Emrah Bayam

Background: Low-flow, low-gradient aortic stenosis with reduced left ventricular ejection fraction is a heterogeneous condition with challenging severity assessment. Aortic valve calcification reflects fibro-calcific remodeling, while oxidative stress plays a key role in its pathogenesis. Serum uric acid, a marker of oxidative stress, may be associated with valvular calcification. This study investigated the relationship between serum uric acid levels and aortic valve calcification in this population. Methods: This retrospective study included 85 patients. Aortic valve calcification was quantified using computed tomography with the Agatston method, and patients were categorized as true severe or pseudo-severe according to sex-specific calcium thresholds. Of the patients, 57 were classified as true severe and 28 as pseudo-severe aortic stenosis. Results: Patients with higher calcification burden had significantly elevated serum uric acid levels (6.77 ± 1.57 vs. 5.08 ± 1.10 mg/dL, p < 0.001). Serum uric acid showed a modest correlation with aortic valve calcium score (ρ = 0.339, p = 0.002) and remained independently associated with CT-defined true severe low-flow, low-gradient aortic stenosis in multivariable analysis. ROC analysis yielded an area under the curve of 0.823 and identified a serum uric acid threshold of 5.45 mg/dL associated with a greater likelihood of CT-defined true severe low-flow, low-gradient aortic stenosis. Conclusions: Serum uric acid is associated with CT-derived aortic valve calcification and may provide insight into underlying fibro-calcific remodeling in this population.

Atrial fibrillation (AF) is a common electrical complication in patients with acute myocardial infarction. The HAVOC score was originally proposed as a clinical tool for predicting AF in patients with cryptogenic stroke or transient ischemic attack. This study evaluated the predictive value of the HAVOC score for new-onset AF (NOAF) in patients with ST-segment elevation myocardial infarction (STEMI). Between August 2019 and December 2024, the data of 1640 patients (mean age: 56.3 ± 11.2 years, male: 1134, 69.1%) with STEMI were retrospectively analyzed. Patients were divided into two groups: those with and those without NOAF. All patients underwent electrocardiographic monitoring and echocardiographic evaluation following primary percutaneous coronary intervention. Overall, NOAF was observed in 115 patients. A comparison of the clinical and demographic characteristics between the groups showed that age, hypertension frequency, chronic obstructive pulmonary disease, and history of stroke were higher in the NOAF group. Left ventricular ejection fraction was significantly lower (38.2 ± 10.8 vs. 47.9 ± 10.1%, p < 0.001) and left atrial diameter (42.2 ± 4.5 vs. 37.5 ± 4.1 mm, p = 0.001) was significantly higher in these patients. Furthermore, the incidence of unsuccessful intervention, contrast-induced nephropathy, and in-hospital mortality as well as the HAVOC score were significantly higher in patients with NOAF. A high HAVOC score (odds ratio [OR] = 1.078; 95% confidence interval [CI]: 1.022-1.258; p = 0.001) was identified as an independent predictor of NOAF in patients with STEMI. The HAVOC score appears to be a useful tool for predicting NOAF in patients with STEMI. Identifying individuals with high HAVOC scores may enable early recognition and prevention of AF-related complications.

Background: The presystolic wave (PSW), a late-diastolic Doppler flow signal in the left ventricular outflow tract, reflects atrial contraction and atrioventricular coupling. Although its presence is considered a physiological finding in healthy individuals, alterations in PSW characteristics may indicate impaired atrial or ventricular compliance. This study aimed to evaluate the relationship between PSW and cerebrovascular events (CVE) in patients with paroxysmal atrial fibrillation (PAF). Methods: In this retrospective study, 380 patients diagnosed with PAF by 24-hour Holter monitoring between January 2019 and January 2025 were analyzed. Transthoracic echocardiography was performed to assess PSW presence, left ventricular systolic and diastolic functions. Patients were divided according to PSW presence and history of CVE (stroke or transient ischemic attack). Clinical, laboratory, and echocardiographic variables were compared, and multivariate logistic regression was used to identify independent predictors of CVE. Results: PSW was identified in 284 (74.7%) patients. Those without PSW were older, had greater left atrial volume index (LAVI) and left ventricular mass index (LVMI), and more frequently had previous CVE (45.8% vs. 16.9%, p < 0.001). In multivariate analysis, high CHA₂DS₂-VASc score, increased LAVI, and absence of PSW were independent predictors of CVE. ROC analysis showed that a PSW peak velocity < 0.30 m/s was associated with the presence of CVE, with 81% sensitivity and 67% specificity (AUC = 0.783, p < 0.001). Conclusion: Absence or reduction of the PSW is independently associated with CVE in PAF patients. PSW assessment provides a simple, reproducible, and noninvasive measure of atrioventricular mechanical function that may be associated with increased thromboembolic vulnerability.

