Muammer Karakayali

Acute myocardial infarction (AMI) requires rapid biochemical confirmation, and saliva offers a non-invasive alternative to venous sampling. We measured high-sensitivity cardiac troponin I (hs-cTnI), Apelin, Elabela, Endoglin, Irisin and ischaemia-modified albumin (IMA) in paired blood and saliva from 60 selected AMI patients presenting within six hours of symptom onset and 30 healthy controls. In blood, Irisin, Elabela and Apelin were lower in patients and Endoglin higher (all p ≤ 0.020). In saliva, Endoglin was higher and Irisin lower (both p < 0.001), and only these differences survived Bonferroni correction and age restriction ( p ≤ 0.030); IMA differed in neither matrix. Blood and salivary values correlated strongly (Spearman rs 0.773–0.979, all p < 0.001), but Bland–Altman analysis showed proportional differences and wide limits of agreement. Salivary hs-cTnI assay signals completely separated the two groups; because elevated serum hs-cTnI was an inclusion criterion and no salivary assay was matrix-validated, this reflects case selection rather than diagnostic accuracy. The adipokine panel did not demonstrate an improvement over hs-cTnI in an exploratory cross-validation analysis. These findings provide preliminary evidence that the six analytes generate measurable assay signals in saliva and support further investigation, including matrix-specific validation and prospective evaluation in undifferentiated chest pain.

Background and Objectives: Pulmonary embolism (PE), the third most prevalent cause of cardiovascular death, is often regarded as a potentially fatal condition. Renal function has been shown to affect the short- and long-term prognosis of acute PE in several large registries. Therefore, the purpose of this study is to investigate the relationship between acute kidney injury (AKI) and the lactate-to-albumin ratio (LAR) in patients hospitalized for PE. Materials and Methods: 264 PE patients were included in this retrospective analysis. Based on the presence or absence of AKI, the study population was split into two groups. Results: Of the 264 patients included in our study, 161 (61%) were female. The median age was 67 ± 16 years. The sample was divided into two groups based on whether AKI developed (No AKI group, n = 176; AKI group, n = 88). A multivariate logistic regression analysis revealed that sPESI score, receiving fibrinolytic therapy (tPA), and LAR (OR: 6.334, 95% CI: 3.070–13.069; p < 0.001) were independently associated with AKI in patients with PE. In particular, an LAR > 0.55 predicted AKI in patients with PE, with a sensitivity of 75% and a specificity of 67% (AUC = 0.749, 95% CI = 0.692–0.800, p < 0.001). Conclusions: Our study demonstrates that the LAR independently predicts AKI in patients with PE. This is the first study that precisely examines this association in PE patients, as far as we are aware.

Background: Hypertension (HT) is a prevalent chronic condition that contributes significantly to morbidity and mortality by leading to target organ damage. Although nitric oxide (NO) underpins endothelial function and has been implicated in several cardiovascular conditions, its association with subclinical hypertension-mediated organ damage remains unclear. This study aimed to investigate the relationship between nitrite/nitrate (NOx)—an indirect index of NO pathways and subclinical myocardial and renal dysfunction in patients with HT. Methods: This study prospectively screened 433 adult hypertensive patients, of whom 400 were included in a cross-sectional analysis after exclusion of conditions potentially confounding cardiac or renal assessment, including end-stage renal disease requiring dialysis. All participants underwent transthoracic echocardiography to assess ventricle functions using left ventricular global longitudinal strain (LV-GLS) and provided a spot urine sample for the measurement of the urine albumin/creatinine ratio (UACR). In addition to NOx levels, inducible and endothelial nitric oxide synthase levels were evaluated from participants’ blood samples. Results: NOx levels were significantly associated with reduced LV-GLS and higher UACR values. In multivariate analysis, lower NOx levels were independently associated with impaired LV-GLS (OR: 0.817; 95% CI: 0.783–0.853; p < 0.001) and albuminuria (OR: 0.905; 95% CI: 0.877–0.934; p < 0.001). Conclusions: NOx may represent an independent biochemical parameter associated with subclinical myocardial and renal dysfunction in patients with HT.

