Abstract 16712: Safety & Efficacy of Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation in Elderly Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tauseef Akhtar ◽  
Usama A Daimee ◽  
Bhradeev Sivasambu ◽  
Erica Hart ◽  
Joseph E Marine ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
The United States ◽  
Rf Ablation ◽  
Limited Data ◽  
Multivariable Model ◽  
Major Complications ◽  
Significant Difference ◽  
The Mean

Introduction: Catheter ablation (CA) for atrial fibrillation (AF) is widely performed, with a rising proportion of patients of advanced age receiving the procedure. There are limited data describing the experience of index radiofrequency (RF) vs. cryoballoon (CB) ablation for AF among elderly patients in the United States. Hypothesis: CB ablation is associated with better outcomes in elderly patients. Methods: We conducted a retrospective analysis of patients > 75 years undergoing index AF ablation between January 2001 and March 2019 at our center. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds after 1 year of follow-up, were assessed in patients with index RF vs. CB ablation. Predictors of ATA recurrence at 1year follow-up were also evaluated. Results: In our cohort of 194 patients, the mean age was 78 + 3.1 years, 58.2% were men, and 39.4% had persistent AF. The mean left atrial (LA) diameter was 4.5 + 0.7, while mean CHA2DS2-VASc score was 3.5 + 1.2. The majority (n=149, 76.8%) underwent RF ablation. The incidence of major complications, including bleeding and cardiac tamponade, was similar in the two sub-groups (RF: 2% vs. CB: 0%, p=0.63). No significant difference in success rate at 1year follow-up was found between patients receiving RF vs. CB ablation (57.7% vs. 64.4% Figure, p=0.94). In a multivariable model adjusting for the age, sex, CHA 2 DS 2 -VASc score, AF type, and index RF vs CB ablation, only LA size was associated with ATA recurrence at 1 year follow-up with each increment of 1 cm in LA size was associated with 1.6-fold greater risk of recurrence [HR=1.59, CI: 1.05-2.41, p=0.02]. Conclusion: In elderly patients undergoing index CA for AF, RF ablation was the predominant modality with similar safety and efficacy relative to CB ablation. LA size was the significant predictor of ATA recurrence at 1year independent of index ablation modality.

scholarly journals Safety and Efficacy of Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation in Elderly Patients and Predictors of Arrhythmia Recurrence

2020 ◽  
Author(s):  
Tauseef Akhtar ◽  
Usama Daimee ◽  
Bhradeev Sivasambu ◽  
Erica Hart ◽  
Eunice Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
The United States ◽  
Rf Ablation ◽  
Limited Data ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
The Mean ◽  
One Year

Introduction: There are limited data describing the experience of index radiofrequency (RF) vs. cryoballoon (CB) ablation for atrial fibrillation (AF) among elderly patients in the United States. Methods: We conducted a retrospective analysis of patients > 75 years of age undergoing index AF ablation between January 2010 and March 2019 at our center. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds after one year of follow-up, were assessed in patients with index RF vs. CB ablation. Predictors of ATA recurrence at 1 year follow-up were also evaluated. Results: In our cohort of 194 patients, the mean age was 78 ± 3.1 years, 58.2% were men, and 39.4% had persistent AF. The mean left atrial (LA) diameter was 4.5 ± 0.7, while the mean CHA2DS2-VASc score was 3.5 ± 1.2. The majority (n=149, 76.8%) underwent RF ablation. The incidence of complications was similar in the two sub-groups (RF: 1.3% vs. CB: 2.2%, p=0.67). No significant difference in success rate at 1-year follow-up was found between patients receiving RF vs. CB ablation (59.7% vs. 66.7%, p=0.68). In a multivariable model adjusting for the relevant covariates only LA size [HR=1.64, CI: 1.15-2.34, p<0.01] was independently associated with ATA recurrence at 1year follow-up. Conclusion: In our cohort of elderly patients undergoing index CA for AF, RF ablation was the predominant modality with similar safety and efficacy relative to CB ablation. LA size was a significant predictor of ATA recurrence at 1year independent of index ablation modality.

