Metin Karayakali

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity with diverse underlying mechanisms, and its diagnostic evaluation remains challenging in routine clinical practice despite advances in multimodality imaging. Systemic inflammatory indices derived from routine laboratory parameters have recently gained attention as potential markers reflecting inflammatory burden in cardiovascular diseases. This study aimed to evaluate the potential diagnostic utility of systemic inflammatory indices in patients with MINOCA and to compare these indices across patients with obstructive myocardial infarction and non-critical coronary artery disease. Methods: In this retrospective single-center observational study, a total of 2,050 consecutive patients who underwent coronary angiography between January 1, 2023, and January 1, 2024 were initially screened. After applying predefined exclusion criteria, including renal failure, pulmonary embolism, cerebrovascular events, arrhythmias, severe valvular heart disease, severe anemia, and incomplete clinical data, 496 patients were eligible for the final analysis. Patients were classified into three groups according to coronary angiographic findings and troponin levels: MINOCA (n = 67), obstructive myocardial infarction (n = 222), and non-critical coronary artery disease (n = 207). Demographic characteristics, laboratory parameters, echocardiographic findings, and systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and C-reactive protein-to-albumin ratio (CAR) were analyzed. Multivariable logistic regression analysis together with receiver operating characteristic (ROC) curve analysis was performed to determine independent predictors associated with MINOCA. Results: Patients with obstructive myocardial infarction were older and had a higher prevalence of diabetes mellitus and hypertension compared with the MINOCA and non-critical coronary artery disease groups (P < 0.001). Systemic inflammatory indices including neutrophil count, SII, NLR, PLR, MLR, C-reactive protein (CRP), and CAR were significantly higher in the obstructive myocardial infarction group, whereas intermediate levels were observed in the MINOCA group (P < 0.001). Left ventricular ejection fraction (LVEF) was significantly lower in the obstructive myocardial infarction group compared with the MINOCA and non-critical coronary artery disease groups (P < 0.001). In multivariate logistic regression analysis, LVEF was identified as an independent predictor of MINOCA when compared with obstructive myocardial infarction, whereas SII remained an independent predictor in comparisons between MINOCA and non-critical coronary artery disease groups. Receiver operating characteristic (ROC) curve analyses demonstrated that LVEF showed the highest diagnostic performance among the evaluated parameters. Conclusions: Systemic inflammatory indices differ significantly among patients with MINOCA, obstructive myocardial infarction, and non-critical coronary artery disease. Easily accessible inflammatory markers together with echocardiographic parameters such as LVEF may provide additional diagnostic value in the clinical evaluation of patients with suspected MINOCA.

Aim: Obesity leads to adverse changes in cardiovascular electrophysiology; however, data comparing overweight and obese young individuals are limited. In this study, ventricular repolarization, cardiac autonomic function, and 24-hour blood pressure (ABPM) were compared between two groups, and the aim was to identify factors independently associated with QTc prolongation.Material and Methods: This retrospective study included 96 young adults aged 18–30 years who underwent simultaneous ABPM and Holter electrocardiography (48 overweight: BMI 25.0–29.9 kg/m²; 48 obese: BMI 30.0–39.9 kg/m²). Heart rate variability (HRV) and metabolic indices including HOMA-IR and MetS-IR were evaluated. Regression and ROC analyses were performed to determine factors associated with QTc prolongation (≥450 ms).Results: QTc was longer in obese individuals (429.43±25.27 vs. 405.38±23.44 ms; p<0.001); Tpe and Tpe/QTc did not differ. LF/HF was higher (1.94 vs. 1.59; p<0.001), RMSSD was lower (45.41±10.24 vs. 54.94±9.89 ms; p<0.001), and nocturnal diastolic BP dipping was more impaired (12.07%±9.42 vs. 16.69%±6.85; p=0.009). The factors independently associated with QTc were BMI (β=0.33; p<0.001), CRP (β=0.28; p=0.001), diastolic BP dipping (β=−0.27; p=0.002), and HbA1c (β=0.17; p=0.049); these factors together accounted for 41.3% of the model variance (R²=0.413). HOMA-IR ≥3.36 (AUC=0.722; p=0.002) and a non-dipper diastolic pattern (AUC=0.701; p=0.004) were the strongest discriminators for QTc prolongation.Conclusion: In young obese adults, repolarization prolongation, autonomic dysfunction, and impaired nocturnal BP patterns are observed. The independent association of BMI, CRP, diastolic dipping, and HbA1c with QTc supports the potential clinical importance of QTc, HRV, and ambulatory BP assessment in young obese individuals.

