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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.

The conglomerate of microorganisms, inflammatory cells, fibrin and platelets that constitutes the characteristic lesion of infectious endocarditis, that is, vegetation, was considered as a major criterion of infectious endocarditis in the 90s thanks to the development of ultrasound. Ecocardiography allows the diagnosis of complications derived from the infection, such as valvular perforation, prosthetic dehiscence, fistula or abscesses. One of the most infrequent complications is the mitral pseudoaneurysm. It has its origin in the impact of a jet of aortic regurgitation on the anterior leaflet of the mitral valve, which is why we have called it mitral fracking. A 60-year-old man who had a recent history of pneumonia and for whom he was still receiving antibiotic treatment, debuted suddenly with dyspnea of minimal effort. He went to a cardiology clinic where he was found to have severe mitral regurgitation. He was directly derived to cardiac surgery of our hospital. Prior to the intervention, a transesophageal ultrasound study was performed in our department, which showed the following findings: a bicuspid aortic valve with a small vegetation on its aortic surface (Figure A, surgical piece), a protuberance on the anterior mitral leaflet (Figure B) with internal flow that caused systolic expansion towards the atrium (Figure C) and diastolic collapse towards the ventricle (figure D): the mitral pseudoaneurysm. The therapeutic action was based on the replacement of both valves with mechanical prostheses. The blood cultures were negative, but the surgical piece revealed unequivocal histological findings of infectious endocarditis. Currently, the patient is stable and the valves are normofunctional in the regular follow-up controls. Abstract 91 Figure.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Cardiology Society, Cardiac Imaging Association. Grant for short extern fellowship in national centers. Background Reports have suggested an association between the development of myocarditis and mRNA vaccines against COVID-19 coronavirus disease. Cardiac magnetic resonance (CMR) findings in this setting have not been widely explored. Purpose The present study explores the clinical profile and CMR imaging findings in patients with a diagnosis of myocarditis during the period of 1 month after COVID-19 vaccination compared to non-related myocarditis during the same period. Methods All patients who underwent a CMR for suspected myocardial infarction with non-obstructive coronary arteries (MINOCA) during a period of 1 year from June 2021 to June 2022 were retrospectively evaluated. Myocarditis was defined by modified Lake Louise criteria (mLLC) and vaccine-related myocarditis was defined as a myocarditis episode in the period of 1 month after vaccination. Electronic medical records were analyzed to collect data on baseline clinical variables, CMR features and clinical events. Results A total of 118 consecutive patients undergoing a CMR for suspected MINOCA were included in the study of whom 48 (40,7%) fulfilled mLLC for myocarditis, of those, 15 cases (31,25%) were vaccine-related myocarditis. Both related and non-vaccine related myocarditis were more frequent among men and there were no differences in cardiovascular risk factors or baseline comorbidities between groups. CMR findings showed that vaccine-related myocarditis had similar LVEF and RVEF compared to other myocarditis and there were no differences in native T1, native T2 or extracellular volume (ECV). (Table 1). Edema in non-vaccine related myocarditis was more frequently observed in inferolateral mid and basal segments (segment 11) whilst in vaccine-related myocarditis edema was more frequently observed in inferoseptal mid segment (segment 9). There were no differences in the localization of the late gadolinium enhancement (LGE). (Table 2.) CMR follow-up was performed in 30 patients between 6 to 8 months after admission, showing LGE persistence without edema in 70% of non-vaccine related patients and 77,8% of vaccine-related patients. There were only 2 myocarditis recurrences. During the clinical follow up there were no deaths or ventricular arrhythmias, there were 3 hospital readmissions, 2 of them for a new myocarditis episode and 1 due to an unrelated myocardial infarction. Conclusions Vaccine-related myocarditis represented a significant proportion of new myocarditis diagnosis from June 2021 and June 2022. There were no differences in baseline characteristics, index CMR and CMR follow-up features between both subtypes. Clinical follow up of vaccine-related myocarditis showed no important events.

Funding Acknowledgements Type of funding sources: None. Background Cardiac magnetic resonance (CMR) is fundamental at the evaluation of patients with differential diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) due to its tissue characterization potential to exclude non-ischaemic causes such as myocarditis and Takotsubo syndrome and better stratify ischaemic disease in acute and chronic disease. Purpose To describe the clinical profile, cardiac magnetic resonance findings, final clinical and CMR diagnosis and clinical 1-year follow-up in patients with a working diagnosis of MINOCA evaluated with a CMR. Methods All patients who underwent a CMR for suspected MINOCA during a period of 1 year from June 2021 to June 2022 were retrospectively evaluated, past medical history, clinical characteristics, CMR reports and 1 year follow up were obtained. Myocarditis was defined by modified Lake Louise criteria. Patients were stratified following CMR diagnosis, accurate CMR diagnosis was considered when matched clinical final diagnosis. Results A total of 107 patients were evaluated with a CMR for a suspected MINOCA from June 2021 to June 2022, of whom CMR classified 51 (47.7%) as myocarditis, 11 (10.3%) as Takotsubo syndromes, 13 (12.2%) as acute ischaemic etiology, 3 (2.8%) as chronic ischaemic etiology, 24 (22.4%) as normal CMR and 5 (4.7%) had other diagnoses (cardiomyopathies and type II myocardial infarctions). Myocarditis patients were younger and more frequently males, ischaemic etiologies were older, had more comorbidities and were more frequently males, Takotsubo syndromes were more frequently females and were frequently hypertense. (Table 1) The final clinical diagnosis corresponded to the diagnosis provided by CMR in 92.2% of myocarditis, 100% of Takotsubo syndromes, 84.6% in acute ischaemic etiologies and 100% of chronic ischaemic etiologies. Patients with a normal CMR or other diagnosis had significantly lower correspondence between final and CMR diagnosis, in this setting CMR was still useful to rule out ischaemic etiology, myocarditis and Takotsubo syndrome. During follow-up there were no clinical differences between groups in terms of deaths, readmissions myocardial infarction and visits for recurrent chest pain. Patients with myocarditis CMR diagnosis were more likely to be followed up with CMR than other groups. (Table 2). Conclusions The final diagnosis of the patient studied for suspected MINOCA was given or facilitated by CMR in most cases, being of clinical use in the diagnostic and the follow up strategy of patients.