Çağlar Özmen

Purpose: Acute decompensated heart failure (ADHF) is associated with substantial in-hospital mortality and frequent early rehospitalization. This study evaluated the prognostic value of the Global Immune–Nutrition–Inflammation Index (GINI) in hospitalized patients with ADHF.Materials and Methods: This retrospective single-center study included 197 consecutive patients hospitalized between January 2023 and December 2025. GINI was calculated from admission laboratory parameters. The primary endpoint was in-hospital all-cause mortality. Secondary endpoints were composites of all-cause mortality or heart failure rehospitalization within 30 and 90 days after discharge.Results: During hospitalization, 26 patients (13.2%) died. Median admission GINI was higher in non-survivors than in survivors (937.7 [469.3–3118.3] vs. 408.8 [80.6–1592.8]). After multivariable adjustment, GINI was not independently associated with in-hospital mortality (adjusted odds ratio [OR], 1.596; 95% confidence interval [CI], 0.900–2.830), whereas log-transformed troponin remained independently associated with mortality (adjusted OR, 2.910; 95% CI, 1.354–6.252). Among 171 patients discharged alive, the composite endpoint occurred in 52 (30.4%) within 30 days and 106 (62.0%) within 90 days. GINI was not independently associated with either post-discharge endpoint after adjustment for N-terminal pro-B-type natriuretic peptide.Conclusion: Admission GINI reflected increased risk in unadjusted analyses but did not provide independent prognostic information beyond established clinical and cardiac biomarkers.

Cardiovascular disease remains the leading cause of morbidity and mortality in kidney transplant recipients, accounting for 20–30% of all post-transplant deaths and arises from a multifactorial interaction between traditional risk factors — hypertension, dyslipidemia, diabetes mellitus, and smoking — and transplant-specific determinants including immunosuppressive drug toxicity, graft dysfunction, acute rejection, and prolonged pre-transplant dialysis. Immunosuppressive agents drive a distinct pathophysiological cascade — calcineurin inhibitors increase the risk of hypertension and dyslipidemia relative to tacrolimus, corticosteroids promote metabolic syndrome and post-transplant diabetes mellitus, and mTOR inhibitors exacerbate dyslipidemia via PCSK9 upregulation — collectively culminating in accelerated atherosclerosis, coronary artery disease, and de novo heart failure occurring in 10–18% of recipients within 36 months of transplantation. Addressing this burden demands a risk-stratified, multidisciplinary strategy that integrates pretransplant cardiac screening, guideline-directed blood pressure and lipid control, immunosuppression optimisation, and the judicious adoption of emerging cardiorenal therapies — and it is only through dedicated randomised trials in this population that the persistent evidence gap can be closed and the full promise of kidney transplantation realised.

Atrial fibrillation (AF) remains one of the most clinically demanding arrhythmias in contemporary cardiology—not because its mechanisms are unknown, but because what we know does not yet translate into precise, individualized management. Existing risk scores predict adverse outcomes reasonably well at the population level but perform inadequately for individual patients, and the molecular substrate driving disease progression remains largely invisible at the bedside. MicroRNAs (miRNAs), small non-coding RNA molecules of 20–25 nucleotides found stably in peripheral blood, have attracted considerable attention as potential biomarkers capable of bridging this gap. Their involvement in atrial fibrosis, electrical remodeling, and inflammatory signaling is mechanistically well-grounded. Whether this mechanistic plausibility can be translated into clinical utility is the central question this review addresses. We summarize the biological rationale for circulating miRNAs as AF biomarkers, review the most consistently replicated miRNA expression findings across clinical studies and meta-analyses, and appraise what the evidence supports—and what it does not—regarding diagnostic accuracy, prognostic value, and clinical decision-making applications. We also outline what the field needs to accomplish to move from promising findings to routine clinical use.

Background/Objectives: Telomeres and telomerase play crucial roles in cellular aging and genome stability. Emerging evidence indicates that alterations in telomerase activity and telomerase reverse transcriptase (hTERT) gene expression may be involved in cardiovascular pathophysiology. However, data on telomerase regulation in patients with stable coronary artery disease (CAD) are limited. This study aimed to compare serum telomerase concentration and hTERT gene expression levels between patients with stable CAD and healthy controls. Methods: A total of 52 patients diagnosed with stable CAD and 50 age-matched healthy controls were enrolled prospectively. Telomerase concentrations were measured in serum samples using the ELISA method, and hTERT mRNA expression was measured in blood samples using RT-PCR. Results: Serum telomerase levels were significantly higher in patients with stable CAD compared with controls (p < 0.05). Similarly, hTERT gene expression was upregulated in the patient group (p < 0.05). Multivariable analysis showed that increased log-transformed telomerase levels (AOR: 2.12, 95% CI: 1.14–5.13, p = 0.024) and hTERT expression (AOR: 1.79, 95% CI: 1.09–3.27, p = 0.037) were independently associated with coronary vessel involvement in stable CAD. These findings indicate an increase in both telomerase level and hTERT transcriptional activity in stable CAD. Conclusions: Increased telomerase level and hTERT expression may reflect a compensatory response to chronic vascular stress and are associated with disease severity in stable CAD.

