The Telescope Array is a detector of extensive air shower produced by ultra High energy cosmic ray. This detector is located on Utah, USA. The construction have been completed and the full operation has been running from March 2008. In this talk, the status of observation and our prospects are described.

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).

Background It has been known that liver stiffness (LS) assessed by transient elastography is associated with right heart dysfunction and the severity of the tricuspid regurgitation. However, the predictive value of LS for adverse outcome in patients with tricuspid regurgitation (TR) is uncertain. Objectives The aim of this study was to identify the prognostic value of LS in patients with moderate or greater degree of TR. Methods A total of 257 patients with moderate or severe TR who underwent both echocardiography and liver transient elastography were retrospectively analysed. Patients who have congenital heart disease or chronic liver disease including, viral hepatitis, alcoholic liver disease, autoimmune hepatitis, hepatocellular carcinoma were excluded. Severe LS was defined as elevated kilopascal (kPa) ≥11 (High kPa). Primary outcome was defined as the composite of all-cause death and unplanned admission for heart failure. Results One hundred forty-one patients had moderate TR and 116 patients had severe TR. One hundred twenty-eight (50%) patients had severe liver stiffness. During a follow-up period (median 637 days, IQR 1317), 116 (45.1%) primary outcomes occurred. In Kaplan-Meier analysis, patients who had severe TR with high kPa showed the worst outcome. Moreover, patients who had high kPa were associated with worse clinical outcome both moderate TR group and severe TR group than patients with low kPa. In multivariate Cox regression analysis, severe liver stiffness was independently associated with primary outcomes (HR=1.66, 95% CI: 1.28–2.16), p<0.001). Conclusions LS is independently associated with adverse clinical outcomes in both patients with moderate and severe TR. The degree of liver fibrosis measured by transient elastography may be a useful marker of cardiac hepatopathy related to TR, and this may contribute to predict the prognosis of TR. Funding Acknowledgement Type of funding sources: None.

Background There is increasing Interest in bio-prosthetic MVD as recent advances in transcatheter MV interventions, but there is limited data. Objectives The aim of this study was to identify the factors determining mitral valve (MV) dysfunction (MVD) in patients who underwent MV replacement with bio-prosthetic valves. Also, we sought to investigate clinical outcomes in patients with bio-prosthetic MVD. Methods A total of 233 patients underwent surgical bio-prosthetic MV replacement between June 1996 and May 2015. Finally, 226 patients (mean age 66.9±11.5 years, 74.3% of women) were analyzed, excluding patients who followed-up for less than 5 years and patients whose baseline or follow-up echocardiography could not be analyzed. Clinical, echocardiographic, and laboratory data were collected early after the surgery and during follow-up. MVD was defined as an increase in mean gradient ≥5 mmHg with leaflet motion limitation and/or newly developed MV regurgitation during follow-up. Clinical outcome was defined as a composite of cardiovascular death, redo MV surgery or intervention, and hospitalization for heart failure. Results During a median of 102.0 months (interquartile range 72.0 to 132.0 months), 65 patients (28.8%) revealed MVD. 8 (12.3%) patients revealed predominant MV obstruction, and 57 (87.7%) showed predominant MV regurgitation. Factors associated with bio-prosthetic MVD by multivariate regression analysis were young age at operation (hazard ratio 0.97, 95% CI 0.95–0.99, p=0.001), end-stage renal disease (hazard ratio 4.29, 95% CI 1.45–12.71, p=0.007), elevated mean diastolic pressure gradient>5.5 mmHg across the bio-prosthetic MV early after operation (hazard ratio 1.86, 95% CI 0.97–3.74, p=0.063) and anemia after operation (hazard ratio 0.84, 95% CI 0.74–0.95, p=0.007). However, the presence of hypertension, dyslipidemia, or porcine bio-prosthesis was not related to the bio-prosthetic MVD. Kaplan-Meier curves revealed significant differences in event-free survivals for the occurrence of bio-prosthetic MVD according to each factor (Figure 1). Patients with bio-prosthetic MVD showed significantly poor clinical outcomes compared with those without bio-prosthetic MVD (event-free survival 43.1% vs. 91.9%, log-rank p<0.001) during the follow-up. Conclusions Young age at operation, end-stage renal disease, elevated mean pressure gradient early after the operation, and anemia after operation were associated with bio-prosthetic MVD in patients who underwent bio-prosthetic MV replacement. FUNDunding Acknowledgement Type of funding sources: None.