Özge Özden

Purpose Obesity injures the heart through hemodynamic, fibrotic, and adipokine pathways, but whether these reverse together or on different timelines after bariatric surgery is unknown. We performed, to our knowledge, the first integrated assessment of biventricular and biatrial cardiovascular magnetic resonance feature-tracking (CMR-FT), fibrosis and adipokine biomarkers, cardiovascular risk, and quality of life after laparoscopic sleeve gastrectomy (LSG), testing whether recovery is uniform or uneven. Materials and Methods In this single-center prospective cohort, 40 patients underwent LSG; 8 were lost to follow-up, leaving 32 (28 with paired CMR; 26 women; aged 36.3 ± 7.6 years; baseline BMI 41.1 ± 4.8 kg/m²) studied before and a median 8.4 months after surgery. Results Left ventricular mass declined from 93.3 to 78.9 g (p < 0.001), alongside improved LVGLS (16.0 to 18.6%, p = 0.003), MAPSE (p = 0.004), and LVEF (p = 0.021). RVEF increased (p = 0.013) without parallel change in RVGLS or TAPSE. Left atrial volume index was unchanged, with only a reservoir-strain trend toward improvement (p = 0.059). Only galectin-3 and endotrophin declined (both p < 0.001); FABP4, apelin, and adiponectin were unchanged. NT-proBNP rose (p < 0.001) despite falling blood pressure and improving strain. Metabolic risk factors improved broadly; Framingham risk and all SF-36 domains improved (p < 0.001). Conclusion Cardiac reverse remodeling after LSG is measurable but uneven within the first year. LV longitudinal mechanics improved alongside mass regression, whereas RVEF rose without parallel longitudinal change, consistent with afterload reduction rather than intrinsic RV recovery. Fibrosis-linked galectin-3 and endotrophin declined while adipokines remained static, indicating distinct fibrotic and adipokine timelines. The components that respond earliest are those that conventional preoperative assessment overlooks. Graphical Abstract

Introduction: Vitamin B12 deficiency may influence cardiac autonomic function and ventricular repolarization. The frontal QRS-T angle is a novel and useful electrocardiographic parameter that reflects the relationship between ventricular depolarisation and repolarisation. The aim of this study was to evaluate the association between serum vitamin B12 levels and the frontal QRS-T angle in asymptomatic individuals. Method: The current retrospective study comprised 92 adults who underwent a standard 12-lead ECG and serum vitamin B12 testing on the same day. Participants were divided into two groups according to their vitamin B12 levels (Group 1 was defined as abnormal having a level of less than 300 pg/mL, while Group 2 was defined as normal having a level of 300 pg/mL or more). The patient's clinical characteristics, laboratory findings and ECG parameters were recorded. The frontal QRS-T angle was calculated automatically using the QRS and T axes provided by the ECG device. Results: The average age of participants was 46.1 (±12.2) years, and 51.9% of participants were female (p < 0.001). Individuals with low vitamin B12 concentrations exhibited a wider frontal QRS-T angle. It was determined that vitamin B12 level is an independent predictive factor for the frontal QRS-T angle. Conclusion: The frontal QRS-T angle may serve as a useful parameter for evaluating electrical changes and susceptibility to ventricular arrhythmias in individuals with vitamin B12 deficiency.

Catheter kinking is a rare but significant complication of trans‐radial coronary interventions, often caused by arterial tortuosity, vessel spasm, or improper catheter manipulation. We present a case of catheter kinking that occurred during coronary engagement in a transradial procedure, which could not be resolved using conventional techniques. Given the failure of guidewire advancement and deep inspiration maneuvers, a femoral access‐assisted balloon trapping technique was employed. This method allowed for the successful retrieval of the kinked catheter while minimizing vascular trauma and ensuring procedural completion. Catheter kinking during trans‐radial coronary interventions poses technical challenges requiring tailored management strategies. This case underscores the effectiveness of femoral access‐assisted balloon trapping technique as a viable and minimally invasive solution. Increased awareness and preparedness for such complications can enhance procedural success and patient safety.

Objective: Homoarginine is a cationic amino acid derived from lysine. Evidence indicates that low-circulating homoarginine concentration is a risk factor for cardiovascular disease and all-cause mortality. A reduction in homoarginine concentrations has been observed in patients with ischemic heart disease, ischemic stroke, ischemic heart disease, and heart failure. The SYNTAX score (SS), an angiographic scoring system, defines the grade and complexity of coronary artery disease (CAD). The objective of this study was to evaluate the relationship between homoarginine level and the severity of CAD according to the SYNTAX score in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 67 subjects were enrolled into the study with the diagnosis of STEMI of those who underwent coronary angiography. STEMI patients were divided into two groups: low-medium SYNTAX score ≤ 14 (35 patients) and high SYNTAX score > 14 (32 patients). Results: Within the high SS group, serum homoarginine levels were markedly lower (2 ± 0.9 vs. 1.3 ± 0.7; p = 0.001). Homoarginine levels and SS showed a significant negative correlation in entire study cohort In multivariate regression analysis, serum homoarginine levels along with serum urea levels were significantly associated with having higher SS (OR 1.073 p = 0.049 and OR 0.346, p = 0.012, respectively). Conclusions: In conclusion, the diminished plasma homoarginine level emerges as an independent predictor of high atherosclerotic burden among STEMI patients. To the best of our knowledge, this is the first study to demonstrate the relationship between homoarginine and coronary artery complexity.