P-wave peak time (PWPT), a novel electrocardiographic marker reflecting atrial conduction delay and structural remodeling, has been associated with diastolic dysfunction and elevated left atrial pressure. Albuminuria, a marker of renal microvascular damage, has also been linked to subclinical diastolic dysfunction. This study aimed to investigate whether PWPT is independently associated with albuminuria in hypertensive patients and to assess its potential diagnostic utility. A total of 367 hypertensive patients were prospectively enrolled. Patients were categorized into albuminuria-positive (n = 110) and albuminuria-negative (n = 257) groups based on their spot urinary albumin-to-creatinine ratio (UACR). Those with UACR > 30 mg/g were classified as albuminuria-positive, and those with UACR < 30 mg/g were classified as albuminuria-negative. Comprehensive demographic, laboratory, electrocardiographic, and echocardiographic data were collected and compared between the two groups. PWPT was significantly prolonged in patients with albuminuria (48 ± 11 ms vs. 39 ± 9 ms, p < 0.001). In multivariate analysis, PWPT (OR = 2.688, 95% CI: 1.969-3.672, p < 0.001) remained an independent predictor of albuminuria, along with HbA1c, left atrial volume index, and heart rate. PWPT exhibited the highest discriminatory power among these variables (AUC = 0.771), with a cutoff of >42 ms yielding 76.4% sensitivity and 68.1% specificity. PWPT is independently associated with albuminuria in hypertensive patients and may serve as a noninvasive marker of early renal microvascular involvement.

Background and Objectives: To date, the role of the modified Rajan’s heart failure (mR-hf) risk score has been studied in patients with heart failure with reduced (HFrEF) and mid-range ejection fraction (EF). However, it has not been investigated in subjects with preserved EF (HFpEF). We aimed to examine the predictive value of the mR-hf risk score for mortality in both HFrEF and HFpEF. Methods: A total of 220 patients with HFrEF and HFpEF were included in this retrospective study. The study sample was divided into two groups according to mortality. Findings were compared between the groups. Results: The Non-survived group included 27 subjects, while the Survived group comprised 193 patients. The mR-hf risk score was significantly lower in the Non-survived group than the Survived group (pConclusion: The mR-hf risk score could be a simple tool for predicting mortality in patients with HF, irrespective of EF.

Lower extremity peripheral artery disease (LEAD) is a disease that impairs quality of life, causes amputation and is associated with mortality. Percutaneous interventions are performed for therapeutic purposes in patients with LEAD. Contrast-induced nephropathy (CIN) may emerge due to the contrast media used during these interventions. This study aimed to investigate the predictive value of six scoring systems, including AGEF, ACEF, Zhi-Feng Yao, CR4EATME3AD3, Mehran, and Tziakas, for CIN. This retrospective study included 690 patients with LEAD. The study population was divided into two groups according to the presence of CIN. In our study, the AGEF, ACEF, Tziakas, Zhi-Feng Yao, CR4EATME3AD3, and Mehran scoring systems demonstrated robust predictive capabilities for the development of CIN following percutaneous intervention in patients with LEAD. Moreover, the AGEF, Zhi-Feng Yao, CR4EATME3AD3, and Mehran scores were identified as independent predictors of CIN development in patients with LEAD revascularized via endovascular interventions. The findings of this study revealed that various scoring systems performed well in predicting CIN in LEAD patients. In addition, among these scoring systems, AGEF has been shown to be the best in terms of predictive power.

BACKGROUND: Hypertension (HT) is one of the most common causes of myocardial dysfunction. Although early detection of myocardial impairment remains challenging, left ventricular global longitudinal strain (LV-GLS) is a sensitive echocardiographic parameter that can identify subclinical myocardial damage. However, its application is limited in routine clinical settings. R-wave peak time (RWPT) is a simple and widely available electrocardiographic parameter that may reflect intramyocardial conduction delay and early structural remodeling. This study aimed to investigate the association between RWPT and LV-GLS in patients with HT. METHODS: This prospective study included 403 patients with a confirmed diagnosis of HT. All participants underwent transthoracic echocardiography and 12-lead surface ECG. LV-GLS was assessed using speckle-tracking echocardiography. ECG images were digitized and analyzed using ImageJ software, and RWPT was defined as the interval from the onset of the QRS complex to the peak of the R-wave. RESULTS: Patients were divided into two groups according to their LV-GLS value of −15.9%, which is defined as the cutoff value of myocardial impairment. Patients with a lower LV-GLS had significantly longer RWPT and QRS durations. In multivariate analysis, RWPT was found to be an independent predictor of impaired LV-GLS (OR: 1.085; 95% CI: 1.056–1.114; P < 0.001). ROC analysis demonstrated an AUC of 0.715 (95% CI: 0.665–0.765; P < 0.001) with a sensitivity of 64.9% and a specificity of 67.7% at a cutoff value of 45.5 ms. CONCLUSIONS: RWPT may serve as a practical, accessible, and sensitive electrocardiographic marker for detecting subclinical myocardial dysfunction in patients with HT.

