Nihat Söylemez

Aortic stenosis is one of the most common valvular diseases, particularly in the elderly population, and its incidence is steadily increasing in aging societies [1]. Severe symptomatic aortic steno...

Background: Systemic inflammation plays a central role in determining postoperative outcomes in patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Traditional inflammatory indices such as the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio have prognostic value; however, their dynamic behavior during cardiopulmonary bypass remains insufficiently characterized. More comprehensive indices, including the systemic immune-inflammation index and the systemic inflammatory response index, may help characterize early intraoperative inflammatory activity; however, their prognostic relevance should be regarded as exploratory and requires prospective validation. Methods: This retrospective nested case–control study included 245 patients who underwent isolated coronary artery bypass grafting, and intraoperative inflammatory indices during cardiopulmonary bypass were evaluated. Because of the nested case–control design, mortality cases were intentionally overrepresented to improve statistical power; therefore, the observed mortality rate does not reflect the true institutional mortality rate. Inflammatory indices (NLR, PLR, SII, and SIRI) were calculated at induction, at the 5th, 45th, and 90th minutes during cardiopulmonary bypass, and in the early postoperative period. Associations between these indices and in-hospital mortality were evaluated using univariate and multivariable logistic regression analyses. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC). Results: The final enriched analytical sample consisted of 51 mortality cases and 194 randomly sampled surviving controls. During cardiopulmonary bypass, inflammatory indices, particularly at the 5th minute, were significantly higher in patients who experienced mortality (p < 0.001 for all major indices). SII demonstrated the strongest predictive performance at the 5th minute (AUC = 0.790), followed by SIRI (AUC = 0.765), PLR (AUC = 0.687), and NLR (AUC = 0.681). In multivariable analysis, SII and SIRI measured at the 5th minute remained independent predictors of mortality. The addition of 5th-minute SII to the limited study-specific clinical model, which included age, ejection fraction, and preoperative creatinine, improved exploratory discrimination for in-hospital mortality (with AUC increasing from 0.698 to 0.797). Conclusions: Early intraoperative assessment of inflammatory indices during cardiopulmonary bypass may provide additional prognostic information in patients undergoing coronary artery bypass grafting. Composite indices, particularly SII and SIRI, showed stronger exploratory discrimination than traditional inflammatory markers in this enriched analytical sample. However, these findings should be considered hypothesis-generating and require prospective external validation before use in perioperative risk stratification or clinical decision-making can be recommended.

Background: Coronary anatomical complexity is commonly used for perioperative risk assessment in patients undergoing coronary artery bypass grafting (CABG), although it may not fully reflect systemic biological vulnerability. This study aimed to evaluate the association between the Prognostic Nutritional Index (PNI), a nutritional–immune marker derived from serum albumin and lymphocyte counts, and in-hospital mortality after CABG in relation to coronary anatomical complexity and established surgical risk scores. Methods: In this single-center retrospective cohort study, 324 consecutive patients who underwent isolated CABG between April 2024 and April 2025 were analyzed. The PNI was calculated according to the standard Onodera formula using preoperative serum albumin and total lymphocyte count. Associations with in-hospital mortality were evaluated using univariable and multivariable logistic regression analyses. Discriminative performance was assessed using receiver operating characteristic curve analysis, while exploratory analyses evaluating the additional prognostic contribution of the PNI beyond surgical risk scores were performed using nested model comparison and reclassification analyses. Internal validation and calibration analyses were also performed. Results: In-hospital mortality occurred in 26 patients. Preoperative and postoperative PNI values were significantly lower in patients who experienced in-hospital mortality. In multivariable analysis, the postoperative PNI remained independently associated with in-hospital mortality, whereas the preoperative PNI lost statistical significance after adjustment for clinical, renal, and surgical risk parameters. Receiver operating characteristic analysis demonstrated modest discriminative ability for the preoperative PNI (AUC: 0.742, 95% CI: 0.661–0.823). Exploratory analyses suggested a modest improvement in model discrimination and risk classification after the addition of the PNI to STS-based models; however, the overall incremental prognostic contribution remained limited. Calibration and internal validation analyses demonstrated acceptable agreement between predicted and observed mortality risk. Conclusions: The postoperative PNI demonstrated a stronger and independent association with in-hospital mortality than the preoperative PNI, suggesting that early postoperative nutritional–immune deterioration may reflect the magnitude of perioperative physiological stress and evolving clinical deterioration after CABG. Although lower preoperative PNI values were associated with mortality in univariable analyses, this association was no longer statistically significant after adjustment for clinical, renal, and surgical risk parameters. These findings indicate that postoperative nutritional–immune status may provide complementary biological information beyond conventional risk models; however, its clinical utility requires confirmation in larger prospective multicenter studies.

