ObjectiveThis study evaluated tumour necrosis factor-α, interleukins 10 and 12, and interferon-γ levels, peripheral blood mononuclear cells, and clusters of differentiation 17c and 86 expression in unilateral sudden sensorineural hearing loss.MethodsTwenty-four patients with unilateral sudden sensorineural hearing loss, and 24 individuals with normal hearing and no history of sudden sensorineural hearing loss (who were attending the clinic for other problems), were enrolled. Peripheral blood mononuclear cells, and clusters of differentiation 11c and 86 were isolated and analysed. Plasma and supernatant levels of tumour necrosis factor-α, interferon-γ, and interleukins 10 and 12 were measured.ResultsThere were no significant differences with respect to age and gender. Monocyte population, mean tumour necrosis factor-α level and cluster of differentiation 86 expression were significantly increased in the study group compared to the control group. However, interferon-γ and interleukin 12 levels were significantly decreased. The difference in mean interleukin 10 level was not significant.ConclusionIncreases in tumour necrosis factor-α level and monocyte population might play critical roles in sudden sensorineural hearing loss. This warrants detailed investigation and further studies on the role of dendritic cells in sudden sensorineural hearing loss.

Objectives Mortality following percutaneous coronary intervention (PCI) is a key quality measurement in clinical practice. This study investigated the 10-year trends of mortality following PCI in an unselected nationwide cohort. Design Retrospective cohort study. Setting A nationwide study in South Korea. Participants PCI claim data from 2006 to 2015 of the National Health Insurance Service and the Statistics of Korea. Measures 1-year cardiovascular or non-cardiovascular death. Results In total, 437,436 patients were included. The annual number of PCI increased from 32,098 to 51,990 over the decade studied (p<0.001). Patients were divided into quartile subgroups according to clinical score for predicting 1-year all-cause death. The proportion of patients in the high-risk quartiles increased, whereas those in the low-risk quartiles decreased (p<0.001). The 1-year cumulative incidence rate of all-cause death did not change in the population with risk scores in the 1st (0.9% to 0.8%) and 2nd (1.3% to 1.3%) quartiles, whereas it increased in the population with risk scores in the 3rd (3.4% to 5.1%) and 4th (15.5% to 19.4%) quartiles (p<0.001). Compared to year 2006, the mean survival time in year 2015 was shorter by 0, 3.3, and 12.4 days in patients with risk scores in the 1st or 2nd, 3rd, 4th quartiles, respectively. These findings were also consistent for cardiovascular or non-cardiovascular deaths. Conclusion The number, proportion, and the overall risk of patients with a high risk for mortality after PCI increased over the decade in Korea. Funding Acknowledgement Type of funding sources: None.