Renal denervation (RDN) has emerged as a potential therapeutic option for resistant hypertension (HT), which remains a major clinical challenge due to poor blood pressure (BP) control despite optimized pharmacotherapy. This study aimed to assess the safety and effectiveness of catheter-based RDN in resistant hypertension patients, based on our center's experience. This retrospective, single-center study included 120 patients with resistant HT who were eligible for RDN and underwent the procedure using the Symplicity Spyral system between January 2023 and December 2024. Office systolic and diastolic BP were assessed at baseline and 6 months after RDN. The primary endpoint was the reduction in BP, while secondary endpoints included changes in the number of antihypertensive medications. At 6 months, office systolic BP decreased significantly from 156 ± 7.7 mmHg to 143 ± 3.7 mmHg, while diastolic BP declined from 93.5 ± 5.5 mmHg to 90 ± 3.9 mmHg (both p < 0.001). Median per-patient reductions were 13 mmHg systolic and 3.5 mmHg diastolic. The mean number of antihypertensive medications decreased from 4.88 ± 0.9 to 4.47 ± 1.1 (p < 0.001). Minor adverse events included acute kidney injury in two patients (1.7%) and femoral artery injury in one patient (0.8%). Catheter-based RDN using the Symplicity Spyral system was safe and effective in reducing BP and medication burden in patients with resistant HT. These results support RDN as a potential therapeutic option in appropriately selected patients.

Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), particularly in the elderly who are more vulnerable due to renal impairment, comorbidities, malnutrition, and chronic inflammation. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been proposed as a biomarker reflecting nutritional and inflammatory status, but its role in predicting CI-AKI in elderly STEMI patients is unclear. This retrospective study included 588 elderly (≥65 years) STEMI patients treated with pPCI between August 2019 and December 2024. CI-AKI occurred in 70 patients (11.9%), who were older and had higher rates of diabetes mellitus (DM), hypertension, and chronic kidney disease, along with lower glomerular filtration rate (GFR), left ventricular ejection fraction (LVEF), and HALP score. The mean HALP score was significantly lower in patients with CI-AKI (2.68 [2.33-3.32] vs 3.85 [2.68-5.37], P < .001). In multivariate analysis, older age, DM, lower LVEF, higher contrast volume, and lower HALP score independently predicted CI-AKI. A HALP score <2.7 predicted CI-AKI with 75% sensitivity and 55% specificity (Area Under the Curve: 0.698). The HALP score provides an accessible, independent predictor of CI-AKI in elderly STEMI patients, enabling improved early risk stratification.

Background: Mycotic aneurysms are rare complications of infective endocarditis, occurring in ∼2% of cases and often associated with high morbidity and mortality. Femoral, carotid, and iliac arteries are most commonly affected. When this complication arises, it further complicates the management and treatment of infective endocarditis, which is already a challenging condition to treat. Case summary: We report a 34-year-old male with a history of mechanical mitral valve replacement who presented with fever, fatigue, and loss of appetite. Due to a high clinical suspicion of infective endocarditis, empirical antibiotics were initiated accordingly. Blood cultures yielded Pseudomonas aeruginosa, and transoesophageal echocardiography revealed vegetation on the mitral prosthetic valve, confirming infective endocarditis. During hospitalization, the patient developed acute leg pain and a drop in haemoglobin levels. Computed tomography angiography revealed a large mycotic aneurysm of the right profunda femoris artery. Due to haemodynamic instability and suspected impending rupture, endovascular treatment was performed using a graft stent. Complete aneurysm exclusion was achieved without complications. The patient completed 8 weeks of intravenous antibiotics. Follow-up imaging confirmed resolution of vegetation, and no abscess or graft infection was observed in the femoral region. He was discharged in stable condition. Discussion: Mycotic aneurysms require urgent and aggressive management due to the risk of rupture. While surgical repair remains the standard of care, endovascular approaches such as graft stent placement offer a viable alternative in haemodynamically unstable patients or those with high surgical risk. This case highlights the importance of timely diagnosis, appropriate antibiotic therapy, and individualized interventional planning to achieve favourable outcomes.