Background: Inflammation plays a central role in the pathophysiology and clinical progression of acute myocardial infarction (MI). Although clopidogrel is known to exert potential anti-inflammatory effects in addition to platelet inhibition, the behavior of the early inflammatory response after treatment initiation and its prognostic significance remain unclear. This study aimed to evaluate dynamic inflammatory changes during the early post-treatment period and their association with in-hospital outcomes in patients with ST-elevation myocardial infarction. Methods: This retrospective, observational, single-center study included 300 patients with ST-elevation myocardial infarction treated with clopidogrel loading therapy. Systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and delta neutrophil index (DNI) were evaluated before treatment and 24–48 h after therapy. In-hospital mortality and major adverse in-hospital outcomes were analyzed. Receiver operating characteristic analysis and multivariable logistic regression models were used to determine prognostic performance and independent predictors. Results: Contrary to the expected anti-inflammatory effect, all inflammatory markers significantly increased after clopidogrel therapy (all p < 0.05). Patients with persistent or increased inflammatory response demonstrated significantly higher rates of in-hospital mortality and major adverse outcomes. Post-treatment SIRI showed the strongest predictive performance for mortality (AUC: 0.81, 95% CI: 0.75–0.87), followed by ΔSIRI (AUC: 0.79). Multivariable analyses identified higher post-treatment inflammatory burden and dynamic inflammatory increases, particularly post-DNI and ΔSIRI, as independent predictors of mortality and adverse clinical course. Conclusions: Early inflammatory activation after clopidogrel therapy is strongly associated with poor in-hospital outcomes in patients with acute myocardial infarction. Persistent or increasing inflammatory burden may reflect an uncontrolled inflammatory response despite antiplatelet treatment and may serve as a practical and powerful prognostic marker for early risk stratification.

Background: Heart failure (HF) remains a major early complication following myocardial infarction (MI), contributing significantly to morbidity and adverse clinical outcomes. Reliable early risk stratification is essential for optimizing post-MI management. This study aimed to evaluate the prognostic performance and incremental value of the HALP (Hemoglobin–Albumin–Lymphocyte–Platelet) score and the AHEAD score in predicting 1-month HF after MI. Methods: This retrospective cohort study included 3205 consecutive patients with MI. The primary endpoint was the development of HF within one month. Three multivariable logistic regression models were constructed: a baseline clinical model (Model 1), a HALP-integrated model (Model 2), and an AHEAD-integrated model (Model 3), with component variables excluded to avoid collinearity. Model performance was assessed using odds ratios (ORs), 95% confidence intervals (CIs), and discrimination metrics (AUC). Incremental predictive value was further evaluated using net reclassification improvement (NRI). Internal validation was performed using bootstrapping and 5-fold cross-validation. A predefined subgroup analysis was conducted in patients with preserved ejection fraction (EF ≥ 40%), excluding EF from the models. Results: In the full cohort, all models demonstrated high discriminative ability for 1-month HF (AUC range: 0.950–0.954), with minimal differences between models. The AHEAD-based model showed the highest point estimate (AUC = 0.954, 95% CI: 0.944–0.963), but ROC curves were largely overlapping. Despite limited changes in AUC, the AHEAD score provided moderate improvement in risk reclassification (NRI = 0.287), whereas the HALP score showed minimal incremental value (NRI = 0.152) and was not independently associated with HF in multivariable analysis. In the EF ≥ 40 subgroup, HF incidence was lower (1.9%), and model performance was attenuated but remained robust (AUC range: 0.839–0.882), with the AHEAD score retaining strong independent predictive value. Peak CKMB and creatinine were consistently associated with increased HF risk. Although the odds ratio for CKMB appeared close to unity, this reflects unit scaling, and clinically meaningful increases corresponded to substantial risk increments. A clear dose–response relationship between AHEAD score and HF probability was observed. Conclusions: While both HALP and AHEAD scores are associated with post-MI HF risk, only the AHEAD score provides consistent independent and incremental prognostic value beyond established clinical predictors. Its simplicity and ability to capture comorbidity burden make it a practical adjunct for early risk stratification, particularly in patients with preserved EF. However, given the minimal differences in discrimination metrics and lack of external validation, these findings should be interpreted cautiously and considered hypothesis-generating.