Background: Atrial fibrillation (AF) increases ischemic stroke risk nearly fivefold. Although the CHA ₂ DS ₂ ‐VA score is widely used for risk stratification, its predictive performance is limited, particularly in intermediate‐risk patients. Left atrial (LA) enlargement, a marker of structural remodeling, may improve risk prediction. Aims: To evaluate whether adding LA diameter to CHA ₂ DS ₂ ‐VA (creating CHA ₂ DS ₂ ‐VALa) enhances ischemic stroke prediction in AF patients. We additionally derived a multivariable β‐weighted model and benchmarked its performance against CHA ₂ DS ₂ ‐VA (and the simplified +1 LA rule). Methods: This retrospective study included 1648 AF patients. LA diameter was measured by standardized echocardiography. A ROC‐derived cut‐off (> 4.7 cm) defined enlargement. Patients were followed for a mean of 4.18 ± 0.35 years. Imaging‐confirmed ischemic stroke events were identified through institutional hospital records and the electronic health registry, and were validated using hospitalization documentation, neurology consultation notes, discharge summaries, and available brain CT/MRI findings. Predictors were assessed using multivariable logistic regression, and Kaplan–Meier/log‐rank analyses compared CHA ₂ DS ₂ ‐VALa versus CHA ₂ DS ₂ ‐VA. Results: Imaging‐confirmed ischemic stroke events occurred more frequently in patients with LA > 4.7 cm (25 [3.8%] vs. 21 [2.1%], p < 0.001). Elevated CRP, NT‐proBNP, diabetes, hypertension, CAD, and heart failure were also associated with stroke. LA > 4.7 cm independently predicted events (OR 1.97, 95% CI 1.36–2.86, p < 0.001). ROC analysis showed strong discrimination for LA diameter (AUC 0.872; sensitivity 82%, specificity 85%). Kaplan–Meier analysis demonstrated superior prediction with CHA ₂ DS ₂ ‐VALa compared to CHA ₂ DS ₂ ‐VA (log‐rank p < 0.001). Conclusion: The CHA ₂ DS ₂ ‐VALa score significantly improves stroke risk stratification in AF by integrating LA diameter into conventional scoring. As echocardiographic measurement is widely available and reproducible, this modification offers a simple, pragmatic approach to refine residual stroke‐risk stratification and support closer evaluation and follow‐up in anticoagulated AF patients. Prospective validation in diverse populations is warranted.

Background/Objectives: Laparoscopic sleeve gastrectomy (LSG) treats severe obesity, but data on its effects on 24 h blood pressure (BP) patterns, blood pressure variability (BPV), and cardiac autonomic nervous system (CANS) in obese patients without hypertension or diabetes are limited. We evaluated these parameters before and after LSG. Methods: 78 patients with severe obesity (BMI ≥ 40 kg/m²) without hypertension or diabetes who underwent LSG between January 2016 and December 2019 were included in the study. Patients underwent ambulatory blood pressure monitoring (ABPM), ambulatory electrocardiographic monitoring, and laboratory tests before and six months after surgery. Results: Preoperative ABPM was characterized by a significant proportion of masked hypertension (43.5%), high 24 h BP (mean SBP 138.9 ± 5.5 mmHg, DBP 81.1 ± 4.9 mmHg), high BP load (39% SBP, 38% DBP), and a non-dipper pattern (67.9%). After LSG, significant improvements were observed in mean 24 h SBP, DBP (p < 0.001), BPV, BP load, and non-dipper patterns. HRV parameters (SDANN, RMSSD) increased significantly (p < 0.001) and HRT parameters improved: TO became more negative from −0.54 ± 1.73 to −2.53 ± 1.97, TS increased from 5.98 ± 3.49 to 9.87 ± 4.28 ms/RR (p < 0.001). We found a strong association between decreased body mass index and BP changes. Changes in glucose, HbA1c, and HOMA-IR predicted CANS improvement (β = 0.24–0.38; R² = 20.8–29.7%). Conclusions: Six months after LSG, significant improvements in BP, BPV, and CANS were observed. BP reduction was primarily associated with weight loss, while glucose control was associated with autonomic improvements. LSG was associated with early improvements in surrogate cardiovascular risk markers through combined weight-dependent and metabolic-hormonal mechanisms.

The American Heart Association’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations established estimated glomerular filtration rate (eGFR) as a component of cardiovascular risk assessment. However, the anatomical substrate underlying this risk—coronary atherosclerotic burden—remains inadequately characterized across renal function spectrum. This retrospective study included 1181 patients (mean age: 60.2 ± 8.9 years, 65.7% male) undergoing elective coronary angiography. Patients divided groups using eGFR; eGFR ≥90 (n = 596), 60 to 89 (n = 497), and 30 to 59 mL/min/1.73 m ² (n = 88) were evaluated by stratification. Coronary atherosclerotic burden was determined using Gensini score. eGFR demonstrated a strong correlation with Gensini score (ρ = −0.352, P < .001). Each 10 mL/min/1.73 m ² eGFR decline conferred 40% increased odds of severe coronary atherosclerosis (odds ratio [OR] = 0.960, 95% CI: 0.951-0.970, P < .001). Patients with eGFR 30 to 59 mL/min/1.73 m ² exhibited 6-fold higher odds compared with preserved renal function (OR 6.073, 95% CI: 3.352-11.005, P < .001), independent of traditional risk factors. This study provides an anatomical validation for incorporating eGFR into cardiovascular risk assessment. Our angiographic evidence demonstrates that even mild renal dysfunction is accompanied by increased atherosclerotic burden. These findings bridge the gap between epidemiological risk prediction and pathophysiological reality, reinforcing the cardiovascular-kidney-metabolic health continuum and supporting aggressive risk modification strategies in patients with declining renal function, particularly among diabetic women.

