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Background and Aims Few populaion-based studies have investigated the long-term colectomy rates of ulcerative colitis [UC]. We aimed to assess the colectomy rates over 40 years of different therapeutic eras in a prospective population-based inception cohort from Veszprem Province, Western Hungary. Methods Patient inclusion lasted between January1, 1977, and December31, 2018. Patient follow-up ended December 31, 2020. Colectomy rates and disease course were examined in three different eras based on the time of UC diagnosis; cohort A [1977–1995], cohort B [1996–2008], and cohort C [2009–2018]. Results A total of 1370 incident UC patients were included [male 51.2%, median age at diagnosis 37 years]. Median follow-up was 17 years (interquartile range [IQR] 9–24); 87 patients [6.4%] underwent colectomy. The cumulative probability of colectomy in the total population was 2.6% (95% confidence interval [CI] 2.2-3.0), 4.2% [95% CI 3.6-4.8], 7.0% [95% CI 6.2-7.8], and 10.4% [95% CI 9.1-11.7] after 5, 10, 20, and 30 years, respectively. The proportion of extensive colitis at diagnosis increased over time [24.2%/24.3%/34.9% in cohorts A/B/C, respectively, p = 0.001]. Overall exposure to immunomodulators [11.3%/20.9%/34.4% in cohorts A/B/C, respectively, p Conclusion No differences in colectomy rates have been observed in the incident UC patients over 40 years despite increasing use of immunomodulators and biologic therapies.

Background Few population-based studies have investigated the long-term colectomy rates of ulcerative colitis (UC). The present study is a continuation of the Veszprem IBD population based cohort with a follow-up of the incidence and disease course for over 40 years. We aimed to assess the colectomy rates over 40 years of different therapeutic eras in a prospective population-based inception cohort from Veszprem Province, Western Hungary. Methods Patient inclusion lasted between January1,1977 and December31, 2018. Patient follow-up ended December 31,2020. Both in-hospital and outpatient records were collected and comprehensively reviewed at diagnosis and during clinical follow-up. Disease extension was evaluated based on the Montreal classification. Colectomy rates and disease course were examined in three different eras based on the time of UC diagnosis; cohort-A(1977-1995),cohort-B(1996-2008), and cohort C(2009-2018). Results Data of 1,370 incident UC patients were analyzed (male/female: 702/668; median age at diagnosis: 37 years(y) [IQR: 26-51]), with a median of 17y (IQR 9-24) follow-up. Table 1. The overall colectomy rate was 76/1,370 patients during the total follow-up. The proportion of extensive colitis at diagnosis increased over time (24.2% / 24.3% / 34.9% in cohorts A/B/C; p=0.001). Overall immunosuppressive therapy exposure was increasing in the cohorts (11.3% / 20.9% / 34.4%; p Conclusion No differences in proximal disease progression and colectomy rates have been observed in the incident UC patients over 40 years despite increasing use of immunomodulators and biological therapies.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): An investigator-initiated study. Research grant received from Biosense Webster (IIS 653). Background Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. The high power short duration ablation has shown good efficacy and safety profile. Recently, very high power short duration has been introduced, but initial efficacy results were discouraging. Purpose The goal of this study was to compare the long-term durability of PVI performed with a 90W vs. 50W power setting. Methods Patients were randomized in a 1:1 fashion to undergo PVI either with 90W or 50W power. The ablation protocol was the following: in the case of 50W, the ablation index target values were 400 on the posterior wall and 500 on the anterior wall, and the inter-lesion distance was Results A total of 40 patients were included in the study (20-20 on each treatment arm). Age was 65±8 years, 19 were females, BMI was 30±3.5, and 23 patients had paroxysmal AF. The most frequent comorbidities were hypertension (n=32) and diabetes (n=14). Procedure time (75 min vs. 84 min, p=0.02), left atrial dwelling time (63 min vs. 71 min, p=0.01), and radiofrequency time (335 sec vs. 1035 sec, p Conclusions A similarly high rate of durable PVI can be achieved both with 90W and 50W power settings if a slightly smaller inter-lesion distance is targeted on the anterior wall in case of 90W. Procedure time, left atrial dwelling time, and radiofrequency time is shorter with a 90W power setting compared to 50W.