Background: The C-reactive protein-to-albumin ratio (CAR) has emerged as a composite biomarker reflecting both systemic inflammation and nutritional status. This study investigated the prognostic value of preoperative and postoperative CAR in predicting early mortality following coronary artery bypass grafting (CABG). Methods: This retrospective study included 273 patients who underwent isolated CABG. Patients were categorized as mortality (+) (Ex group, n = 41) and mortality (−) (Non-Ex group, n = 232). Preoperative and postoperative CAR values were calculated and compared between groups. Independent predictors of mortality were evaluated using logistic regression analysis. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: Early mortality occurred in 41 patients (15.0%). Both preoperative and postoperative CAR values were significantly higher in the mortality (+) group compared with the mortality (−) group. In multivariable logistic regression analysis, postoperative creatinine remained independently associated with early mortality, whereas neither preoperative nor postoperative CAR retained independent statistical significance after adjustment for clinical variables and renal function despite moderate discriminative performance in crude and ROC-based analyses. ROC analysis showed that CAR demonstrated moderate discriminative ability for mortality prediction, with postoperative CAR showing better performance than preoperative CAR. Conclusions: Although CAR demonstrated moderate discriminative performance for early mortality after CABG in unadjusted analyses, it did not independently predict mortality after adjustment for clinical variables and renal function. Therefore, CAR may be more appropriately interpreted as a supportive inflammation-based risk stratification marker rather than a stand-alone prognostic predictor.

Background: ST-elevation myocardial infarction (STEMI) is most commonly caused by atherosclerotic coronary artery occlusion. In some instances, non-atherosclerotic mechanisms should also be considered. We present a case of a floating thrombus in the aortic root moving in and out of the right coronary ostium, leading to STEMI. Case summary: A 70-year-old man with stage IIIA lung adenocarcinoma receiving ongoing chemotherapy presented with syncope. The ECG revealed ST-segment elevation in the inferior leads and intermittent complete atrioventricular block with a heart rate of 40 bpm. A temporary transjugular pacemaker was inserted because of haemodynamic instability. Coronary angiography showed patent coronary arteries but cyclic radiolucency at the right coronary artery (RCA) ostium during RCA injections. Transoesophageal echocardiography identified a 2.5–3.0 cm pedunculated, mobile mass consistent with thrombus attached to the right coronary sinus, intermittently prolapsing into the RCA ostium. Surgical thrombectomy or fibrinolysis was deemed high risk because of prior thoracic radiotherapy and active malignancy with cranial metastases. A pre-emptive RCA guidewire was placed, and the thrombus obstructing the RCA ostium was successfully removed with multiple-pass aspiration using a 10F PRONTO.035 extraction catheter, achieving TIMI 3 flow. Haemodynamic status and rhythm improved subsequently. The patient was discharged on apixaban. Discussion: This case illustrates dynamic RCA obstruction caused by an aortic root thrombus managed with catheter-based aspiration. However, this approach should be considered on a case-by-case basis, given its high thromboembolic potential.