P1896Single-procedure success-rate of pulmonary vein isolation using point-by-point tagging lesions algorithm based on contact force technology: preliminary results of the multicentric SMOP study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Rordorf ◽  
S Cornara ◽  
L Frigerio ◽  
A Sanzo ◽  
E Chieffo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Success Rate ◽  
Contact Force ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Italian Population ◽  
Ablation Lesion ◽  
Rf Ablation ◽  
The Mean

Abstract Background Pulmonary veins isolation (PVI)is an effective therapy for atrial fibrillation (AF), recommended by current guidelines. However, recurrences after first radio-frequency (RF) catheter ablation (CA) are still high. PV reconnection could be due to ineffective transmural lesions; automated ablation lesion tags (the VisiTag algorithm) based on predefined parameters of catheter stability and contact force (CF) have been developed to allow the detection of ineffective ablation lesion, nevertheless there is a lack of multicenter studies exploring this technology. Objective the aim of our study was to assess the rate of recurrence after a first PVI procedure in a large, multicentric Italian population and to explore the efficacy of Visitag algorithm (CARTO 3) used to guide RF ablation of AF. Methods we analyzed 214 patients of the SMOP-AF study (Substrate Mapping as Outcome Predictor in Atrial Fibrillation Ablation), a prospective multi-centric study enrolling patients with paroxysmal and persistent AF undergoing a first PVI procedure after an high-density mapping during sinus rhythm. During the procedure, ablation was guided by an automated annotation system in which tag based on predefined parameters were displayed real-time in each lesion site on the electroanatomical map. Visitag settings for the catheter position stability were a 2,5 mm distance limit for at least 7 sec and a minimum CF of 5 g over 30% of the ablation and a FTI>400 g*s. Where available (n=106, 49.5%), Ablation Index (AI), which also incorporates information on delivered RF power, was used instead of FTI to guide RF ablation with a threshold range of 400–550 for anterior/roof and 330–420 for posterior/inferior segments. Minimum and mean contact force, time and power values for each RF-lesion were recorded while both FTI and AI values were calculated automatically by the CARTO system. Comparison between groups were made by cross-tables, Mann-Whitney or Student T test as appropriated. Results the mean age of the enrolled population was 59±9 years, left ventricular ejection fraction was 59±9%. AF was paroxysmal in 89.7%, persistent in 10.3% of the patients and refractory to at least one anti-arrhythmic drug in 86.4% of the population. At 3 months follow-up 85% of the patients were free from AF recurrences and the success rate increased to 90.8% at 3–6 months, and 86.3% at 3–12 months follow-up. The mean ablation time was shorter in AI-guided vs. FTI-guided procedures (31±9 vs 46±29 min; p<0.001). There was a trend toward a reduction in AF recurrences when AI vs. FTI was used, both at 6 and 12 months (respectively 5,4% vs 13.6%; p 0.06 and 9.6% vs 18.5%; p 0.08). Conclusion PVI isolation using dedicated algorithms developed to guide the effectiveness of RFCA leads to a very high success-rate after a single procedure. The use of AI, which integrates contact force information with delivered power, reduces the procedural time and increases the overall success-rate

Abstract 249: The Costs and Acute Outcomes Following Pulmonary Vein Isolation for Atrial Fibrillation in Elderly Patients a Comparison Between Cryoballoon and Radiofrequency Ablation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Chao-Feng Chen
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Dwell Time ◽  
Complication Rates ◽  
Rf Ablation ◽  
Significant Difference

Backgroup: Limited comparative data exist regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) ablation versus radiofrequency (RF) ablation in elderly patients (>75 years ). This study aims to compare the costs and periprocedural outcomes in elderly patients using these two strategies. Methods: Elderly patients (>75years) with symptomatic drug-refractory AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients by CB or RF. The costs and periprocedural outcomes of the two strategies are compared using SPSS 22. Results: 324 elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF received PVI using RF (n=176) and CB-2 (n=148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure duration and left atrial dwell time (128.9±18.3 vs. 152.8±18.9 minutes, P<0.001; 89.4±18.4 vs. 101.9± 22.2minutes, P <0.001), but greater fluoroscopy utilization (24.3±10.9 vs. 19.2±7.5 minutes, P <0.001). Periprocedural complications occurred in 3.4% (CB-2) and 9.1% (RF) of patients (P=0.037). There was no significant difference between 2 groups for AF/atrial tachycardia (AT) recurrence until discharge (16.2 vs. 18.7%, P = 0.552). The length of stay after ablation was shorter, but the costs were greater in the CB-2 group ( P <0.001). Conclusions: Both CB-2 and RF ablation appear to be safe and effective for AF in elderly patients (>75 years). In addition, CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower complication rates, but its costs and fluoroscopy time are greater than those of the RF group.