Aims While left ventricular (LV) adaptation to regular, intense exercise has been thoroughly studied, data concerning the right ventricular (RV) mechanical changes and their continuum with athletic performance are scarce. The aim of this study was to characterize biventricular morphology and function and their relation to sex, age, and sports classes in a large cohort of elite athletes using three-dimensional (3D) echocardiography. Methods and results Elite, competitive athletes (n = 422) and healthy, sedentary volunteers (n = 55) were enrolled. Left ventricular and RV end-diastolic volumes (EDVi) and ejection fractions (EFs) were measured. To characterize biventricular mechanics, LV and RV global longitudinal (GLS) and circumferential strains (GCS) were quantified. All subjects underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Athletes had significantly higher LV and RV EDVi compared with controls (athletes vs. controls; LV EDVi: 81 ± 13 vs. 62 ± 11 mL/m2, RV EDVi: 82 ± 14 vs. 63 ± 11 mL/m2; P < 0.001). Concerning biventricular systolic function, athletes had significantly lower resting LV and RV EF (LV EF: 57 ± 4 vs. 61 ± 5%; RV EF: 55 ± 5 vs. 59 ± 5%; P < 0.001). The exercise-induced relative decrease in LV GLS (9.5 ± 10.7%) and LV GCS (10.7 ± 9.8%) was similar; however, the decrement in RV GCS (14.8 ± 17.8%) was disproportionately larger compared with RV GLS (1.7 ± 15.4%, P < 0.01). Right ventricular EDVi was found to be the strongest independent predictor of VO2/kg by multivariable linear regression. Conclusion Resting LV mechanics of the athlete’s heart is characterized by a balanced decrement in GLS and GCS; however, RV GCS decreases disproportionately compared with RV GLS. Moreover, this mechanical pattern is associated with better exercise capacity.

Background Limited data are available on the incidence and risk of colorectal cancer (CRC) in ulcerative colitis (UC) from population-based studies in Eastern Europe. We aimed to identify the long-term incidence trends and predictors of CRC in a prospective population-based inception cohort from Veszprem, Western Hungary. Methods Patient inclusion for the inception cohort was between January 1,1977 and December 31,2018, and follow-up ended December 31,2020. The risk of CRC was estimated using standardized incidence ratios (SIRs). Age-and gender-specific CRC rates of the background population were derived from the National Cancer Registry. Results A total of 1,370 incident UC patients were included [male:51.2%, median age at diagnosis:37years). During a median follow-up of 17 years(IQR9-24), CRC was diagnosed in 41 UC patients(2.99%), equaling 1.76/1000 person-year(py).Median age at CRC diagnosis was 59(IQR:50.0-67.5) years. Overall SIR of CRC was 2.02(CI95%:10.1-12.1). SIRs were higher in extensive colitis (SIR:3.77, CI95%:2.41-5.91). The cumulative probability of CRC at 10-,20 and 30 years was 0.9% (95%CI0.6-1.2), 3.5%(95%CI2.8-4.2), and 6.5%(95%CI5.4-7.6), and there was no difference in the risk of CRC over different decades of UC diagnosis in a Kaplan Meier analysis(Log-rank=0.693). In multivariate analyses, co-existing PSC(HR4.19;95%CI1.72-10.20), colonic dysplasia(3.42;95%CI1.04-11.26), and extensive colitis (HR2.15;95%CI1.29-3.60) were identified as a significant predictor for CRC. Conclusion We report an increased CRC risk in UC patients with a standardized incidence ratio of approximately 2 folds, with a stable CRC risk over four decades. Disease extent, co-existing PSC and dysplasia were identified as predictors of CRC.

