Seda Elcim Yildirim

Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Its prevalence increases significantly with age. Therefore, it is particularly important in the elderly population. Despite this, elderly patients have been underrepresented in clinical studies, and optimal medical treatment is less frequently provided to this group. The aim of this study is to identify age-related patterns in elderly patients and to evaluate their relationships with comorbidities. Materials and Methods: 118 patients with permanent AF aged ≥75 years (middle-old) and 153 patients with permanent AF aged 65-75 years (youngest-old) were retrospectively evaluated. Demographic, biochemical and echocardiographic parameters were compared between groups. Results: There were 85 cases (72%) of hypertension, 43 cases (36%) of diabetes mellitus, 56 cases (48%) of coronary artery disease in patients with AF aged ≥75 years. There were 91 cases (60%) of hypertension, 43 cases (28%) of diabetes mellitus, 60 cases (39%) of coronary artery disease in patients with AF aged 65-75 years. Patients with AF aged ≥75 years had more hypertension, diabetes mellitus and coronary artery disease compared to the patients with AF aged 65-75 years (p=0.021, p=0.092, p=0.108, respectively). However, only hypertension reached statistical significance. Also, creatinine [1.15±0.36 mg/dl vs 1.03±0.23 mg/dl, p=0.003], urea [53.4±29.8 mg/dl vs 41.4±15.5 mg/dl, p<0.001] levels were higher; while eGFR [54.9±14.8 ml/min vs 69.5±17.7 ml/min, p<0.001], hemoglobin (11.5±2.1 g/dl vs 12.9±1.8 g/dl, p<0.001) and albumin [3.67±0.54 g/dl vs 4±0.44 g/dl, p=0.003] levels were lower in patients with AF aged ≥75 years compared to the patients with AF aged 65-75 years. Conclusion: Comorbidities especially hypertension and chronic kidney disease are more frequently observed in patients with AF as age increases. It is important to remember that in elderly patients with AF, it is essential to manage not only the arrhythmia itself but also any additional comorbidities.

Objective: Myocardial bridging (MB) is a congenital anomaly in which an epicardial coronary artery courses intramyocardially. MB-related compression is often asymptomatic but can rarely cause sudden cardiac death, arrhythmia, or ischemia. This study aimed to investigate the prevalence, demographic characteristics, and gender differences of MB. Materials and Methods: A total of 2950 patients who underwent invasive coronary angiography (CA) were retrospectively evaluated. Clinical characteristics, biochemical/hematological parameters, and angiographic findings were compared between genders. Results: MB was identified in 119 (4%) patients, of whom 75 (63%) were males and 44 (37%) were females. The mean age of patients was 61.4±10.6 yr. Among patients with MB, 60.5% had hypertension, 31.9% had diabetes mellitus, 53.8% had coronary artery disease, and 47.9% were smokers. MB was most frequently detected in the mid segment of the left anterior descending artery (LAD) in 61 patients (51.3%). No significant gender differences were observed in MB length, vessel distribution, or compression rate. Conclusion: MB is not an uncommon finding during invasive CA in middle-aged patients. The prevalence was 4% in our study. The most common site was the mid segment of the LAD. No gender-based differences were observed in MB length, vessel distribution, or compression rate.

Introduction: Adherence to the Mediterranean diet has been associated with favorable cardiovascular and metabolic outcomes. However, its relationship with chronotropic response during exercise testing remains insufficiently explored. This study aimed to evaluate the association between Mediterranean Diet Adherence Score (MEDAS) and exercise test parameters, particularly chronotropic response, in patients undergoing exercise testing. Methods: This single-center, prospective observational study included patients referred for exercise testing in a cardiology outpatient clinic. Adherence to the Mediterranean diet was assessed using the MEDAS questionnaire. Exercise test parameters, including exercise duration, peak heart rate, heart rate reserve, chronotropic index, and double product, were recorded using the standard Bruce protocol. Laboratory parameters were obtained from fasting blood samples. Patients were categorized into low and high MEDAS groups based on the median score. Multivariable linear regression analysis was performed to identify determinants of chronotropic index. Results: A total of 312 patients were included. Patients with higher MEDAS scores demonstrated higher chronotropic index and heart rate reserve values compared with those with lower adherence. Fasting glucose, triglyceride levels, and triglyceride–glucose index tended to be lower in the high MEDAS group. MEDAS score showed a weak but significant negative correlation with body mass index. In multivariable analysis, beta-blocker and calcium channel blocker use were the strongest determinants of chronotropic index, while MEDAS score was not independently associated after adjustment. Conclusion: Higher adherence to the Mediterranean diet is associated with favorable trends in chronotropic response and cardiometabolic parameters in patients undergoing exercise testing. MEDAS may serve as a practical complementary tool for lifestyle-based cardiovascular risk assessment.

