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ABS20190928_0001
Renal Insufficiency and Contrast Nephropathy
Comparisons of Different Hydration Strategies in Patients with Very Low-Risk Profiles of Contrast-Induced Nephropathy
Shuai Miao1, Zheng-Kai Xue2, Kang-Yin Chen2, Tong Liu2, Seung-Woon Rha3
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, China1, The Second Hospital of Tianjin Medical University, China2, Korea University Guro Hospital, Korea (Republic of)3
Background:
Contrast induced nephropathy (CIN) is a common complication of coronary angiography (CAG) with worse long-term outcomes and increased mortality. The necessity of normalsaline hydration has not been well established in patients with low risk profiles of CIN. Moreover, there is no randomized study using high-sensitive biomarkers such as cystatin C (Cys C) and neutrophil gelatinase-associated lipocalin (NGAL) to compare the different hydration strategies in patients with very low-risk profiles of CIN. 
Methods:
A total of 150 patients undergoing CAG with very low-risk profiles of CIN were randomly assigned to 3 groups as follows: 1) preventive hydration group (Preventive Group, n=50, normal saline hydration was given 6h before till 12h after the procedure);2) remedial hydration group (Remedial Group, n=50, normal saline hydration was given after the procedures for 12h); 3) no hydration group (NH group, n=50, normal saline was only given during the procedure). Serum creatinine (Cr), Cys C and NGAL were serially tested. Very low-risk profiles of CIN was defined as Mehran¡¯s risk score¡Â 2. 
Results:
Intention-to-treat analysis were performed in 144individuals, and no case suffered from CIN in the present study. Either at 24h or at 72h after the procedure, the serum levels of Cr and Cys C (0.72 ¡¾ 0.11mg/Lfor preventive group, 0.67 ¡¾ 0.14mg/L for remedial group and 0.70 ¡¾ 0.16mg/L for NH group) didn¡¯t differ significantly among the three groups. Urinary NGAL also didn¡¯t differ significantly among three groups either at 6h or at 48h (6.31 ¡¾6.60 ng/ml for preventive group, 5.00 ¡¾ 5.86 ng/ml for remedial group and 6.97 ¡¾6.37 ng/ml for NH group) after the procedure. Subgroup analysis in patients underwent percutaneous coronary intervention (PCI) showed that there was no significant difference of serum Cr, Cys C and urinary NGAL at different timepoints among the three groups.
Conclusion:
This study suggests that normal saline hydration migh tbe unnecessary in patients with very low-risk profiles of CIN. It seems to be safe, economical and time-saving for the interventionists to perform contrast procedure in outpatient or same day admission department for this particular subset of patients with Mehran¡¯s risk score ¡Â 2 regardless CAG or PCI.
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