Background Few population-based studies have investigated the long-term surgery rates of Crohn’s disease (CD). The present study is a continuation of the Veszprem IBD population based cohort with a follow-up since 1977. Our aim was to analyze the long-term disease course and surgery rates over different therapeutic eras in a prospective population-based database from Veszprem Province, including incident CD patients. Methods Patient inclusion was between January 1, 1977 and December 31, 2018; follow-up ended December 31, 2020. Both in-hospital and outpatient records were collected and comprehensively reviewed at diagnosis and during clinical follow-up. Surgery rates were examined in three different eras based on time of diagnosis: cohort-A, 1977-1995; cohort-B, 1996-2008; and cohort-C, 2009-2018. Results Data of 946 incident CD patients were analyzed (male/female: 496/450; median age at diagnosis:28 years(y) [IQR: 22-40]), with a median of 15y(IQR 9-21) follow-up.Table 1. Overall immunosuppressive therapy use was increasing by time (48.0%/62.4%/65.5%), as well as the probability of biological therapy initiation within 5 years of diagnosis (0.0±0%/7.3±1.2%/22.7±2.2%) in cohorts A/B/C. Figure 1. The cumulative probability of disease behavior progression in patients with luminal (B1) behavior into stenosing or penetrating phenotype (B2/B3) was 27.1±5.3%/ 21.5±2.5%/ 11.3±2.2% in cohorts A/B/C after 5 years (pLogRank Conclusion Disease behavior progression decreased, however no differences in resective surgery risk at 5 and 10 years from diagnosis have been observed in incident CD patients despite the increasing use of immunosuppressives and biologicals in this population based cohort. However, a decrease is shown in long term (20y) surgery risk comparing the earliest cohort to latter ones with higher immunosuppressive and biological use.

Background The number of epidemiological population-based studies on unclassified inflammatory bowel disease (IBD-U) patients are very limited. The present study is a continuation of the Veszprem IBD population based cohort with a follow-up of the incidence and disease course of IBD-U since 1977. Our aim was to evaluate incidence, prevalence, disease course, time to biological therapy and surgery rates in a prospective population-based database of incident IBD-U patients diagnosed between 1977 and 2018, with follow-up until 2020. Methods Both in-hospital and outpatient records were collected. The source of age- and gender-specific demographic data was derived from the Hungarian Central Statistical Office. Medical therapy, time to first biological therapy, disease progression, and colectomy was registered. Results Data of 119 incident IBD-U patients were analyzed (male/female: 55/64; median age at diagnosis: 34 years(y) (IQR: 24-47)). Adjusted mean incidence rate was 0.76 (CI95%: 0.63-0.9) /105 person-years in the total study period, and 0.96 (CI95%: 0.79-1.16) /105 person-years between 1990-2018. Disease extent at diagnosis was proctitis in 7.6%, one-sided colitis (left-sided colitis, or isolated right-sided colitis) in 36.1%, and extensive (pancolitis) in 56.3%. The probability of progression in colonic disease extent was 6.7% (SE:2.3) at 3 years, 10.3% (SE:2.8) at 5 years and 15.3% (SE:3.4) at 10 years. Figure 1. The probability of developing terminal ileitis, thus disease classification change – Crohn’s disease was 2.6% (SE:1.5) at 5 years and 3.5% (SE:1.7) at 10 years. Figure 2. Perianal disease developed in 5% (n=6) of all patients during the total follow-up. The probability of receiving biological therapy in patients diagnosed after the year 2000 (n=62), was 15.5% (SE:4.8) at 5 years, and 19.4% (SE:5.3) at 10 years. Figure 3. The overall resective surgery rate was 16.8% at the end of follow-up. Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal- or total colectomy. The cumulative probability of resective surgery was 7.6% (SE:2.4) at 1 year, 9.3% (SE:2.7) at 5 years, 13.5% (SE:3.3) at 10 years, and 18.5% (SE:3.9) at 20 years. Figure 4. Conclusion Initial disease phenotype was severe in most cases of IBD-U and colonic progression is substantial over time. Disease classification change to Crohn’s disease with development of terminal ileitis or perianal disease was low. High rates of biological therapy and surgery are suggestive of a severe disease course of IBD-U.

