Fatma Can

Background and Objectives: Composite indices from routine inflammatory, haematological and nutritional measurements are widely reported as prognostic markers after acute coronary syndromes, but whether they add information beyond their components is uncertain. Materials and Methods: In 30-day survivors of non-ST-segment elevation myocardial infarction (NSTEMI) undergoing coronary angiography at a single centre, thirteen composite indices and six prespecified components were evaluated for five-year all-cause mortality using ROC analysis, Cox regression and the change in Harrell’s C-index (ΔC) over a study clinical model. Each index was also compared with a freely weighted model of its own constituents and with a reference model adding CRP and albumin. Results: Among 561 patients (median follow-up 5.48 years), 94 died, 86 within five years. Composite-index AUCs ranged from 0.616 to 0.689; none exceeded CRP alone after multiplicity correction. Eight indices were nominally associated with mortality after adjustment (hazard ratios 1.26–1.38 per 1 SD), but every bootstrap confidence interval for ΔC over the clinical model included zero. Fixed indices and freely weighted constituents performed similarly (cross-validated ΔC −0.0089 to +0.0053), with one small exploratory difference favouring the fixed MLR ratio. Adding CRP and albumin raised the C-index from 0.7720 to 0.7826; over this reference, no estimable composite showed evidence of association (all p ≥ 0.19). Conclusions: In 30-day survivors of NSTEMI, composite indices showed no evidence of improved long-term mortality discrimination over a study-specific clinical model and contained no information beyond their measured constituents. Their independent associations may largely reflect information already present in the components. Small gains cannot be excluded; the findings do not establish equivalence.

Background: The purpose of this study was to compare the prognostic value of Controlling Nutritional Status (CONUT) and Prognostic Nutritional Index (PNI) scores for predicting in-hospital mortality among patients who presented with ST-segment elevation myocardial infarction (STEMI) and received primary percutaneous coronary intervention (P-PCI). Methods: This retrospective cohort study comprised 4599 STEMI patients who received P-PCI. The primary outcome was described as in-hospital mortality. Multivariable logistic regression analysis was performed to determine the association between in-hospital mortality and CONUT and PNI scores. Model performance and goodness-of-fit measures were used for comparison. Results: In-hospital mortality rate was 5.7% (n = 261). Patients who died during the index hospitalization were older and more likely to have diabetes, prior myocardial infarction (MI), revascularization history, longer total ischemic time, no-reflow and reduced left ventricular ejection fraction (LVEF). According to body mass index (BMI) categories, moderate-to-severe malnutrition was observed in approximately 17–21% and 8–10% of patients according to the CONUT and PNI scores, respectively. Both CONUT and PNI scores were significantly associated with in-hospital mortality. However, the model incorporating CONUT demonstrated superior goodness of fit and higher discriminative performance compared with the model incorporating PNI. Conclusions: Among patients with STEMI, moderate-severe malnutrition was present in nearly 10% and 20% when evaluated using PNI and CONUT, respectively. The CONUT score demonstrated superior predictive performance for in-hospital mortality compared with PNI.

This study aims to investigate the effects of iodinated contrast media (ICM) exposure on thyroid function in patients with subclinical hyperthyroidism. The study included 46 patients with subclinical hyperthyroidism who presented to the cardiology outpatient clinic and underwent angiographic imaging procedures. Thyroid function tests (TSH, fT3, fT4) of the patients before and after the procedure were analyzed retrospectively. Patients were divided into two groups as low volume (< 200 ml) and high volume (≥ 200 ml) according to the volume of contrast medium received. Pre- and post-procedure comparisons as well as analyses according to low and high-volume exposure were performed. After the procedure, 50% of the patients became euthyroid and 41.3% remained in the same group (subclinical hyperthyroidism). 2 patients (4.3%) developed clinical hyperthyroidism, and another 2 patients (4.3%) developed clinical hypothyroidism. TSH values increased significantly after the procedure (p < 0.01), but no significant change was observed in fT3 and fT4 values. In patients with subclinical hyperthyroidism, thyroid function mostly remained stable or became euthyroid after ICM exposure. However, a group of patients developed clinical hypothyroidism or hyperthyroidism. These results suggest that patients with subclinical hyperthyroidism should be closely monitored when using ICM. Long-term follow-up will contribute to a better understanding of the possible risks in this patient group.

