YKL-40 may play a role in the pathophysiology of BD and provide a useful marker for monitoring patients with BD.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Korea University Introduction Implantable loop recorder (ILR) is useful to reveal hidden arrhythmia. The real-world using trend of ILR implantation and indication were studied using nationwide database. Purpose To assess the indication of ILR and diagnostic rate of meaningful arrhythmia Method We analyzed the 1,460 patients who underwent ILR implantation (male 62%, mean age 62±16) from 2008 to 2019 using Korea Health Insurance review and assessment service database. Result The embolic stroke of undetermined source (ESUS) group, syncope group and palpitation group were 619 (42.3%), 765 (52.3%), 76 (5.2%) as implantation indication, respectively. From 2016 to 2019, the ESUS group increased by 14 times and the syncope group by 4 times. Among patients with ESUS, 191 patients (31%) were diagnosed with atrial fibrillation within 1 year. Bradycardia needed pacing therapy was revealed in 28%, tachycardia in 6% and atrial fibrillation in 24% in syncope group. The predictors of atrial fibrillation in ESUS group were age (OR: 1.024 per year, CI: 1.006-1.042, p=0.0072) and heart failure (OR: 2.215, CI:1.357-3.615, p=0.0015). The mean time from ILR to pacing therapy was 3±2 months in syncope group and that to anticoagulation in ESUS group was 6±3 months. Discussion The use of ILR for evaluation of ESUS is increasing, with atrial fibrillation diagnostic rate of 30%. The time to treatment differed by group.

Background Increased prevalence of nonalcoholic fatty liver disease (NAFLD) and inflammatory bowel disease (IBD) has been reported; however, the effects of NAFLD on the outcome of IBD remains unclear. We investigated whether the presence of NAFLD could influence the outcomes of patients with IBD. Methods We recruited 3,356 eligible patients with IBD into our study between November 2005 and November 2020. Hepatic steatosis and fibrosis were diagnosed using hepatic steatosis index (HSI) of ≥30 and fibrosis-4 (FIB-4) of ≥1.45, respectively. Primary outcome was clinical relapse, defined based on the following: IBD-related admission, surgery, or first use of corticosteroids, immunomodulators, or biologics agents for IBD. Results Prevalence of NAFLD in patients with IBD was 16.7%. Patients with hepatic steatosis and advanced fibrosis were older, had a higher body mass index, and were more likely to have diabetes (all p<0.05). Multivariate cox regression analysis revealed that hepatic steatosis was independently associated with an increased risk of relapse in patients with ulcerative colitis (UC) (hazard ratio [HR] 1.697, 95% confidence interval [CI] 1.291-2.230; p<0.001) and Crohn’s disease (CD) (HR 1.536, 95% CI 1.130-2.087; p=0.006). Advanced liver fibrosis was not associated with an increased risk of clinical relapse in patients with UC or CD (all p>0.05). Conclusion Hepatic steatosis was independently associated with increased risks of clinical relapse in patients with UC and CD, whereas fibrotic burden in the liver was not. Future studies should investigate whether the assessment and therapeutic intervention of NAFLD will improve clinical outcomes of patients with IBD.

Background Rheumatic mitral stenosis (MS) is a significant cause of valvular heart disease. Pulmonary artery systolic pressure (PASP) reflects the hemodynamic consequences of MS and is used to determine treatment strategies. However, PASP progression and expected outcomes in patients with moderately severe MS remain unclear. Purpose We aimed to examine the impact of progression rate of PASP in moderately severe MS. Methods A cohort of 866 consecutive patients with moderately severe rheumatic MS (1.0 cm2. Results Data-driven phenotyping identified two distinct trajectories based on PASP progression: a rapid progression group (N=38, 8.7%) and a slow progression group (N=398, 91.3%). Patients in the rapid progression group were older and had more comorbidities than patients in the slow progression group, including diabetes, and atrial fibrillation (all P<0.05). The initial mean diastolic pressure gradient and PASP were higher in the rapid progression group than in the slow progression group (6.2±2.4 mmHg vs. 5.1±2.0 mmHg, P=0.001, and 42.3±13.3 mmHg vs. 33.0±9.2 mmHg, P<0.001, respectively). During a mean follow-up of 7.0±3.0 years, the event-free survival rate was significantly lower in the rapid progression group than in the slow progression group (log-rank P<0.001). Rapid PASP progression was a significant risk factor for composite outcomes even after adjusting for comorbidities (hazard ratio: 3.08, 95% confidence interval (CI): 1.68–5.64, P<0.001). Multivariate regression analysis revealed that PASP>40 mmHg was independently associated with the probability of rapid progression group allocation (odds ratio: 4.95, 95% CI: 2.08–11.99, P<0.001). Conclusions Two groups with distinct patterns of PASP progression were identified. Rapid PASP progression was associated with a significantly higher risk of the composite outcomes. The main independent echocardiographic predictor for rapid progression group allocation was initial PASP>40 mmHg. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): This study was supported by a Severance Hospital Research fund for Clinical excellence (SHRC) (C-2020-0041) and a faculty research grant of Yonsei University College of Medicine (6-2020-0156).

Funding Acknowledgements Type of funding sources: None. Backgrounds Novel oral anticoagulants (NOACs) are effective to prevent stroke in patients with atrial fibrillation. Real world long-term data on the efficacy and safety of NOACs compared to warfarin in Asians are lacking. Purpose We aimed to explore the effectiveness and safety of NOAC in Asian patients with atrial fibrillation. Methods The medical records were reviewed in registry of four tertiary referral hospitals between January 1, 2012, and December 31, 2020. The primary outcome was the composite of thromboembolism, major bleeding and all caused mortality. Results Data were analyzed for 19,994 participants with oral anticoagulant and atrial fibrillation (median age, 72 years; female, 41.5%; warfarin, 35.5%; median CHA2DS2-VASc score, 3). The rate of the primary outcome was 5.5% per year in the NOAC group, as compared with 6.0% per year in the warfarin group (HR with NOAC, 0.70; 95% confidence interval [CI], 0.63 to 0.77; P<0.001 for superiority). The rate of ischemic event was 2.2% per year in the NOAC group, as compared with 2.8% per year in the warfarin group (HR, 0.56; 95% CI, 0.48 to 0.65; P<0.001). The rate of major bleeding was 1.9% per year in the NOAC group, as compared with 2.2% per year in the warfarin group (HR, 0.69; 95% CI, 0.58 to 0.82; P<0.001), and the rates of all caused death were 1.9% and 3.2%, respectively (HR, 0.85; 95% CI, 0.71 to 1.02; P=0.08). conclusion In Asian patients with atrial fibrillation, NOAC was effective and safe to prevent thromboembolic events with less bleeding compared to warfarin.