Funding Acknowledgements Type of funding sources: None. INTRODUCTION Both angina and dyspnea symptoms are the most common clinical manifestations of cardiac ischaemia. Nevertheless, cardiac ischaemia may be detected on control functional tests of patients with ischaemic dilated cardiomyopathy despite being asymptomatic. The aim of this study was to assess the effect of elective myocardial revascularization on patient’s prognosis  depending on baseline clinical symptoms. METHODS All consecutive patients with ischaemic left ventricular dysfunction (LVEF <40% determined by gated-SPECT) who underwent stress-rest SPECT in our hospital between January 2010 and February 2018 were included. Baseline patients’ clinical presentation (angor pectoris, dyspnea or asymptomatic) and major adverse events (myocardial infarction, heart failure hospitalization and cardiovascular death) were retrospective recorded.  RESULTS A total of 748 patients with multiple comorbid conditions (smoking habit 69%, hypertension 78,7%, diabetes mellitus 49,5%, atrial fibrillation 22,1%, previous myocardial infarction 69% and previous heart failure hospitalization 24,9%) were included. Nonemergent coronary intervention during the first year (17,9% of patients) was associated with a reduction in the composite event (HR 0.69 [0.5-0.95]) but the multivariate analysis showed a prognostic benefit of revascularization in symptomatic patients (HR = 0.59 [0.37 - 0.94]) that was not observed among asymptomatic patients. The relative risk of the composite endpoint was RR = 0.63 (p <0.001) for asymptomatic vs. symptomatic non-revascularized patients and RR = 1.09 (p = 0.60) for asymptomatic vs. symptomatic revascularized patients. Finally, asymptomatic patients presented more necrosis (17.3 vs. 20.2%, p <0.01) and less ischemia (9.7 vs. 5.7%, p <0.001) than symptomatic patients.  CONCLUSION Patients with ischaemic dilated cardiomyopathy without symptoms of dyspnea or angina present less ischaemia and more necrosis in stress-rest SPECT than symptomatic patients. Moreover, unlike symptomatic patients, asymptomatic patients do not benefit from elective revascularization. Therefore, the clinical presentation should be considered when deciding revascularization of patients with ischaemic dilated cardiomyopathy and a positive SPECT test. Abstract Figure. Kaplan-Meyer curves

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Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Vall d"Hebron - Vall d"Hebron Institut de Recerca. CIBERCV BACKGROUND Patients with structural heart disease (SHD) or bundle branch block (BBB) are at high risk of having an arrhythmic syncope (AS).  In patients with recurrent syncope episodes (RSE)  complete work-up including electrophysiological study (EPS) and/or implantation of a loop recorder (ILR) is recommended, however patients with their first episode may also be at risk of an AS. AIM To determinate if the patients with SHD or BBB with a single syncope episode (SSE) are at high risk of having an AS and compare it with patients with recurrent episodes (RSE). METHODS Cohort study carried out in a tertiary hospital that is a reference centre for syncope. From January 2008 to August 2020 patients with SHD or BBB with syncope of unknown origin after the initial evaluation and without direct indication of an ICD were included. They were managed according the current ESC guidelines. RESULTS 417patients were included  (74 ±11 y. o; 39% female). Mean follow up was 2.5 ±1 y. 223 patients were diagnosed from an AS [113 (53%) in SSE group and 110 (54%) in RSE group, p = 0.9], 210 were due to bradyarrhythmia (AV block or sinus arrest). No differences in baseline characteristics where found comparing both groups, except that BBB was slightly more prevalent in patients with RSE (81% vs 90%, p = 0.01) (FIGURE- PANEL A). Risk of AS was 53% in patients with SE and 54% (p = 0.9). RSE were not associated with an increased risk of AS in univariate analyses (OR 1.01 IC95% 0.7-1.5) neither in the multivariate (FIGURE- PANEL B). EPS and ILR diagnostic yield was 45% / 32% respectively in SSE group and 44% / 33% in RSE group (p = 0.8) (FIGURE - PANEL C).  After appropriate treatment, recurrence syncope rate was 10% in SSE group and 9% in RSE group (p = 0.8). No significant differences in mortality rate were found. CONCLUSIONS Patients with SHD or BBB and single syncope episode are at a high risk of having AS, and similar to those with RSE. EPS and ILR offer a similar diagnostic yield in both groups. Complete syncope work-up must be recommended in these patients despite having had only a single episode. Abstract Figure

Objectives: Chronic lung disease, specifically COPD and asthma, impacts more than 500 million adults worldwide, and is associated with high healthcare spending and significant disease related morbidity. While the direct impact of substance use disorder is well documented, little is known about the indirect impact of substance misuse within this patient population. Utilizing administrative data, we quantified the secondary morbidity, mortality and healthcare utilization attributable to substance misuse in patients with chronic lung disease on a national scale. Methods: Utilizing the National Readmissions Database we identified patients with a diagnosis of COPD or asthma admitted to a hospital within the United States between 2012-2015. Within this patient subgroup, ICD-9/10-CM codes were utilized to determine the prevalence of substance misuse by drug class. Utilizing weighted regression analysis, morbidity, mortality and healthcare utilization differences between the two groups were identified. The impact of tobacco use, with or without associated substance misuse, was determined, and adjusted for in final analysis. Results: 1,087,226 patients with an index admission for COPD or asthma were identified. Of these patients 4.01% had a documented diagnosis of substance misuse. Patients with documented substance misuse of any kind had an increased cost per index admission, with an increased risk of respiratory failure (OR: 1.44 (95%CI: 1.37, 1.52, p,0.001) and need for mechanical ventilation (OR 1.44 (95%CI: 1.37, 1.52 p ,0.05). The additional index admission costs totaled $24 million for our cohort. Additionally substance misuse was associated with an increased risk of readmission. (OR 1.29 95%CI: 1.25, 1.33 p,0.001). Conclusions: Substance misuse is associated with an increase in healthcare utilization and healthcare cost in patients with chronic lung disease. Targeted substance misuse treatment in this patient population has the potential for significant cost savings to the healthcare system.