Background: Perioperative hypotension is a frequent but underrecognized complication during transcatheter aortic valve implantation (TAVI). Although reduced left ventricular ejection fraction (EF) and low baseline blood pressure have been linked to hemodynamic instability, the role of metabolic comorbidities and procedural factors remains less well established. Methods: We retrospectively analyzed 123 patients who underwent transfemoral TAVI between June 2016 and June 2022. Perioperative hypotension was defined as a sustained systolic blood pressure < 90 mmHg or ≥30% reduction from baseline for at least 5 min. Clinical, laboratory, and procedural predictors were assessed using multivariate logistic regression, and model performance was evaluated by ROC curve analysis. Results: Perioperative hypotension occurred in 57% of patients. Independent predictors were diabetes mellitus (OR 2.79, 95% CI 1.03–7.56, p = 0.044), reduced EF (p = 0.027), lower baseline diastolic blood pressure (OR 0.935 per mmHg, 95% CI 0.893–0.978, p = 0.004), and longer procedural duration (OR 1.038 per minute, 95% CI 1.001–1.076, p = 0.044). The predictive model demonstrated good calibration and discrimination (AUC 0.844). Patients with hypotension had significantly higher in-hospital mortality (12.9% vs. 1.9%, p = 0.027) and longer ICU stay. An exploratory finding suggested less frequent use of sugammadex among hypotensive patients (11.4% vs. 32.1%, p = 0.005). Conclusions: Perioperative hypotension is common during TAVI and strongly associated with early mortality. Our study uniquely identifies diabetes mellitus as an independent predictor, alongside ventricular dysfunction, baseline blood pressure, and procedural duration. These findings suggest that careful preprocedural risk stratification, hemodynamic vigilance, and optimization of anesthetic management may improve outcomes in vulnerable patients.

Objective: With the growing number of individuals over the age of 90 (nonagenarians), understanding the risk factors and clinical outcomes associated with acute coronary syndrome (ACS) in this population has become increasingly important. This study aims to compare demographic, biochemical, and clinical parameters between nonagenarian ACS patients and a control group of healthy individuals within the same age bracket, as well as to analyze differences within the ACS group according to myocardial infarction type and evaluate the impact of percutaneous coronary intervention (PCI) on in-hospital mortality. Methods: 104 patients aged 90–100 years diagnosed with ACS for the first time between January 2022 and January 2024 were included in this retrospectively designed case-control study. The patients were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups based on their electrocardiographic findings. The control group included 113 healthy individuals within the same age range with no prior history of coronary artery disease. Data on traditional risk factors, including lipid profiles and family history, were analyzed using logistic regression models. Additionally, differences in clinical outcomes, including the length of hospital stay and mortality rates, were evaluated based on the application of PCI. Results: The ACS group exhibited significantly higher glucose, white blood cell count, and total cholesterol levels, along with lower hemoglobin and mean corpuscular volume, compared to the control group (p < 0.05). While no significant difference was found in low-density lipoprotein (LDL) levels, high-density lipoprotein (HDL) levels were significantly lower in ACS patients (p < 0.001). Family history played a more substantial role in the STEMI group compared to the NSTEMI group (p = 0.049). Additionally, STEMI patients were more likely to undergo invasive procedures, which were associated with reduced in-hospital mortality (p = 0.042). In contrast, no significant difference in mortality was observed in the NSTEMI group based on PCI status. Conclusions: This study highlights the distinct risk profiles of elderly ACS patients, emphasizing the critical role of low HDL levels and family history, particularly in STEMI cases. Furthermore, PCI was shown to reduce in-hospital mortality rates in STEMI patients, suggesting that invasive treatment approaches may be beneficial even in this vulnerable population. Personalized and multidisciplinary management strategies are essential for this vulnerable population. Further prospective research is needed to validate these findings and guide clinical decision-making for nonagenarians.

Objective: With the growing number of individuals over the age of 90 (nonagenarians), understanding the risk factors and clinical outcomes associated with acute coronary syndrome (ACS) in this population has become increasingly important. This study aims to compare demographic, biochemical, and clinical parameters between nonagenarian ACS patients and a control group of healthy individuals within the same age bracket as well as to analyze differences within the ACS group according to myocardial infarction type and evaluate the impact of percutaneous coronary intervention (PCI) on in-hospital mortality. Methods: This retrospective case-control study included 104 patients aged 90-100 years diagnosed with ACS for the first time between January 2022 and January 2024. The patients were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups based on their electrocardiographic findings. The control group consisted of 113 healthy individuals in the same age range who had no history of coronary artery disease. Data on traditional risk factors, including lipid profiles and family history, were analyzed using logistic regression models. Additionally, differences in clinical outcomes, including length of hospital stay and mortality rates, were evaluated based on the application of PCI. Results: The ACS group exhibited significantly higher glucose, white blood cell count, and total cholesterol levels, along with lower hemoglobin and mean corpuscular volume, compared to the control group (p<0.05). While no significant difference was found in low-density lipoprotein (LDL) levels, high-density lipoprotein (HDL) levels were significantly lower in ACS patients (p<0.001). Family history played a more substantial role in the STEMI group compared to the NSTEMI group (p=0.049). Additionally, STEMI patients were more likely to undergo invasive procedures, which were associated with reduced in-hospital mortality (p=0.042). In contrast, no significant difference in mortality was observed in the NSTEMI group based on PCI status. Conclusion: This study highlights the distinct risk profiles of elderly ACS patients, emphasizing the critical role of low HDL levels and family history, particularly in STEMI cases. Furthermore, PCI was shown to reduce in-hospital mortality rates in STEMI patients, suggesting that invasive treatment approaches may be beneficial even in this vulnerable population. Personalized and multidisciplinary management strategies are essential for this vulnerable population. Further prospective research is needed to validate these findings and guide clinical decision-making for nonagenarians.

