512 The impact of intervention in mitral regurgitation / Hypertrophic cardiomyopathy and to reverse cardiac remodeling only in the subgroup of patients with functional MR (Table 1). Conclusions: Preprocedural GLS was significantly related to cardiovascular mor- tality in our series beyond LVEF. Successful PMVR was associated with an im- provement in LVF and reverse LV remodeling in the subgroup of patients with functional MR. Funding Acknowledgements: Research grant in Interventional Cardiology from the Spanish Society of Cardiology HYPERTROPHIC CARDIOMYOPATHY P2585 Coronary microvascular pathology as the major determinant of severe fibrosis in end-stage hypertrophic cardiomyopathy (HCM) G. Galati 1 , O. Leone 2 , A. Cappelletti 1 , R. Molfetta 3 , M. Volpe 3 , F. Ancona 1 , V. Magni 1 , C. Capogrosso 1 , S. Stella 1 , S. Castelvecchio 3 , C. Rapezzi 4 , A. Margonato 1 . 1 San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy; 2 S.Orsola-Malpighi University Hospital, Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy; 3 IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy; 4 Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy Background: A large number of studies performed using both Positron Emission Tomography and Cardiovascular Magnetic Resonance (CMR) documented that myocardial ischemia is an independent predictor of cardiovascular mortality in HCM and that severe microvascular abnormalities are related to End Stage-HCM (ES-HCM) and to refractory heart failure. Furthermore, CMR studies proved that areas of microvascular ischemia were associated to Late Gadolinium Enhance- ment, especially in the subendocardium. However, a systematic pathology study focused on coronary microvasculopathy (CM) in ES-HCM was never performed. Purpose: To assess the role of CM in causing severe fibrosis and to evalu- ate quantitative rapport between severe CM and fibrosis type in 30 transplanted hearts of ES-HCM. Methods: For each heart, 16 samples were considered. Histomorphometric quantification of fibrosis for each sample was perfomed. The extent of fibrosis was defined severe if ≥40% of the whole examined myocardial area. A semi- quantitative visual evaluation of each fibrosis type was carried out: specimens with score +++ for replacement fibrosis (RF) were defined as mainly RF, spec- imens with score +++ for interstitial fibrosis (IF) were defined as mainly IF, the others were defined as Mixed fibrosis (MF). CM was classified on the basis of lumen stenosis (LS) as Mild: LS<30%, Moderate: LS ≥30% and <60%, Severe: LS≥60%. Results: 179 out of 480 (37.3%) of the specimens showed severe fibrosis. 70.9% (127/179) showed predominant RF, 9.5% (17/179) MF, 19.6% (35/179) predomi- nant IF. Table 1 shows the causality rapport between the severity of CM (and its pattern) and the different fibrosis types. Coronary microvasculopathy in ES-HCM Conclusion: CM - intimal hyperplasia and medial hypertrophy - plays a major role in causing severe fibrosis in ES-HCM. However, severe CM showed to be the major determinant only of severe RF (71.6%), but not of both severe MF (23.6%) and IF (8.6%). This finding, on one hand, is the first pathological evidence Abstract P2585 – Table 1 Severe Replacement Fibrosis Severe Mixed Fibrosis Severe Interstitial-Perimyocyte Fibrosis Total specimens with severe fibrosis (=127) (=17) (=35) (=179) Severe coronary microvasculopathy 91/127 (71,6%) 4/17 (23.6%) 3/35 (8.6%) 98/179 (54.7%) Moderate coronary microvasculopathy 35/127 (27.6%) 5/17 (29.4%) 5/35 (14.3%) 45/179 (25.2%) Mild coronary micovasculopathy 1/127 (0.8%) 8/17 (47%) 27/35 (77.1%) 36/179 (20.1%) Multifocal/diffuse pattern 123/127 (96.8%) 15/17 (88.2%) 17/35 (51.4%) 155/179 (86.5%) that CM is related to severe replacement fibrosis in ES-HCM, on the other hand it reinforces the emphasis on the clear genetic origin of mixed and interstitial fibrosis. Finally, this study provides the first documentation that ES-evolution it’s