Background/aim: Systemic sclerosis (SSc) is a complex autoimmune disease characterized by vascular disorders and fibrosis. This study aimed to compare pulmonary artery wall thickness (PAWT) in SSc patients without PAH with idiopathic PAH (IPAH) and healthy controls and to investigate the effect of increased PAWT and inflammation on vascular changes in SSc patients. Materials and Methods: This cross-sectional study included 60 SSc patients, 30 IPAH patients, and 40 age- and sex-matched healthy controls, all of whom underwent echocardiographic evaluation. Data were analyzed including patient demographics, disease duration, type of skin involvement, lung involvement, and autoantibody status. Results: PAWT was significantly increased in the SSc group compared to the control group. There is a strong correlation between PAWT and modified Rodnan skin score (mRSS) and mRSS is an independent risk factor for increased PAWT. A correlation was also found between PAWT and echocardiographic parameters including systolic pulmonary artery pressure (sPAP). Conclusion: PAWT is elevated in SSc patients, potentially reflecting underlying inflammatory processes independent of PAH. Regular echocardiographic assessments, including PAWT measurement, may contribute to the understanding and management of vascular involvement in SSc.

Introduction: Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions which increase in frequency over the years. Electrical storm (ES) is defined as the occurrence of 3 or more continuous ventricular arrhythmia. The sympathetic nervous system has an important role in Ventricular arrythmias (VA) and is the target of treatment. Studies show that stellate ganglion blockade (SGB) can reduce cardiac sympathetic tone and is an alternative bridge therapy in VAs. Patient concerns: Among the patients who were admitted to the hospital with the complaints of general condition disorder and palpitation. Diagnosis: Patients were referred to the Cardiology department and diagnosed VA and ES. Patients who applied to the Cardiology Department with the diagnosis of VA or ES and did not benefit from antiarrhythmic drug therapy were selected and evaluated by a team of 2 anesthesiologists (cardiothoracic and pain specialists) and 2 cardiologists (1 of whom is an electrophysiology specialist). Intervention: In our study, ultrasound (USG) guided left SGB was applied to 10 VA and ES patients with implantable cardiac defibrillator (ICD). The 6-month results of the patients were evaluated retrospectively. For blockage, the solution was prepared by adding 8 mg dexamethasone, 40 mg lidocaine and 10 mg bupivacaine to 10 mL with physiological saline. The success of the procedure was evaluated with the development of Horner syndrome in the left eye. Outcomes: Resistant VA developed in 2 of 10 patients who had left SGB due to VF/VT ES and were excluded from the study. One (1) month after the procedure it was seen that there was a statistically significant decrease in the number of shocks in 8 patients in the 6th month controls compared to the pre-procedure. The number of VES in the 1st and 6th months of the patients was also statistically significantly decreased compared to the pre-SSD (P = .01, P = .01, P = .01, respectively). Conclusion: Unilateral USG-guided SGB application is an effective and safe method in patients with ES and VA. Long-term results can be satisfactory in successful responders in whom SGB is performed with a combination of local anesthetic and steroid.

Aim: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians’ recommendations on vaccination rates. Methods: This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics. Results: The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 ± 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians’ recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25–1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15–1.92), p = 0.002] patients’ knowledge [OR = 1.93 (95% CI = 1.56–2.40), p < 0.001], and their physician’s recommendation [OR = 5.12 (95% CI = 1.92–13.68), p = 0.001]. Conclusion: To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates.

Purpose: This study aims to evaluate the relationship between the platelet/lymphocyte ratio (PLR) measured at admission and the occurrence of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Materials and Methods: This study included 126 patients with acute STEMI treated with primary PCI. Hemoglobin, thrombocyte, and lymphocyte levels of the patients were retrieved from the files at the time of admission. Postprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural myocardial blush grade (MBG), and TIMI thrombus scale were evaluated from the coronary angiography records. Results: Patients were divided into two groups according to TIMI flow grade after PCI as normal coronary flow (n = 66) and no-reflow groups (n = 60). The no-reflow group had lower LVEF and higher PLR compared to the normal coronary flow group PLR was significantly higher in patients with lower TIMI flow grade and MBG. Conclusion: PLR measured at admission was found to be higher in STEMI patients who developed no-reflow after primary PCI compared to the normal coronary flow group. PLR can be used as a predictor for no-reflow in such patients. Amaç: Bu çalışmanın amacı, primer perkütan koroner girişim (PKG) ile tedavi edilen akut ST-segment yükselmeli miyokard infarktüsü (STYMİ) hastalarında başvuru sırasında ölçülen platelet/lenfosit oranının (PLO) ile no-reflow fenomeni oluşumu arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntem: Bu çalışmada, primer PKG ile tedavi edilen akut STYMİ'li 126 hasta kapsanmıştırr. Hastaların hastaneye başvuru anındaki hemoglobin, trombosit ve lenfosit düzeyleri dosya verilerinden elde edildi. Hastaların işlem sonrasındaki miyokard infarktüsünde tromboliz (TIMI) akım derecesi, miyokardın boyanma derecesi (MBG) ve TIMI trombüs ölçeği koroner anjiyografi kayıtlarından değerlendirildi. Bulgular: Hastalar PKG sonrası TIMI akım derecesine göre normal koroner akım (s=66) grubu ve azalmış koroner akım (no-reflow) grubu (s=60) olmak üzere iki gruba ayrıldı. No-reflow grupta normal koroner akım grubu ile kıyaslandığında daha düşük SVEF ve daha yüksek PLO vardı. TIMI akım derecesi ve MBG' si daha düşük olan hastalarda, PLO anlamlı olarak daha yüksekti. Sonuç: Primer PKG sonrasında no-reflow gelişen STYMİ hastalarında başvuru sırasında ölçülen PLO daha yüksek saptanmıştır. PLO, bu tür hastalarda no-reflow için bir öngörürücü olarak kullanılabilir.