A better comprehension of patients' risk profiles is therefore needed. Purpose The present study explores the impact of glomerular filtration rate (GFR) in the embolic–haemorrhagic balance among a large cohort of AF patients. Methods The study cohort included all patients from the health area of Vigo (Galicia, Spain) diagnosed with AF between January 2014 and April 2020. Subjects without data regarding to glomerular filtration rate were excluded. The final population of the study consisted of 15,457 patients. The risk of ischaemic stroke and major bleeding was determined by competing risk regression using the Fine and Gray model, considering death as a competing risk. Results During a mean follow-up of 4.29±1.82 years, 3,678 patients died (23.80%), 850 had an ischaemic stroke (5.50%) and 961 had a major bleeding (6.22%). The incidence of stroke and bleeding increased as baseline GFR declined. GFR <30 mL/min/1.73 m2 was associated with increased stroke and major bleeding (Figure 1). Interestingly, below GFR <30 mL/min/1.73 m2, bleeding risk was clearly higher than the embolic risk (Figure 2). As glomerular filtration rate decreased, anticoagulation was associated with an increased bleeding risk (sHR 1.72, 95% CI 1.15–2.56; P=0.01 for patients with GFR 30–59 mL/min/1.73 m2 and 2.05, 95% CI 0.80–5.28; P=0.13 for subjects with <30 mL/min/1.73 m2 in comparison with those with GFR >60 mL/min/1.73 m2, respectively), but it was not associated with a reduction in embolic risk in patients with GFR <30 mL/min/1.73 m2 (sHR 1.91, 95% CI 0.73–5.04; P=0.19) Conclusions In advanced chronic kidney disease (GFR <30 mL/min/1.73 m2), the increase of major bleeding risk was higher than the increase of ischaemic stroke risk, with a negative anticoagulation balance (greater increase in bleeding than reduction in embolism). In this setting, left atrial appendage occlusion appears to be an alternative to consider. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular magnetic resonance (CMR) is established as the gold standard non-invasive test for the diagnosis of acute myocarditis. However, current evidence on CMR after an acute myocarditis in the follow-up is contradictory. There are patients who can show an improvement on late gadolinium enhancement (LGE) extension but timing for CMR follow-up and the amount of this improvement is unclear. A better comprehension of patients’ profiles is therefore needed. Purpose To explore the clinical profile and index CMR findings in patients with acute myocarditis and persistent LGE in follow-up CMR focusing on the differences between those who present mild improvement (less than fifty percent of previously affected segments) versus patients who present a better improvement (more than fifty percent). Methods All patients with an acute myocarditis diagnosis from June 2021 to June 2022 and a follow-up CMR were retrospectively evaluated. Myocarditis was defined by modified Lake Louise criteria (mLLC). Electronic medical records were analyzed to collect data on baseline clinical variables, CMR features, treatment and follow-up events. A CMR was performed on follow-up based on clinician’s criteria. Results A total of 49 consecutive patients fulfilled updated LLC for myocarditis. 30 cases (61.2 %) had a follow-up CMR. The mean time to first CMR control was 186 +/- 95 days (6,2 months). After excluding patients with no LGE at index CMR, 22 patients were analysed. Of those, 13 had reduced LGE extent in less than fifty percent of previously affected segments, and 9 showed an improvement of more than fifty percent. There were no differences in cardiovascular risk factors or baseline comorbidities (Table 1). There were no differences between groups in terms of left and right ventricular ejection fraction. T1, T2 and ECV maps were similar en both groups. Patients with less LGE improvement tend to have more initial edema extension although this tendency was not statistically significant whilst there were no differences in LGE extension at index CMR. Both groups presented similar affected segments and in both cases inferolateral segments were the most affected (Table 2). There were no differences in clinical events after 13 months of mean follow-up time, there were no differences between groups regarding to corticoid, colchicine and NSAID prescription. Conclusions In our cohort, there were no differences in baseline characteristics, CMR findings, treatment and clinical events between patients with significant LGE improvement at 6 months after an acute myocarditis and those with only mild improvement.