a complex phenomenon and that CM could explain only the cases with severe RF. P2586 Fragmented qrs as a predictor of ventricular arrhythmic events in patients with hypertrophic cardiomyopathy S. Ogura, K. Nakamura, A. Watanabe, N. Nishii, T. Miyoshi, H. Morita, H. Ito. Okayama University Hospital, Cardiology, Okayama, Japan Background: Multiple spikes within the QRS complex (fragmented QRS [fQRS]) are associated with the occurrence of ventricular arrhythmic events (VAEs) in myocardial infarction and Brugada syndrome. However, the association between fQRS and the occurrence of VAEs in hypertrophic cardiomyopathy (HCM) has not been fully elucidated. Purpose: We investigated the association between fQRS and cardiac events in patients with HCM. Methods: We evaluated the associations of the existence of fQRS (Figure 1A) with cardiac events including VAEs (non-sustained or sustained ventricular tachy- cardia and ventricular fibrillation), hospitalization for heart failure and all cause death in 146 patients with HCM (46 patients with fQRS vs 100 patients without fQRS). The median follow-up period was 5.3 years. Results: All cardiac events occurred in 29 patients with fQRS and in 32 patients without fQRS (63% vs 32%; P=0.0001). Among the cardiac events, VAEs oc- curred in a significantly larger percentage of patients with fQRS than patients without fQRS (54% vs 23%; P=0.0001), whereas there was no significant dif- ference in the frequency of hospitalization for heart failure or all cause death between patients with and without fQRS (hospitalization for heart failure: 20% vs 13%, P=0.338; all cause death: 17% vs 6%, P=0.068). Multivariable analysis showed that the existence of fQRS was associated with VAEs (HR, 2.392; CI, 1.330–4.300; P=0.004) but not with hospitalization for heart failure (HR, 0.956; CI, 0.379–2.415; P=0.924). Kaplan-Meier analysis also showed a significant dif- ference in the frequency of VAEs between with and without fQRS (log rank; P=0.001) (Figure 1B), not in occurrences of hospitalization for heart failure (log rank; P=0.515). Late gadolinium enhancement in cardiac MRI (CMR) was ob- served more frequently in patients with fQRS than in patients without fQRS (38% vs 11%; P=0.033). Figure 1 Conclusions: fQRS represents a predictor of VAEs and existence of myocardial injury as assessed by CMR in patients with HCM. P2587 The role of three-dimensional speckle tracking imaging in risk stratification and prognosis in hypertrophic cardiomyopathy J. Wang, J. Zhao, F. Yang, N. Kang, W.X. Li, L. Zuo, L. Liu. Fourth Military Medical University, Department of Ultrasound, Xian, China People’s Republic of Background: Although many prognostic variables have been reported, the risk stratification of patients with hypertrophic cardiomyopathy (HCM) has long been controversial due to considerable discordance. Three-dimensional speckle track- ing imaging (3D-STI) may provide a more clinical relevant evaluation in HCM. Purpose: To investigate whether 3D-STI combined with conventional echocar- diography can identify cardiac functional characteristics and predict adverse car- diovascular events in patients with HCM. Methods: The study population consisted of a consecutive series of 180 HCM patients admitted in HCM center of the Hospital from July 2014 to August 2016. All patients were followed up to March 2017 after comprehensive evaluation of 3D-STI and conventional echocardiography for a composite end point. Results: Totally 175 HCM patients completed the follow-up [(435±204) days]. During follow-up, 25 patients (14.3%) reached a composite end point: 8 cases of the primary end point (3 cases of SCD, 3 cases of survival after defibrillation, and 2 cases of appropriate ICD discharge); 17 cases of the second end point (14 cases of heart failure hospitalization, 2 cases of thromboembolism, and 1 case of Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/suppl_1/ehy565.P2585/5081725 by guest on 30 May 2020