Early implementation of stereoelectroencephalography in children: a multiinstitutional case series

2021 ◽  
pp. 1-8
Author(s):  
Jacob R. Lepard ◽  
Irene Kim ◽  
Anastasia Arynchyna ◽  
Sean M. Lew ◽  
Robert J. Bollo ◽  
...  
Keyword(s):  
Case Series ◽  
The United States ◽  
Postoperative Hemorrhage ◽  
Pediatric Epilepsy ◽  
Continuous Variables ◽  
Early Implementation ◽  
Significant Difference ◽  
Normative Practice ◽  
The Mean

OBJECTIVE Pediatric stereoelectroencephalography (SEEG) has been increasingly performed in the United States, with published literature being limited primarily to large single-center case series. The purpose of this study was to evaluate the experience of pediatric epilepsy centers, where the technique has been adopted in the last several years, via a multicenter case series studying patient demographics, outcomes, and complications. METHODS A retrospective cohort methodology was used based on the STROBE criteria. ANOVA was used to evaluate for significant differences between the means of continuous variables among centers. Dichotomous outcomes were assessed between centers using a univariate and multivariate logistic regression. RESULTS A total of 170 SEEG insertion procedures were included in the study from 6 different level 4 pediatric epilepsy centers. The mean patient age at time of SEEG insertion was 12.3 ± 4.7 years. There was no significant difference between the mean age at the time of SEEG insertion between centers (p = 0.3). The mean number of SEEG trajectories per patient was 11.3 ± 3.6, with significant variation between centers (p < 0.001). Epileptogenic loci were identified in 84.7% of cases (144/170). Patients in 140 cases (140/170, 82.4%) underwent a follow-up surgical intervention, with 47.1% (66/140) being seizure free at a mean follow-up of 30.6 months. An overall postoperative hemorrhage rate of 5.3% (9/170) was noted, with patients in 4 of these cases (4/170, 2.4%) experiencing a symptomatic hemorrhage and patients in 3 of these cases (3/170, 1.8%) requiring operative evacuation of the hemorrhage. There were no mortalities or long-term complications. CONCLUSIONS As the first multicenter case series in pediatric SEEG, this study has aided in establishing normative practice patterns in the application of a novel surgical technique, provided a framework for anticipated outcomes that is generalizable and useful for patient selection, and allowed for discussion of what is an acceptable complication rate relative to the experiences of multiple institutions.

scholarly journals Estimation of efficiency of epicardial radiofrequency ablation of anatomic zone ganglionic plexi in patients with coronary heart disease and atrial fibrillation

2015 ◽  
Vol 18 (1) ◽  
pp. 14
Author(s):  
A. M. Chernyavskiy ◽  
S. S. Rakhmonov ◽  
Yu. Ye. Kareva ◽  
Ye. A. Pokushalov ◽  
I. A. Pak
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Radiofrequency Ablation ◽  
Rf Ablation ◽  
Ablation Procedure ◽  
The Mean ◽  
Artery Disease

The results of epicardial radiofrequency ablation of anatomic zone ganglionic plexi of the left atrium during CABG of patients with coronary heart disease and atrial fibrillation are analyzed. From 2009 to 2012 RF ablation procedure was performed in 92 patients with atrial fibrillation and coronary artery disease. Depending on the form of AF the patients were randomized into three groups. The mean follow-up was 14.49.6 months (from 3 до 36 months). Freedom from AF during 24 months after surgery was 78.6% for patients with paroxysmal AF, 42.5% for patients with persistent AF and 39% for patients with long-term persistent AF.

scholarly journals Association of the degree of thrombocytopenia with cause of death in patients with atrial fibrillation: the Fushimi AF Registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Ishigami ◽  
S Ikeda ◽  
K Doi ◽  
Y Hamatani ◽  
Y Ide ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Failure ◽  
Body Weight ◽  
Platelet Count ◽  
Cause Of Death ◽  
Cardiac Death ◽  
Severe Thrombocytopenia ◽  
Significant Difference ◽  
The Mean