Background: Transesophageal echocardiography (TEE) is a vital diagnostic tool in clinical practice, particularly in transcatheter interventions where it aids in both pre-operative planning and intra-operative guidance. Traditional TEE probes often require general anesthesia due to patient discomfort. However, the development of miniaturized TEE probes presents a promising alternative, enabling routine examinations and interventions with minimal sedation. This study evaluates the feasibility of performing a complete 2D/4D TEE protocol with the new 4D mini-TEE probe in the echocardiography department and its application in transcatheter interventions. Methods: This is a retrospective study that included 30 consecutive patients from two high-volume European hospitals (Interbalkan Medical Center, Thessaloniki, Greece, and Rennes University, France) that underwent TEE or transcatheter interventions. The new 4D mini-TEE 9VT-D probe (GE Healthcare) was utilized. The quality of the images and the tolerance of the probe were assessed in the cath lab during interventions and in the echocardiography department during routine TEE examinations. Results: Direct comparison of the 4D mini-TEE probe with the standard 6VT-D probe confirmed the excellent image quality of this new pediatric probe. Most of the patients required minimal sedation or local oropharyngeal anesthesia, with satisfactory tolerance reported. Most of the transcatheter procedures did not require general anesthesia and intubation, resulting in shorter procedural time. Both 2D and 4D imaging modalities offered adequate intra-operative guidance for transcatheter procedures. Conclusions: The 4D mini-TEE probe delivers exceptional imaging capabilities for routine examinations and transcatheter interventions without needing sedation. Its use reduces esophageal trauma and the need for general anesthesia, enhancing patient comfort and safety.

Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 ± 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 ± 10.6 vs. 62.1 ± 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 ± 5.4 vs. 21.8 ± 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF.

Introduction: Transesophageal echocardiography (TEE) is a vital diagnostic tool in clinical prac-tice, particularly in transcatheter interventions where it aids in both pre-operative planning and intra-operative guidance. Traditional TEE probes often require general anesthesia due to patient discomfort. However, the development of miniaturized TEE probes presents a promising alter-native, enabling routine examinations and interventions with minimal sedation. This study evaluates the feasibility of performing a complete 2D/4D TEE protocol with the new 4D-mini-TEE probe in echocardiography departments and its application in transcatheter interventions. Methods: This prospective, observational study included 30 consecutive patients from two high-volume European hospitals (Interbalkan Medical Center, Thessaloniki, Greece, and Rennes University, France) undergoing TEE or transcatheter interventions. The new 4D-mini-TEE 9VT-D probe (GE Healthcare) was utilized. The quality of the images and the tolerance of the probe were assessed in the Cath lab during interventions and in the echocardiography department during routine TEE examinations. Results: Direct comparison of the 4D-mini-TEE probe with the standard 6VT-D probe, confirmed the excellent image quality of this new pediatric probe. Most of the patients required minimal sedation or local oropharyngeal anesthesia, with satisfactory tolerance reported. Most of the transcatheter procedures did not require general anesthesia and intubation, resulting in shorter procedural time. Both 2D and 4D imaging modalities offered adequate intra-operative guidance for transcatheter procedures. Conclusions: The 4D-mini-TEE probe delivers exceptional imaging capabilities for routine ex-aminations and transcatheter interventions without needing sedation. Its use reduces esophageal trauma and the need for general anesthesia, enhancing patient comfort and safety.

Background and Objectives: We aimed to ascertain the predictive power of the left atrial coupling index (LACI) in patients with end stage renal disease (ESRD) for heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a retrospective study including 100 subjects between 18 and 65 years of age with ESRD and not on dialysis treatment. Patients were divided into groups with and without HFpEF. The LACI was defined as the ratio of the left atrial volume index (LAVI) to the a′ wave in tissue Doppler imaging (TDI). Statistical analyses were performed, including univariate and multivariate regression analyses. Results: The mean age of the participants was 47 ± 13.3 years. Individuals with HFpEF exhibited a higher LACI. Univariate and multivariate regression analyses demonstrated that the predictive capacity of the LACI for HFpEF was considerably higher than that of the LAVI and other echocardiographic parameters. Conclusions: Higher LACI levels were consistently related to the presence of HFpEF in ESRD patients. The LACI can be easily obtained in daily practice using conventional Doppler echocardiographic measurements during left atrial functional assessments.