Introduction Hypertension is a common and persistent disorder and mostly causes myocardial structural and functional abnormalities. As a subtype pattern of HT, the reverse-dipper blood pressure (BP) is associated with worse cardiovascular outcomes and early-phase subclinical myocardial damage compared to other patterns. The Left Atrial Coupling Index (LACI) is a novel echocardiographic parameter developed to assess the mechanical function. Aim The aim of this study was to investigate the role of the LACI in predicting the reverse-dipper BP pattern in patients with hypertension. Methods A total of 404 hypertensive patients who underwent 24-hour ambulatory blood pressure monitoring were prospectively enrolled. Patients were classified into dipper, non-dipper, and reverse-dipper groups based on their nocturnal BP profiles. Comprehensive echocardiographic evaluations were performed, and LACI was calculated for each patient. Results A reverse-dipper BP pattern was observed in 26%(n = 105) of the 404 patients. Those with a reverse-dipper BP pattern exhibited higher mitral E/A ratio, E/Em means, left atrial volume index (LAVI), and LACI, along with lower Em septal, Am lateral mitral, and Am septal values. LACI (OR:3.837, 95% CI: 2.620–5.620, p < 0.001), LAVI, and Am lateral mitral value were found to be independent predictors of the reverse-dipper BP pattern. ROC curve comparison demonstrated that LACI was a better predictor of the reverse-dipper BP pattern than LAVI. Conclusions Our study demonstrates that LACI, an easily accessible echocardiographic parameter, is a more robust predictor of the reverse-dipper BP pattern compared to traditional echocardiographic markers. Graphic abstract

Objective: This study aimed to explore the role and compare the accuracy of the left atrial coupling index (LACI) with other efficient traditional parameters for predicting atrial high‐rate episodes (AHREs) in patients with cardiac implantable electronic devices (CIEDs). Methods: This retrospective study included 203 patients with CIEDs whose echocardiographic data were recorded at least 6 months ago. The study population was divided into two groups based on whether the patients had developed AHRE. Subsequently, patients in the two groups were compared in terms of echocardiographic measurements, including left atrial functions, LACI, left atrial volume index (LAVI), left ventricle end‐diastolic diameter (LVEDD), and lower left ventricle ejection fraction (LVEF). Results: AHRE was observed in 42.8% ( n = 87) of the 203 patients. Those with AHRE had a higher mean mitral E/Em, LAVI, LACI, LVEDD, and lower LVEF. LACI (OR: 1.752, 95% CI: 1.356–2.263; p < 0.001), LAVI, and age were found to be independent predictors of AHREs. A receiver operating characteristic (ROC) curve comparison demonstrated that the LACI was a better predictor of AHRE than the LAVI. Conclusion: AHRE often progresses to atrial fibrillation, which has unfavorable consequences; therefore, predicting AHRE becomes vital. LACI, an easily accessible echocardiographic parameter, is a more robust predictor of AHRE than traditional parameters such as LAVI.

Summary: Background: Percutaneous superficial femoral interventions remain the preferred method of treatment for superficial femoral artery (SFA) disease. Nevertheless, long term restenosis continues to be a major limitation of percutaneous interventions. In this context, the objective of this study is to compare the efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting long-term (5 years) restenosis due to percutaneous interventions to the superficial femoral artery. Patients and methods: The sample of this retrospective study consisted of 545 peripheral artery disease (PAD) patients with a percutaneous intervention to the SFA. Of these patients, 362 and 183 were included in the group of PAD patients without long-term (5 years) SFA restenosis (Group 1) and in the group of PAD patients with long-term SFA restenosis (Group 2). The efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting the development of long-term SFA restenosis were comparatively analyzed. Results: CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scores all increased with long-term SFA restenosis. The receiver operating characteristic (ROC) curve analysis revealed that all five risk scoring systems successfully predicted long-term SFA restenosis, whereas the paired ROC curve analysis revealed that CHA2DS2-VASc-HS scores of >4 had the best prognostic power in predicting long term SFA restenosis. Conclusions: The study findings indicated that the CHA2DS2-VASc-HS score was an independent predictor of the development of SFA restenosis. The CHA2DS2-VASc-HS risk scoring system, which is the modified version of CHA2DS2-VASc, outperformed the CHA2DS2-VASc, HATCH, ATRIA, and ATRIA-HSV, the modified version of ATRIA, risk scoring systems in predicting long-term (5 years) SFA restenosis.