Background Sex-specific survival following percutaneous coronary intervention (PCI) varies among studies. This might be clarified using relative survival, which adjusts observed survival in relation to that seen in sex- and age-matched general population. We investigated sex-specific relative survival after PCI. Methods A total of 48,783 patients were enrolled in the year 2011 Korean nationwide PCI cohort. Primary outcome was all-cause death. Observed and relative survival at 5 years conditional on surviving 0 days, 30 days, 1 year, and 2 years were assessed. Sex-specific differences in cardiovascular risk factors were adjusted via age-group stratified propensity score matching. Results In the unadjusted analyses, 15,710 female patients had a higher frequency of cardiovascular risk factors compared with 33,073 male patients. Both observed survival (hazard ratio [HR]=1.28, 95% confidence interval [CI]=1.22–1.34) and relative survival (HR=1.21, 95% CI: 1.16–1.27) were worse in female compared with male (p<0.001, all). In analyses of propensity score-matched 14,454 pairs, female showed a higher observed survival (HR=0.78, 95% CI: 0.74–0.82) but a lower relative survival (HR=1.19, 95% CI: 1.13–1.26) compared with male (p<0.001, all). Neither observed nor relative survival differed between female of age≤50s and age-matched male, but they were lower in female of age≥60s than age-matched male. These findings were consistent in further analyses conditional on surviving 30 days, 1 year, and 2 years. Conclusions The 5-year relative survival of female aged≥60 years adjusted by clinical risk factors was lower than that of age-matched male, which mandates the need for the excessive risk reduction in older female undergoing PCI. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Background/Introduction Proton pump inhibitor is commonly used for gastroprotective effect in patients with a combination of antiplatelets and anticoagulants. However, data quantifying the concomitant proton pump inhibitor for clinical adverse outcomes other than gastrointestinal bleedings of oral anticoagulant is lacking. Purpose We aimed to explore the effect of concomitant proton pump inhibitor on the effectiveness and safety of oral anticoagulant in patients with atrial fibrillation. Methods The medical records were retrospectively reviewed from four tertiary referral hospitals between January 1, 2012, and December 31, 2020. Concomitant use of drug was quantified as the overlapping proportion over the duration of oral anticoagulant therapy. Primary endpoint was the time to occurrence of ischemic stroke, systemic embolism, intracardiac thrombus, major bleeding events, or death. Results Data were analyzed for 20,750 episodes with oral anticoagulant and atrial fibrillation (median [IQR] age, 71 [63-78] years; female, 42.5%; warfarin, 37.3%; median [IQR] CHA2DS2-VASc score, 3 [2-5]). The risk of primary endpoint was greatest in the group of persistent use (80% or more of overlapping proportion) of proton pump inhibitor among the other groups with less overlapping proportion (adjusted hazard ratio, 1.88; 95% confidence interval, 1.63–2.16; P for groups, <0.001). Concomitant proton pump inhibitor was not associated with the risk of major bleeding from the gastrointestinal tract. Conclusion Among patients with atrial fibrillation receiving oral anticoagulant, concomitant use of proton pump inhibitor increased the rate of thromboembolism, major bleeding, or death in proportion of overlapping period.

Background Hepatic sinusoidal obstruction syndrome (HSOS) is a well-known fatal complication of hematopoietic cell transplantation (HCT), but the impact of cardiac abnormalities on the occurrence of HSOS has been poorly evaluated. Therefore, the authors investigated whether the structural changes or dysfunction of the heart before HCT is associated with the future occurrence of HSOS. Methods A total of 92 patients who underwent HCT were divided into 2 groups; HSOS group (n=11, 6 males, 53.8±15.9 years) vs no HSOS group (n=81, 51 males, 48.6±14.7 years). According to the modified Seattle criteria, HSOS was defined as otherwise unexplained occurrence of 2 or more of the following events within 20 days of HCT; serum total bilirubin >2 mg/dL, hepatomegaly or right upper quadrant pain, sudden weight gain due to fluid accumulation (>2% of baseline body weight). Echocardiography examinations were performed 1 month before HCT, and echocardiographic findings were compared between the groups. Results HSOS was developed in 11 patients (12.0%). HSOS group had significantly larger left ventricular end-diastolic volume index (LVEDVI) (65.2±4.9 vs 53.2±6.9 ml/m2, p<0.001) and relatively worse systolic function than no HSOS group (LV ejection fraction: 56.4±3.4 vs 65.1±5.9%, p<0.001, LV global longitudinal strain: −17.9±1.4 vs −20.1±2.0%, p=0.001). LV diastolic functional parameters were also significantly worse in HSOS group than in no HSOS group (E/E' ratio: 11.3±1.8 vs 9.1±2.0, p=0.002, left atrial global longitudinal strain: 27.7±3.3 vs 34.9±5.9%, p<0.001). However, left atrial volume index was not different between the groups (30.8±2.8 vs 29.0±3.3 ml/m2, p=0.078). By receiver operation characteristic curve analysis, among significantly different variables, LVEDVI was the most powerful predictor for HSOS, and the optimal cutoff value was 59.25 mL/m2. (81.8% sensitivity and 77.8% specificity, AUC 0.909). Predictor of HSOS: ROC analysis Conclusions The present study demonstrated that structural changes or dysfunction of the heart are more prevalent in patients with HSOS after HCT and larger LVEDVI, among them, can be a useful predictor of upcoming HSOS. Routine echocardiographic study before HCT would be useful to identify high risk group for HSOS, and the development of HSOS should be carefully monitored in HCT patients with cardiac structural changes or dysfunction on echocardiography.