Background Few population-based studies have investigated rates and management of perianal disease and long-term perianal surgery rates in Crohn’s disease (CD). The present study is a continuation of the Veszprem IBD population based cohort with a follow-up osince 1977. Our aim was to analyze the long-term rates of perianal surgical procedures over different therapeutic eras in a prospective population-based database from Veszprem Province, including incident CD patients. Methods Patient inclusion was between January 1, 1977 and December 31, 2018; follow-up ended December 31, 2020. Both in-hospital and outpatient records were collected. Perianal surgical procedure was defined as any perianal surgical procedure including fistulotomy, abscess drainage or seton placement. Surgery rates were examined in three different eras based on time of diagnosis: cohort-A, 1977-1995; cohort-B, 1996-2008; and cohort-C, 2009-2018. Results Data of 946 incident CD patients were analyzed (male/female: 496/450; median age at diagnosis: 28 years(y) [IQR: 22-40]). Median follow-up time for the entire cohort was 15 years (IQR: 9-21). Table 1. Perianal disease at diagnosis was present in 17.4% (n=165) of the total cohort, and in 24.7%/ 18.5%/ 13.2% in cohorts A/B/C, respectively. By the end of follow-up, an additional 9.3% (n=88) of the total cohort developed perianal disease. Cumulative immunosuppressive and biologic therapy exposure increased by time in cohorts A/B/C (Table 2 and Figure 1), and biologic use was higher in patients with perianal disease compared to the overall population.Figure 2. The overall rate of perianal surgical procedures was 44.7% (113/253) in patients with perianal disease during the total follow-up. The cumulative probability of perianal surgical procedure in patients with perianal disease was 28.3±2.9% after 10 years, 41.0±3.5% after 20 years, and 64.1±5.1% after 30 years. No statistically significant differences have been observed in the cumulative probability of perianal intervention between cohorts A/B/C: 24.2±5.4%/ 19.9±3.5%/ 29.4±5.8% after 5 years; 33.9±6.0%/ 23.6±3.8%/ 31.7±6.1% after 10 years; [LogRank=0.594]. Figure 3. Cox-regression multivariate analysis showed that stenosing or penetrating disease (B2/B3) behavior (HR 1.81; 95%CI 1.19-2.75; p=0.005) was independent predictor of perianal surgical procedure. Table 3. Conclusion The burden of perianal disease and perianal surgical interventions was high in this cohort. Patients with perianal CD had higher exposure to biologicals. No difference was observed in perianal surgical intervention rates despite the increasing use of immunosuppressives and biologicals over time, however these procedures may partly represent a medical decision and the complex management of perianal disease.

Aims To investigate contraction patterns of the systemic right ventricle (SRV) in patients with transposition of great arteries (TGA) post-atrial switch operation and with congenitally corrected transposition of great arteries (ccTGA). Methods and results Right ventricular (RV) volumes and ejection fraction (EF) were measured by three-dimensional echocardiography in 38 patients with the SRV (24 TGA and 14 ccTGA; mean age 45 ± 12 years, 63% male), and in 38 healthy volunteers. The RV contraction was decomposed along the longitudinal, radial, and anteroposterior directions providing longitudinal, radial, and anteroposterior EF (LEF, REF, and AEF, respectively) and their contributions to total right ventricular ejection fraction (LEFi, REFi, and AEFi, respectvely). SRV was significantly larger with lower systolic function compared with healthy controls. SRV EF and four-chamber longitudinal strain strongly correlated with B-type natriuretic peptide (BNP) level (Rho −0.73, P < 0.0001 and 0.70, P < 0.0001, respectively). In patients with TGA, anteroposterior component was significantly higher than longitudinal and radial components (AEF 17 ± 4.5% vs. REF 13 ± 4.9% vs. LEF 10 ± 3.3%, P < 0.0001; AEFi 0.48 ± 0.09 vs. REFi 0.38 ± 0.1 vs. LEFi 0.29 ± 0.08, P < 0.0001). In patients with ccTGA, there was no significant difference between three SRV components. AEFi was significantly higher in TGA subgroup compared with ccTGA (0.48 ± 0.09 vs. 0.36 ± 0.08, P = 0.0002). Conclusion Contraction patterns of the SRV are different in TGA and ccTGA. Anteroposterior component is dominant in TGA providing compensation for impaired longitudinal and radial components, while in ccTGA all components contribute equally to the total EF. SRV EF and longitudinal strain demonstrate strong correlation with BNP level and should be a part of routine echocardiographic assessment of the SRV.

