Ekrem Guler

Background: Whether the initial clip type selected during transcatheter edge-to-edge repair (TEER) of the mitral valve—grasping width and arm length—independently influences procedural and echocardiographic outcomes remains uncertain. Methods: We retrospectively analyzed 138 consecutive patients undergoing mitral TEER. The first implanted clip was classified as narrow standard-length (NT), long narrow-arm (XT), or long wide-arm (XTW). Determinants of initial clip selection and its association with procedural success (residual mitral regurgitation [MR] ≤ 1+), post-procedural transmitral gradient, and the need for ≥2 clips were assessed using multivariable logistic and linear regression. Results: Median age was 74.0 (66.0–80.0), 74.5 (66.0–82.5), and 75.0 (70.0–79.0) years, and median LVEF was 35.0% (30.0–50.0), 30.0% (25.0–45.0), and 40.0% (25.0–45.0), for the NT, XT, and XTW groups, respectively; 66% of patients overall were male. An XTW clip was implanted first in 61.6% of patients. XTW selection was independently associated with larger effective regurgitant orifice area, lower LVEF, longer posterior leaflet length, and secondary MR (all p < 0.05), whereas NT selection favored younger age, smaller orifice, and higher LVEF. After adjustment for these factors, no statistically significant independent association was detected between initial clip type and residual MR ≥2+, post-procedural transmitral gradient, or the need for additional clips (all p > 0.05); however, confidence intervals were wide. On univariable analysis, larger left atrial size and moderate-to-severe tricuspid regurgitation were associated with residual MR ≥ 2+, but neither remained significant after multivariable adjustment. Conclusions: Initial clip selection was associated with valve anatomy, LVEF and MR etiology. No statistically significant independent association between initial clip type and procedural or short-term echocardiographic outcomes was detected in this cohort. Given the observational design, confounding by indication, limited sample size and wide confidence intervals, clinically relevant effects cannot be excluded, and these findings do not establish the superiority or equivalence of any clip-selection strategy.

Background and Objectives: Patients with impaired left ventricular ejection fraction (LVEF) undergoing transcatheter aortic valve implantation (TAVI) remain at high risk for adverse outcomes despite successful procedures. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in heart failure, but their long-term impact after TAVI is not well established. Materials and Methods: This single-center retrospective study included patients with LVEF < 50% who underwent transfemoral TAVI between January 2015 and September 2025. Patients were stratified according to SGLT2i use. The primary outcome was a composite of all-cause mortality and heart failure (HF) hospitalization requiring intravenous diuretics. Secondary outcomes included all-cause mortality, HF hospitalization, and changes in echocardiographic parameters at 6 months. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for baseline differences. Time-to-event analyses were performed using IPTW-weighted Cox models and adjusted survival curves. Results: The study included 226 patients (78 SGLT2i users, 148 non-users) with a median follow-up of 37 months. After IPTW adjustment, SGLT2i use was associated with a lower rate of the composite outcome (32.8% vs. 50.8%, p = 0.019) and a lower crude long-term mortality (32.8% vs. 47.4%, p = 0.056). Acute kidney injury after TAVI occurred less frequently among SGLT2i users (3.4% vs. 17.4%, p = 0.013). In IPTW-weighted Cox analyses, SGLT2i use was associated with a reduced risk of all-cause mortality (HR 0.57, 95% CI 0.32–0.98) and the composite outcome (HR 0.56, 95% CI 0.33–0.96). SGLT2i users demonstrated greater reductions in left ventricular end-diastolic diameter at 6 months. Conclusions: In patients with impaired LVEF undergoing TAVI, SGLT2 inhibitor therapy was associated with improved long-term survival, better composite outcome-free survival, and lower rates of post-TAVI acute kidney injury. Larger prospective studies are warranted to confirm these findings.

Purpose In our study, we aimed to assess the role of acceleration time (AT), ejection time (ET), and AT/ET ratio to distinguish between true and pseudo severe AS in patients with classical low flow-low gradient (LF-LG) aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF). Methods Sixty-seven classical LF-LG AS with reduced LVEF patients who underwent dobutamine stress echocardiography (DSE) were included in the study. According to DSE results, all patients were divided into two groups; true AS and pseudo severe AS. Aortic valve calcium score was measured in patients with inconclusive DSE results. AT and other ejection dynamics (ET and AT/ET) were calculated by taking baseline echocardiographic records into account for all patients. The predictive power of AT and other ejection dynamics were evaluated to estimate true and pseudo severe AS. Results According to DSE results, out of 67 patients, 44 (65.7%) was diagnosed as true severe AS. There was a statistically significant relation between baseline AT and true AS [adjusted OR 4.47 (95% CI 1.93–10.4), p = 0.001]. The best cutoff value of AT was measured as 100 msec according to the Youden index. This value had a sensitivity value of 77%, specificity value of 87%, positive predictive value of 92%, and a negative predictive value of 67%. Conclusion The measurement of AT can predict the DSE outcome and can be used for diagnostic purposes to distinguish between true and pseudo severe AS in classical LF-LG AS patients with reduced LVEF.

Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm² and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7–9) and novel 3D TEE score was found 4 (IQR 3–4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS.

Anadolu Kardiyoloji Dergisi, Anadolu Kardiyol Derg, The Anatolian Journal of Cardiology, Anatol J Cardiol, Cardiology, Cardiovascular Medicine, Surgery, Pediatric Cardiology, Angiology

Background: In this study, we aimed to determine pulmonary vein (PV) variation patterns in patients undergoing cryoballoon ablation for atrial fibrillation (AF) and their impacts on procedural success and recurrence and also to identify predictors for recurrence.Methods: We enrolled 54 patients with AF and having symptoms despite medical therapy. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by computed tomography scan. Ablation procedure was performed with single balloon and predictors for AF recurrence were determined.Results: The study population consisted of 54 patients (male: 50 [27%], mean age: 53 ± 12) with AF. Paroxysmal AF and persistent AF were detected in 55.6% (30) and 44.4% (24) of the patients, respectively. Mean procedural and fluoroscopy times were 73 ± 19 minutes and 16 ± 4 minutes, respectively. The number of the patients with PV variation of right pulmonary vein (RPV) with >2 ostia and accessory PV was 27.8% (15) and 18.5% (10). During the follow‐up, 20.4% (11) of patients had AF recurrence. Patients with recurrence had greater transverse LA size (62 ± 6 mm vs 57 ± 5 mm, P: 0014), longitudinal LA size (65 ± 5 mm vs 61 ± 6 mm, P: 0025), LA volume (78 ± 17 mL vs 65 ± 14 mL, P: 0011), fluoroscopy time (20.4 ± 4.6 minutes vs 15.7 ± 3.5 minutes, P: 0001), RPV with >2 ostia (72.7% vs 27.3%, P: 0001), right upper pulmonary vein (RUPV) diameter (21.6 ± 2.8 cm vs 15.8 ± 2.1 cm; P < 0001), and persistent AF (33.3% vs 66.7%, P: 0046). In multivariate analysis, RUPV diameter (β: 1006; P: 0010; odds ratio [OR]: 2736; 95% confidence interval [CI]: [1267–5906]) and fluoroscopy time (β: 0327; P: 0050; OR: 1386; 95% CI: [1000–1921]) were determined as independent predictors for AF recurrence.Conclusions: Transverse and longitudinal LA size, LA volume, fluoroscopy time, presence of persistent AF, RUPV size, and the number of RPV ostia are associated with AF recurrence following cryoballoon‐based ablation. RUPV size and fluoroscopy time are predictors for recurrence.