Dilated cardiomyopathy is characterized by progressive left ventricular dilation and impaired systolic function, with inflammation recognized as a key contributor to disease onset and adverse outcomes. C-reactive protein reflects systemic biochemical inflammation, whereas Delta Neutrophil Index represents the circulating immature neutrophil fraction and provides a cellular dimension of inflammatory burden. The combined diagnostic and prognostic value of these two biomarkers in dilated cardiomyopathy has not been adequately explored. This retrospective study included one hundred and fifty patients with dilated cardiomyopathy and one hundred and fifty age-, diabetes-, and hypertension-matched controls. Demographic, laboratory, and echocardiographic measurements were analyzed. The diagnostic and prognostic performances of C-reactive protein, Delta Neutrophil Index, and their combined model were assessed using logistic regression, receiver operating characteristic curve analysis, reclassification metrics, calibration testing, and decision curve analysis. Additional analyses were performed for patients with left ventricular ejection fraction below twenty percent, and mortality predictors were examined within the dilated cardiomyopathy cohort. Both C-reactive protein and Delta Neutrophil Index levels were significantly higher in patients with dilated cardiomyopathy than in controls and were further elevated in those with severely reduced ejection fraction. Delta Neutrophil Index remained independently associated with severe left ventricular dysfunction (ejection fraction ≤ 20%) in multivariable analysis (odds ratio 2.51). Each biomarker showed an independent association with the presence of dilated cardiomyopathy, and their combined model achieved the highest diagnostic accuracy. In receiver operating characteristic analysis, the area under the curve was 0.895 for Delta Neutrophil Index, 0.691 for C-reactive protein, and increased to 0.920 for the combined model, with a sensitivity of 81.3% and specificity of 92.0%. Delta Neutrophil Index was independently associated with severe left ventricular dysfunction and mortality, while C-reactive protein, age, ejection fraction, urea, and sodium also contributed to mortality risk. Delta Neutrophil Index was independently associated with mortality (odds ratio 2.51), while C-reactive protein, age, ejection fraction, urea, and sodium also contributed to mortality risk. The combined model provided significant improvement in risk reclassification and demonstrated superior calibration and greater net clinical benefit across a wide range of decision thresholds. C-reactive protein and Delta Neutrophil Index offer complementary diagnostic and prognostic information in dilated cardiomyopathy. Their combined use enhances diagnostic discrimination, strengthens risk stratification, and improves identification of patients at high risk for severe ventricular dysfunction and mortality. Incorporation of these accessible biomarkers into clinical evaluation may support earlier recognition and more tailored management of high-risk individuals.

Premature ventricular contraction is generally known as benign in the absence of structural heart disease; however, premature ventricular contraction-induced left ventricular systolic dysfunction or ventricular arrhythmias are defined in some cases. Ventricular repolarization duration differs between myocardial cells, which causes myocardial electrical heterogeneity and is thought to be responsible for ventricular arrhythmias. In our study, we aimed to evaluate the association of ventricular repolarization parameters including Tp-Te interval, Tp-Te/QT ratio, and QRS-T angle with premature ventricular contraction frequency in patients with premature ventricular contraction burden. A total of 80 subjects who were admitted to our cardiology department and underwent 24-h electrocardiography Holter monitoring were included. Patients were divided into two groups: group 1 is defined as premature ventricular contraction burden that had frequent premature ventricular contraction ≥1% in 24-h Holter monitoring, and group 2 is defined as rare premature ventricular contraction <1% in 24-h Holter monitoring. Tp-Te interval and Tp-Te/QT ratio are statistically significantly prolonged in the premature ventricular contraction burden group than in the control group (85.3±13.9 vs. 65.7±11.9, p<0.001; 0.19±0.03 vs. 0.15±0.02, p<0.001, respectively). QRS-T angle was statistically significantly abnormal in the premature ventricular contraction burden group (p=0.024). Increased Tp-Te interval and widened QRS-T angle are associated with ventricular arrhythmias and might be used for the prediction of premature ventricular contraction burden in patients with premature ventricular contraction in electrocardiography in the absence of 24-h Holter monitoring.