Abstract Background Thrombocytopenia is sometimes found in routine blood tests and is associated with an increased risk of mortality in general population. We have previously reported that atrial fibrillation (AF) patients with thrombocytopenia have a higher mortality than those without thrombocytopenia. However, association of the degree of thrombocytopenia with cause of death in AF patients is unknown. Purpose We aimed to investigate the association of baseline platelet count with cause of death including cardiac death, intracranial death, malignancy, infection, extracranial bleeding death, renal failure death, respiratory failure death and undetermined death. Methods The Fushimi AF Registry was designed to enroll all of the AF patients in Fushimi-ku, Kyoto. Fushimi-ku is densely populated with a total population of 283,000 and is assumed to represent a typical urban community in Japan. We started to enroll patients from March 2011, and follow-up data with baseline platelet counts less than 150,000/μL were available in 853 patients by the end of September 2020. We divided them into 3 groups according to baseline platelet level: Mild thrombocytopenia (100,000–149,999/μL, n=703), Moderate thrombocytopenia (50,000–99,999/μL, n=120), and Severe thrombocytopenia (&lt;50,000/μL, n=30). Results In the entire cohort, the mean age was 76 years, 34% were women, the mean body weight and body mass index was 59.3 kg and 22.9 kg/m2, and the median platelet count were 121,000/μL (interquartile range 109,000 to 141,000/μL). Compared to Mild thrombocytopenia, patients with Moderate or Severe thrombocytopenia were more likely to have chronic kidney disease (42.2% vs 54.2% vs 73.3%, p=0.0003), have higher HAS-BLED score (1.90 vs 2.14 vs 2.00, p=0.047) and lower hemoglobin (12.8g/dL vs 11.7g/dL vs 11.2g/dL, p&lt;0.0001) and were less often prescribed anti platelet drugs. Age, sex, body weight, systolic blood pressure, previous stroke, previous major bleeding, hypertension, diabetes mellitus, CHADS2 score and CHA2DS2-VASc score were comparable between three groups. During the median follow-up period, the incidence rate (per 100 person-years) of all-cause death was 6.82 vs 15.27 vs 9.64. (p&lt;0.001) On univariate analysis, the incidence of all-cause death was higher in Moderate group than Mild group. (HR: 2.15; 95% CI 1.61–2.87, p&lt;0.0001), but there was no significant difference between Mild and Severe groups. (HR: 1.44; 95% CI 0.78–2.64, p=0.243). The incidence of cardiac death was comparable between three groups. (Mild vs Moderate: HR 0.65; 95% CI 0.15–2.75, p=0.56, Mild vs Severe: HR 1.11; 95% CI 0.15–8.23, p=0.92) Regarding other causes of death such as intracranial bleeding, extracranial bleeding, malignancy, infection, renal failure, respiratory failure and undetermined cause, there was no significant difference. Conclusion Mortality was higher according to the degree of thrombocytopenia in AF patients, but the cause of death was not different among three groups. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Comparison between early versus late pulmonary vein isolation in the management of atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Intan-Goey ◽  
M Scherrenberg ◽  
M Falter ◽  
T Kaihara ◽  
P Dendale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mortality Rate ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Medical Cost ◽  
Electrical Cardioversion ◽  
Control Treatment ◽  
Significant Difference ◽  
The Mean

Abstract Background Atrial fibrillation (AF) is the most common type of arrhythmia. The health burden of AF keeps increasing with the rising incidence of AF caused by the aging population and the high prevalence of unhealthy lifestyle. Pulmonary vein isolation (PVI) is the cornerstone of invasive rhythm control treatment in AF. Randomized controlled trials have shown superiority of an PVI strategy compared to conservative treatment. However, the best timing to perform a PVI to achieve the most optimal outcome is still unknown. Purpose To investigate whether the timing of performing PVI has consequences for the AF management in terms of medical cost, the number of repeated electrical cardioversion and hospitalisations and mortality. Methods In this monocentric retrospective observational study, all patients who underwent an electrical cardioversion and PVI between January 2012 and January 2020 were included using a hospital administrative data record. Follow-up data were collected up to a maximum of 67 months. Early PVI is defined as patients receiving a PVI after a first electrical cardioversion; late PVI is defined as patients receiving PVI after more than one electrical cardioversion. We compared the two groups for the mean medical cost, the number of repeated electrical cardioversions performed, any unplanned hospitalization associated with AF and mortality. Results A total of 407 patients were included in this analysis. Respectively, in the early versus the late PVI strategy groups, the mean age was 64.5 vs. 66.3 years (p=0.105) and the mean follow-up was 1630±843 vs. 2039±781 days (p&lt;0.001). The mean medical cost since the first cardioversion was €8533 vs. €8987 (p=0.503), the number of additional electrical cardioversion performed was 0.4 vs 3.0 (p&lt;0.001) and mortality rate was 2,8% vs. 0% (p=0.116). The Log-rank analysis showed a significant difference (p&lt;0.001) between both groups in the time to first unplanned hospitalisation on cardiology ward after PVI in favor of early PVI strategy. Conclusions An early PVI tends to be superior to a late PVI strategy in the management of AF with less need for repeated electrical cardioversion and lower hospitalisation rate. Total medical cost and mortality rate were comparable in both approaches. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas

2021 ◽  
Author(s):  
T. J. Marini ◽  
S. L. Weiss ◽  
A. Gupta ◽  
Y. T. Zhao ◽  
T. M. Baran ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Standard Of Care ◽  
The United States ◽  
Epidemiological Studies ◽  
Thyroid Ultrasound ◽  
Target Region ◽  
Experienced Radiologist ◽  
Significant Difference ◽  
Size Evaluation

Abstract Purpose Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. Methods The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. Results Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen’s kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. Conclusion Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.

scholarly journals THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 497.2-497
Author(s):  
J. Arroyo Palomo ◽  
M. Arce Benavente ◽  
C. Pijoan Moratalla ◽  
B. A. Blanco Cáceres ◽  
A. Rodriguez
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Statistical Tests ◽  
Median Number ◽  
Painful Joint ◽  
Significant Difference ◽  
The Mean ◽  
Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

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