Low adiponectin and high lipoprotein(a) [Lp(a)] levels are associated with endothelial dysfunction, atherosclerosis, and coronary artery disease. Cardiac syndrome X (CSX) is characterized by anginal symptoms, positive stress test, and documentation of normal epicardial coronary arteries with angiography. In this study we aimed to investigate the relationship between CSX and circulating levels of adiponectin and Lp(a). We enrolled 53 female patients with CSX and 33 patients as the control group. The diagnosis of CSX was made according to presence of angina, findings suggestive of ischemia during stress electrocardiography or myocardial perfusion scintigraphy, and documentation of normal coronary arteries in coronary angiography. The control group consisted of patients with atypical angina and normal stress electrocardiography test results. Both groups were matched in terms of hypertension, diabetes mellitus, and metabolic syndrome. Adiponectin levels were significantly decreased in patients with CSX (4.57 μg/ml vs. 13.18 μg/ml; p=0.001); however, Lp(a) levels were significantly increased (36.30 mg/dl vs. 7.24 mg/dl; p < 0.001). Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) concentrations did not differ between the case group and the control group (p=0.14, p=0.62, p=0.64, respectively). There was no significant difference between groups in terms of age, body mass index, waist circumference hypertension, hyperlipidemia, diabetes mellitus, or metabolic syndrome. In multivariate analysis, Lp(a) and adiponectin were found to be independent predictors of CSX. An Lp(a) level of > 21 mg/dl had 84 % sensitivity and 96 % specificity {area under the curve (AUC)= 0.922, p < 0.0001, 95 % CI [0.842–0.970]} and an adiponectin level of ≤ 5.18 μg/ml also had 58.7 % sensitivity and 82.1 % specificity (AUC=0.726, p=0.0003, 95 % CI [0.609–0.823]) for detecting CSX. We detected low adiponectin and high Lp(a) levels in patients with CSX and these findings may be related to the microvascular injury in CSX. Niedrige Werte für Adiponectin und hohe Werte für Lipoprotein(a) [Lp (a)] stehen in Zusammenhang mit endothelialer Dysfunktion, Atherosklerose und koronarer Herzkrankheit. Das kardiale Syndrom X (CSX) ist durch Anginasymptome, ein positives Belastungs-EKG und den Nachweis normaler epikardialer Koronararterien in der Angiographie gekennzeichnet. In der vorliegenden Studie war es das Ziel, den Zusammenhang zwischen CSX und den zirkulierenden Blutwerten für Adiponectin und Lp(a) zu untersuchen. In die Studie aufgenommen wurden 53 Patientinnen mit CSX und 33 Patienten als Kontrollgruppe. Die Diagnose eines CSX wurde gestellt, wenn Angina, Hinweise auf eine Ischämie im Belastungs-EKG oder in der Myokardperfusionsszintigraphie und der Nachweis normaler Koronararterien in der Koronarangiographie vorlagen. Die Kontrollgruppe bestand aus Patienten mit atypischer Angina und normaler Belastungs-EKG-Untersuchung. Beide Gruppen wurden in Bezug auf Hypertonie, Diabetes mellitus und metabolisches Syndrom gematcht. Die Adiponectinwerte waren bei Patienten mit CSX signifikant erniedrigt (4,57 μg/ml vs. 13,18 μg/ml; p=0,001), jedoch waren die Lp(a)-Werte signifikant erhöht (36,30 mg/dl vs. 7,24 mg/dl; p < 0,001). Bei den Konzentrationen von Low-Density-Lipoprotein(LDL)-Cholesterin, High-Density-Lipoprotein(HDL)-Cholesterin und Triglyzeriden (TG) bestanden keine Unterschiede zwischen der Fall- und der Kontrollgruppe (p:0,14; p:0,62; p:0,64). Auch gab es keinen signifikanten Unterschied zwischen den Gruppen in Bezug auf Alter, Body-Mass-Index, Taillenumfang, Hypertonie, Hyperlipidämie, Diabetes mellitus und metabolisches Syndrom. In der multivariaten Analyse stellten sich Lp(a) und Adiponectin als unabhängige Prädiktoren eines CSX heraus. Ein Lp (a) > 21 mg/dl wies eine Sensitivität von 84 % und eine Spezifität von 96 % für die Erkennung eines CSX auf (Fläche unter der Kurve, AUC=0,922; p < 0,0001; 95 %-KI: 0,842–0,970) und für einen Adiponectinwert ≤ 5,18 μg/ml betrug die Sensitivität 58,7 % und die Spezifität 82,1 % (AUC= 0,726; p=0,0003; 95 %-KI: 0,609–0,823). Die Autoren wiesen niedrige Werte für Adiponectin und hohe Werte für Lp(a) bei Patienten mit CSX nach, was möglicherweise in einem Zusammenhang mit mikrovaskulären Läsionen bei CSX steht.

Anadolu Kardiyoloji Dergisi, Anadolu Kardiyol Derg, The Anatolian Journal of Cardiology, Anatol J Cardiol, Cardiology, Cardiovascular Medicine, Surgery, Pediatric Cardiology, Angiology

Purpose: Transesophageal echocardiography (TEE) has a pivotal role in invasive cardiology practice in terms of guiding a variety of procedures. It is challenging to perform TEE examination with sedated patients due to difficulties in cooperation and positioning the patient properly, therefore the risk of complications is escalated. We aimed to assess the impact of pediatric TEE probe utilization on procedural success and complication rates; in comparison with conventional adult TEE probe.Methods: Fifty‐eight patients undergoing atrial fibrillation (AF) ablation with TEE guidance were enrolled and patients were grouped based on probe size: Group 1 (n = 35) included patients undergoing the procedure with adult TEE probe guidance and Group 2 (n = 23) included patients with pediatric TEE probe guidance. Procedural success, postprocedural odynophagia and periprocedural intra‐oral bleeding frequency, number of intubation attempts, TEE imaging time, and midazolam doses for both groups were compared.Results: Odynophagia frequency was significantly higher in Group 1 (25.7% [n = 9] vs. 0%, P = 0.008) besides oral mucosal bleeding was also higher in Group 1, although the difference did not reach statistical significance (5.7% [n = 2] vs. 0%, P = 0.513). Number of repeated attempts was lower in Group 2 (median, 1; range [3–1] vs. 1, [1–1], P = 0.038). Image resolutions and septal puncture success rates were similar for both groups. Total imaging time with TEE was significantly shorter in Group 2 (6.4 ± 1.8 min vs. 3.6 ± 0.9 min, P < 0.001). Midazolam dose was lower in Group 2 (7.0 ± 1.7 vs. 6.2 ± 1.7, P = 0.065).Conclusion: Using TEE probes with smaller size for guiding invasive percutaneous procedures performed in cardiac catheterization laboratory decreased TEE‐associated complication rates and enhanced patient comfort without any negative effect on procedural success.