Background: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large‐scale study aimed to retrospectively evaluate the long‐term outcomes of the patients who underwent reoperation or TC of PVLs. Methods and Results: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in‐hospital or long‐term outcomes were assessed. The primary end point was defined as the all‐cause death during follow‐up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P =0.549) and procedural success (73.7 versus 65.2%; P =0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in‐hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75–5.88]; P =0.001; and adjusted odds ratio (inverse probability‐weighted), 4.55 [95% CI, 2.27–10.0]; P P =0.435; and adjusted HR (inverse probability‐weighted), 1.11 [95% CI, 0.67–1.81]; P =0.679). Conclusions: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long‐term mortality rates compared with surgery.

Purpose: Data about the association of malnutrition with prognosis in pulmonary arterial hypertension (PAH) is limited. This study aims to evaluate the relationship of Controlling Nutritional Status (CONUT) score with long-term mortality in PAH. Materials and methods: All consecutive patients newly diagnosed with PAH between 2013 and 2020 were evaluated. CONUT score at diagnosis was calculated through total lymphocyte, albumin and total cholesterol levels. Primary outcome was long-term all-cause mortality. Patients were followed up for 62 (31.3-91.5) months. Results: 92 patients (mean age=43.915.7 years, 65.2% women) were included. 37% of the patients had any degree of malnutrition according to CONUT score (2). Patients without malnutrition were significantly more in the low-risk categories of risk stratification tools (44.8% vs 17.6% according to ESC/ERS guideline, p=0.03; 70.7% vs 35.3% and 70.7% vs 32.4% according to REVEAL 2.0 and REVEAL Lite 2, p

Background: Left atrial (LA) strain is a robust measure of LA function and is a useful parameter to assess left ventricular filling pressure. While initially considered as a “load-independent” parameter of LA function, later studies have found that acute changes in LA preload may affect LA reservoir and contractile strains. Acute alterations in blood pressure (BP) induces a change in left ventricular (LV) filling pressure without imposing a volume load, thus providing an opportunity to assess the effects of the change in LA afterload on LA mechanics. This study aims to understand the effect of acute BP changes on LA strain. Methods: A total of 40 patients admitted to the emergency department with hypertensive urgency were included. All patients underwent a comprehensive echocardiographic examination including measurement of LA reservoir, conduit and contractile strains. A repeat set of measurements were obtained after BP lowering. Results: Average drop in mean BP following intervention was 18.1 ± 5.4%. LV end-systolic and end-diastolic volumes, as well as maximum and minimum LA volumes were decreased significantly after BP reduction. The absolute increases in reservoir and contractile strains were 2.3 ± 4.7% (7.9% ± 13.8% relative to baseline) and 2.5 ± 3.3% (13.5 ± 19.0% relative to baseline), respectively, with both changes being statistically significant (p = 0.003 for reservoir and p < 0.001 for contractile strains). There were no significant changes in conduit strain after BP intervention (p = 0.79). The change in both LA reservoir and contractile strains were more evident in those with a previous diagnosis of hypertension and those with a smaller degree of change in mean BP after intervention. Conclusion: In patients with an acute hypertension, lowering BP leads to an acute improvement in LA reservoir and contractile strains. Thus, acute changes in systemic BP should be considered when LA mechanics are evaluated.

Introduction: Percutaneous left atrial appendage closure (LAAC) is considered in patients with non-valvular atrial fibrillation (AF) who cannot receive long-term anticoagulant therapy or who experience thromboembolism despite anticoagulant therapy. The structural feature of the left atrial appendage (LAA) and high variability of the clinical features of the patients endorse the difficulty of the procedure. In this study, it was aimed to present our single-center LAAC experience and in-hospital follow-up results of the patients. Patients and Methods: Patients who had undergone LAAC in our cardiology clinic between 2017 and 2022 were included in the study retrospectively. All clinical, laboratory and imaging characteristics of the patients and in-hospital follow-up results were evaluated. Results: Median age of 29 patients included in the study was 78 years (65-82, IQR= 25-75) and 17 were males (58.6%). Median score of CHA₂ DS₂ -VASc was 4 (4-6, IQR= 25-75). In addition, median value of the HASBLED score was 3 (3-4, IQR= 25-75). The rate of complete closure, minor bleeding during the procedure, and pericardial tamponade were 27 (93.1%), 1 (3.4%), and 1 (3.4%) respectively, and the device was dislocated immediately after the procedure in one patient (3.4%). The most common type of LAA appendix was chicken wings 15 (51.7%). Conclusion: Success rate of the LAAC procedure was high in this single-center study conducted in our country with a relatively high number of patients.