Background: Obstructive sleep apnea syndrome (OSAS) is associated with sympathetic overactivity, intermittent hypoxia, and increased vascular resistance, leading to cardiovascular morbidity. Electrical cardiometry (EC) is a novel, non-invasive technology that continuously measures hemodynamic parameters such as systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), cardiac output (CO), and cardiac index (CI). The aim of this study was to compare SVR and SVRI values, measured by EC, between patients with OSAS and age- and sex-matched healthy controls. Methods: In this retrospective case–control study, 70 participants were enrolled, including 33 patients with polysomnography-confirmed OSAS and 37 healthy controls matched for age and sex. All participants underwent standard EC measurement (ICON^® Cardiotronics, Osypka Medical, GmbH, Berlin, Germany) under resting, supine conditions. Hemodynamic parameters such as SVR, SVRI, and CI were compared between groups. Results: EC revealed significantly higher SVR (1498.7 ± 335.6 vs. 1260.1 ± 251.5 dyn·s·cm⁻⁵, p = 0.013) and SVRI (2969.4 ± 749.1 vs. 2347.4 ± 481.0 dyn·s·cm⁻⁵·m², p < 0.001) in patients with OSAS compared with controls, while CI was significantly lower in the OSAS group (2.6 ± 0.5 vs. 3.2 ± 0.8 L/min/m², p < 0.001), indicating increased vascular load and reduced cardiac performance. Conclusions: This study is the first to apply EC in OSAS. EC-derived parameters, particularly SVRI and CI, effectively differentiated OSAS patients from healthy subjects, reflecting increased vascular afterload and reduced cardiac performance. These findings suggest that EC is a feasible, non-invasive tool for assessing hemodynamic alterations in OSAS and may have potential for bedside monitoring and future risk stratification studies.

Objective: Coronary artery tortuosity (CAT) is frequently observed in invasive angiography, though its aetiology and clinical significance remain ambiguous. The aim of our study was to investigate the parameters affecting CAT in patients without normal coronary artery disease (CAD). Materials and Methods: 110 patients with CAT and no CAD and and 140 patients with no CAT and CAD were evaluated retrospectively. CAT was defined by ≥3 bends with a change in vessel direction of ≥45° present in both systole and diastole along the main trunk of at the least one coronary artery. Demographic, biochemical, echocardiogrphic and angiographic parameters were compared between groups. Results: Patients with CAT were older and more often female gender. 24 (21.8%) were males and 86 (78.2%) were females in patients with CAT. The mean age of the patients with CAT were 61.4±10.6 years and the control group was 55.9±10.9 years. Among the patients with CAT, 62.7% had hypertension, 27.3% had diabetes mellitus and 30% were smokers. But, there was not significant difference between groups (p=0.469, p=0.446, p=0.242, respectively) . Left anterior descending artery (LAD) was the most commonly affected tortuous coronary artery (86.4%). Multivariate analysis showed significant relationship between age (p=0.019), female gender (p

Background: Acute kidney injury (AKI) is a frequent complication following transcatheter aortic valve implantation (TAVI) and has been linked to increased mortality. However, the temporal pattern of this association remains uncertain. This study aimed to evaluate the time-dependent impact of AKI on mortality after TAVI using advanced survival analyses. Methods: We retrospectively analyzed 381 consecutive patients who underwent transfemoral TAVI between December 2016 and October 2024 at two tertiary cardiovascular centers. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. The primary outcome was all-cause mortality. Patients were categorized into AKI and non-AKI groups. Clinical outcomes, including 30-day, 1-year, and overall mortality, were evaluated. Results: Among 381 patients who underwent TAVI, 59 (15.5%) developed AKI according to the AKIN criteria. During a 33.9 months (18.0–59.2) median follow-up of overall mortality was significantly higher in the AKI group compared with those without AKI. In the multivariate Cox regression analysis, AKI was significantly associated with long-term mortality (HR: 2.07, 95% CI 1.32–3.25; p = 0.002). The time-varying hazard ratio curve demonstrated that the excess mortality risk associated with AKI was most pronounced in the early period and gradually declined thereafter. In time-interval–specific analyses, AKI was strongly associated with mortality within the first month (HR 6.30, 95% CI 3.03–13.08, p < 0.001) and remained significant up to 12 months (HR 2.18, 95% CI 1.32–3.59, p = 0.002). Beyond the first year, this association attenuated and lost statistical significance at 12–36 months (HR 0.90, p = 0.79), 36–60 months (HR 0.57, p = 0.24), and >60 months (HR 0.43, p = 0.13). Conclusions: AKI is an important predictor of early and mid-term mortality following TAVI, but its long-term prognostic impact is less pronounced. Preventive strategies and early management of AKI may improve outcomes in this high-risk population.