The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in Canada, is over 0.75% in 2021. Many individuals with IBD are immunocompromised. Consequently, the World Health Organization’s declaration of a global pandemic uniquely impacted those with IBD. Crohn’s and Colitis Canada (CCC) formed the COVID-19 and IBD Taskforce to provide evidence-based guidance during the pandemic to individuals with IBD and their families. The Taskforce met regularly through the course of the pandemic, synthesizing available information on the impact of COVID-19 on IBD. At first, the information was extrapolated from expert consensus guidelines, but eventually, recommendations were adapted for an international registry of worldwide cases of COVID-19 in people with IBD. The task force launched a knowledge translation initiative consisting of a webinar series and online resources to communicate information directly to the IBD community. Taskforce recommendations were posted to CCC’s website and included guidance such as risk stratification, management of immunosuppressant medications, physical distancing, and mental health. A weekly webinar series communicated critical information directly to the IBD community. During the pandemic, traffic to CCC’s website increased with 484,755 unique views of the COVID-19 webpages and 126,187 views of the 23 webinars, including their video clips. CCC’s COVID-19 and IBD Taskforce provided critical guidance to the IBD community as the pandemic emerged, the nation underwent a lockdown, the economy reopened, and the second wave ensued. By integrating public health guidance through the unique prism of a vulnerable population, CCC’s knowledge translation platform informed and protected the IBD community.

Inflammatory bowel disease (IBD) is a disease that results from dysregulation of the immune system and frequently requires medications that can affect the immune response to infections; therefore, it was imperative to quickly understand the risk of coronavirus disease 2019 (COVID-19) infection on persons living with IBD and how that risk may be increased by commonly used IBD medications. The IBD research community in Canada and beyond quickly established collaborative efforts to better understand the specific risk posed by COVID-19 on persons with IBD. We learned that IBD itself was not a risk factor for death or serious complications of COVID-19, and that most commonly used drug classes (with the notable exception of corticosteroids) do not increase the risk of COVID-19-related adverse outcomes. The risk factors for serious complications and death from COVID-19 appear to be similar to those identified in the wider population; those being advanced age, having pre-existing heart or lung disease, and smoking. We recommend that persons with IBD do not alter their course of therapy to avoid complications of COVID-19, though the indiscriminate use of corticosteroids should be avoided. Persons with IBD should follow the same public health recommendations as the general population to reduce their personal risk of acquiring COVID-19.

BackgroundNonalcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both conditions seem more frequent in patients with inflammatory bowel disease (IBD). We aimed to assess the effect of NAFLD and liver fibrosis on intermediate–high cardiovascular risk in IBD.MethodsWe prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP ≥275 dB m−1 and liver stiffness measurement by TE ≥8 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator and categorized as low if ResultsOf 405 patients with IBD included, 278 (68.6%), 23 (5.7%), 47 (11.6%), and 57 (14.1%) were categorized as at low, borderline, intermediate, and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (31.9%) and 35 (8.6%) patients, respectively. After adjusting for disease activity, significant liver fibrosis and body mass index, predictors of intermediate–high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% CI, 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI, 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI, 1.35–3.98).ConclusionsAssessment of cardiovascular risk should be targeted in IBD patients with NAFLD, particularly if they have longer IBD duration and ulcerative colitis.