Heart failure (HF) outcomes may vary by gender and geographic region, yet data from middle-income countries remain limited. This study aimed to evaluate the impact of gender and urban-rural residence on clinical outcomes and quality of life in HF patients from Tokat, Turkey. In this retrospective study, 200 HF patients (54% male, 50% rural) were analyzed. Baseline characteristics, including comorbidities and laboratory parameters, were compared by gender and region. Primary outcomes were mortality and hospital readmission at one year. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Cox regression analysis identified risk factors for adverse outcomes. Females exhibited higher mortality (17.4% vs. 13.0%, p=0.04) and hospital readmission rates (40.2% vs. 28.7%, p=0.02) than males, alongside worse MLHFQ scores (53.4 ± 15.4 vs. 46.0 ± 13.2, p<0.01). Rural patients had elevated mortality (20.0% vs. 10.0%, p=0.02) and ACCEPTED MANUSCRIPT Accepted manuscript readmission (43.0% vs. 25.0%, p<0.01) compared to urban counterparts, with poorer MLHFQ scores (54.8 ± 15.0 vs. 44.2 ± 13.0, p20 km (HR=1.90, 95% CI: 1.15-3.14, p=0.02) as mortality predictors. SGLT-2 inhibitor use was associated with reduced readmission risk (HR=0.40, 95% CI: 0.18-0.89, p=0.02). Gender and regional disparities significantly influence HF outcomes in Tokat, with females and rural patients facing worse prognosis. Interventions targeting education, healthcare access, and optimized therapies may mitigate these inequities.

Aim: Non-dipper hypertension (NDHT) is associated with increased cardiovascular mortality. Lots of different electrocardiographic parameters can be used for this purpose. Some electrocardiographic repolarization parameters and some particular parameters obtained from 24 hours holter recordings frequently were used. The aim of this study was to evaluate ventricular arrhythmia risk by using most of this electrocardiographic parameters in patients with dipper hypertension (DHT) and NDHT.Material and methods: 220 patients with hypertension were included this study. Patients were divided into two groups as DHT and NDHT according to the 24 hours ambulatory blood pressure monitoring. Two groups were compared with electrocardiography and echocardiography parameters and also were compared with heart rate variability (HRV) and heart rate turbulence (HRT) parameters.Results: There were no significant differences between DHT and NDHT groups with regard to demographic and laboratory datas. Also echocardiography parameters normally distributed and have no significant differences between two groups. There were no significant differences between DHT and NDHT groups with regard to left ventricular mass index (p=0.280). Although QT, QT dispersion, HRV and HRT parameters differences were not statistically significant , results were in favour of DHT in terms of ventricular arrhythmia risk. Conclusion: When hypertensive patients having no statistically significant differences in terms of left ventricular diamaters and left ventricular mass between them were divided as DHT and NDHT; there were no statistically significant differences between two groups with regard to electrocardiographic ventricular arrhythmia parameters although results were in favour of DHT.

Objective: To evaluate left and right ventricular functions using tissue Doppler echocardiography (TDE) and myocardial performance index (MPI) methods in patients with slow coronary flow (SCF) and to determine the relationship between these parameters and thrombolysis in myocardial infarction frame count in SCF patients. Subjects and Methods: Thirty-five patients (20 males and 15 females) with SCF who underwent coronary angiography and 35 age- and sex-matched controls (14 males and 21 females) without SCF who underwent elective coronary angiography were enrolled in the study. Left ventricular (LV) and right ventricular (RV) functions were examined using conventional echocardiography and TDE. Results: LV systolic myocardial velocity (Sm), early myocardial velocity (Em), late myocardial velocity (Am), and Em/Am ratio were similar in both the SCF and control groups; however, isovolumetric relaxation time (IRT) was higher in the SCF group compared to the control group (IRT: 99 ± 17 vs. 88 ± 20; p = 0.01). In patients with SCF, LV MPI was higher than in the control group, but this was not statistically significant (0.61 ± 0.11 vs. 0.56 ± 0.12; p = 0.07). The RV tricuspid annular velocities and MPI were similar in the SCF and control groups. Conclusion: This study showed that SCF affected LV functions echocardiographically and could cause partially reduced LV performance. In addition, SCF did not affect RV functions echocardiographically.