Background/Objectives: One of the most prevalent reasons for attending the emergency department (ED) is chest pain. There are many causes of its etiology. Recent studies indicate that coronary slow flow should be considered not only an angiographic phenomenon but also a clinical syndrome. In our study, we aimed to identify laboratory parameters indicative of coronary slow flow. Methods: Patients who presented to the Emergency Department of Balikesir University Hospital with chest pain and underwent coronary angiography between 2019 and 2023 were evaluated. A group of 107 patients with primary coronary slow flow was included as the patient group, while 108 patients without any pathology were included as the control group. Demographic, laboratory, clinical, and angiographic parameters were compared between the two groups to determine the predictors of coronary slow flow. Results: In our study, RCA dominance was detected in the control group, while Cx dominance was detected in our patient group (p < 0.001). CRP and the CRP/albumin ratio were observed to be higher in the patient group (p < 0.001). Conclusions: The inflammatory markers CRP and CRP/albumin ratio were found to be statistically significantly higher in the patient group. These parameters can be used to predict coronary slow flow in the emergency department.

Background/Objectives: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant morbidity, including stroke, heart failure, and increased mortality, necessitating oral anticoagulant (OAC) therapy to reduce thromboembolic risk. However, OACs, including warfarin and non-vitamin K antagonist oral anticoagulants (NOACs), increase the risk of gastrointestinal (GI) bleeding, a serious complication requiring precise risk stratification in the emergency department (ED). Methods: This retrospective cohort study was conducted in the Emergency Department of Balikesir University Hospital in Turkey between 2019 and 2023 and evaluates systemic inflammatory markers as predictors of GI bleeding in AF patients receiving OACs. A total of 155 patients were divided into case (GI bleeding) and control (no GI bleeding) groups, comparing demographics, comorbidities, CHA₂DS₂-VASc and HAS-BLED scores, and inflammatory indices (uric acid/albumin ratio, neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune inflammation index [SII]). Results: For patients receiving NOACs, the case group exhibited significantly higher uric acid/albumin ratio, NLR, PLR, and SII (p < 0.05). For patients receiving warfarin, only the uric acid/albumin ratio was significantly elevated (p < 0.001). Hypolipidemia and elevated uric acid were associated with bleeding risk in patients receiving NOACs, while hypoalbuminemia and elevated urea predicted bleeding in patients receiving warfarin. HAS-BLED scores were significantly higher in bleeding groups, unlike CHA₂DS₂-VASc scores. Conclusions: These findings suggest that inflammatory indices, particularly in patients taking NOACs, are associated with GI bleeding risk stratification. Integrating these biomarkers into clinical practice could optimize personalized anticoagulation strategies, reducing morbidity and mortality in AF patients.

Background and Objectives: The Naples Prognostic Score (NPS), a composite index indicative of nutritional and inflammatory status, has been suggested as an important prognostic marker. Uric acid, an indicator of oxidative stress and endothelial impairment, is also associated with cardiovascular risk. This study sought to examine the synergistic value of NPS and uric acid levels in forecasting long-term major adverse cardiovascular and cerebrovascular events (MACCE) in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI), using time-varying hazard ratio and time-dependent Receiver Operating Characteristic (ROC) analyses. Materials and Methods: A retrospective analysis was conducted on 288 patients diagnosed with CCS from January 2020 to November 2023. The NPS was determined utilizing serum albumin, total cholesterol, the neutrophil-to-lymphocyte ratio (NLR), and the lymphocyte-to-monocyte ratio (LMR). Cox regression, time-varying hazard ratio models, and time-dependent ROC curve analyses were performed to assess both temporal risk patterns and predictive performance. The principal endpoint was the incidence of MACCE. Results: Major adverse cardiovascular and cerebrovascular events (MACCE) occurred in 69 individuals, representing 23.4% of the total cohort. Both high NPS and elevated uric acid were independently associated with an increased risk of MACCE. The integration of the NPS with uric acid showed superior discriminative and reclassification capabilities compared to the use of each marker independently (p < 0.05 for all). Time-varying hazard ratio analyses demonstrated that the prognostic impact of the NPS was more pronounced in the early follow-up, while the effect of uric acid became stronger in the late phase. Time-dependent ROC analyses confirmed that the combined use of the NPS and uric acid provided superior predictive accuracy compared with either parameter alone across the follow-up period. Conclusions: NPS and uric acid offer complementary prognostic information in CCS. Their combined assessment improves long-term risk stratification, while time-varying and time-dependent analyses reveal that their predictive effects evolve dynamically throughout follow-up. This integrated evaluation may improve clinical decision-making and risk stratification in routine practice.