Introduction: Mechanical valve thrombosis (MVT), along with its associated embolic or obstructive complications, can have significant clinical implications. Studies evaluating the relationship of inflammatory and albumin-based markers such as neutrophile-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein to albumin ratio, uric acid to albumin ratio and lactate dehydrogenase to albumin ratio (LAR) with thrombosis burden in patients with left sided mechanical valves are lacking. We aimed to examine the relationship between inflammatory and albumin-based markers, and left sided MVT with and without obstruction. Methods: Eighty-eight patients (age 48.9±13.8, 72.7% female) with left-sided MVT were included in the study. Patients were divided into two groups as obstructive thrombosis (OT) and non-obstructive thrombosis (NOT). Results: NLR, PLR and LAR levels were found to be significantly higher in OT group (P<0.001, P<0.001; P=0.032, respectively). There was a strong correlation between OT and both NLR and PLR (r=0.736 and r=0.645). Of those markers, NLR (odds ratio (OR) 5.68, 95% confidence interval (CI) 1.96 to 16.48, P=0.001) was found to be the independent predictor of OT. On receiver operating characteristic (ROC) analysis, a cut-off value 2.83 of NLR (area under the curve (AUC)=0.931; 95% CI:0.877-0.984; P<0.001) had 86.3% sensitivity and 86.5% specificity for prediction of OT. Conclusion: Increased NLR, PLR, and LAR values were associated with OT in left-sided MVT. Of those, NLR was found to be the most sensitive and specific marker and represented as an independent predictor of OT.

Objectives: Inflammation plays a very important role in the pathogenesis of coronary artery disease (CAD) and its prognosis. Especially; C-reactive protein (CRP) is associated with poor prognosis in patients with CAD. In this study, the relationship between CRP levels and body mass ındex (BMI) was investigated in patients who underwent primary coronary intervention (PCI) due to ST elevation myocardial infarction (STEMI). Methods: Between January 2015 and February 2016, 132 patients who underwent PCI due to acute STEMI were included in the retrospective study. Patients were classified into two groups: (Group 1: BMI 35 kg/m² n=9, total: 36 patients; Group 2: 25 2 n=58 and 30 <BMI BMI <35. Whereas, it was significantly higher in STEMI patients with 25 35. One of the reasons for the better prognosis of mildly overweight and Class 1 obese patients with STEMI diagnosis may be the low values of CRP which has many effects on atherosclerotic plaque formation.

Background: Percutaneous closure of patent foramen ovale (PFO) is used in selected individuals to eliminate the risk of recurrent cerebral embolism due to paradoxical embolization. Although device thrombosis is rare, it can cause serious complications. Herein, we report a 40-year-old woman who developed acute PFO closure device-associated thrombus and was subsequently treated with slow infusion of low-dose tissue plasminogen activator (t-PA) (25 mg/6 h). Case summary: A 40-year-old woman was admitted to the hospital because of an cerebrovascular accident (CVA). Computed tomography and magnetic resonance imaging of the brain demonstrated the presence of an ischaemic lesion in the right cerebellar infarct. Since no pathological finding was detected that could cause CVA, it was considered that there might be paradoxical embolism due to PFO. Percutaneous PFO closure was decided by the heart and brain team. The occluder was implanted under transoesophageal echocardiography (TEE) and fluoroscopy guidance. Although activated clotting time was 250 s, hypermobile acute thrombus measuring 11 × 5 mm was seen on the left atrial side of the PFO device. Slow infusion of low-dose t-PA treatment was given. As soon as after a single-dose t-PA, control TEE was performed and it was seen that almost the entire thrombus was lysed. The patient did not have any complications during the treatment period. Discussion: Acute PFO device thrombosis is a rare but important complication. If there is no contraindication for lytic treatment in acutely developing large PFO device thrombosis, slow infusion of low-dose t-PA may be useful.