Cuma Süleymanoğlu

Background: Intermediate left main coronary artery (LMCA) disease poses a significant diagnostic challenge. Intravascular ultrasound (IVUS) is the guideline‐recommended reference standard for anatomical assessment, whereas quantitative flow ratio (QFR) provides a wire‐free physiological estimate. Conventional coronary angiography (CCA) remains the most widely available assessment modality. However, a systematic three‐way comparison of these modalities in LMCA disease is lacking. Aims: To compare the diagnostic performance, agreement, and correlations of CCA and QFR with IVUS for the assessment of intermediate LMCA disease. Methods: This prospective single‐center study enrolled 135 patients with LMCA lesions who underwent CCA, IVUS, and offline QFR (QAngio XA 3D) between January 2024 and June 2025. IVUS‐derived minimum lumen area (MLA) < 6 mm ² was defined as anatomically significant disease and served as the reference standard. QFR < 0.80 defined functional significance, while CCA diameter stenosis (DS) ≥ 50% defined angiographic significance. Diagnostic performance, inter‐modality agreement, correlation, and Bland–Altman agreement were assessed. Results: The mean age was 63.4 ± 9.7 years, and 88.1% of patients were male. IVUS identified significant disease in 92 patients (68.1%), compared with 68 (50.4%) by CCA and 50 (37.0%) by QFR. Against the IVUS reference standard, CCA demonstrated 67.4% sensitivity and 86.0% specificity (κ = 0.465; AUC = 0.824; optimal threshold DS ≥ 47%), whereas QFR demonstrated 54.3% sensitivity and 100% specificity (κ = 0.426; AUC = 0.848; Youden‐optimal cutoff QFR ≤ 0.49). CCA correlated moderately with IVUS‐derived MLA (r = −0.384; p < 0.001) and QFR (r = −0.512; p < 0.001). Both CCA and QFR systematically underestimated vessel dimensions relative to IVUS (Bland–Altman bias: CCA − 2.50 mm ² ; QFR − 2.21 mm ² ). On multivariable analysis, CCA DS ≥ 50% (OR 2.87; p = 0.011), decreasing QFR value per 0.1‐unit (OR 0.61; p = 0.019), and distal bifurcation location (OR 2.38; p = 0.045) independently predicted IVUS‐defined significant disease. Conclusion: QFR demonstrated perfect specificity and may serve as a rule‐in tool, whereas CCA provided greater sensitivity for initial triage. Neither modality can replace IVUS for anatomical characterization and procedural planning. A multimodality approach may therefore be appropriate for the assessment of intermediate LMCA stenosis.

Introduction: Left bundle branch block (LBBB) complicates electrocardiographic interpretation in acute heart failure (AHF). This study aimed to evaluate the relationship between electrocardiographic parameters, including QRS duration, QRS morphology, and the Selvester QRS score (SQS), and echocardiographic findings in patients with AHF presenting with LBBB across different heart failure phenotypes. Methods: In this retrospective cohort, 275 patients hospitalized with AHF and LBBB were analyzed. Patients were classified as heart failure with reduced ejection fraction (HFrEF, left ventricular ejection fraction [LVEF] 43 yielding 74.5% sensitivity and 69.6% specificity. QRS duration and morphology demonstrated no meaningful predictive value (AUC ≈ 0.49). Conclusion: In AHF patients with LBBB, SQS outperforms conventional QRS metrics in identifying reduced LV systolic function. An SQS >43 provides moderate diagnostic accuracy and may support early risk stratification when echocardiography is not immediately available.

Background: Coronary collateral circulation plays a crucial compensatory role in patients with chronic total occlusion (CTO) by providing alternative blood flow pathways. The HALP score (hemoglobin, albumin, lymphocyte, and platelet) integrates systemic inflammation and nutritional status, but its relationship with collateral development in CTO patients remains unexplored. Aims: This study aimed to evaluate the association between HALP score and coronary collateral circulation quality assessed by Werner classification in CTO patients. Methods: This retrospective cross‐sectional study included 240 consecutive CTO patients who underwent coronary angiography. HALP score was calculated using the formula: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/μL)/platelets (/μL). Collateral circulation was graded using the Werner classification (CC0‐CC3), with good collateral defined as a CC score ≥ 2. Correlation analysis, ROC curve analysis, and multivariate logistic regression were performed to assess the relationship between HALP score and collateral circulation. Results: The median HALP score was 4.20 (IQR: 2.68−5.68). A significant positive correlation was observed between HALP score and Werner grade ( r = 0.807, p < 0.001, R ² = 0.652). Median HALP scores increased progressively across Werner grades: CC0 (1.62), CC1 (3.20), CC2 (4.80), and CC3 (7.70). In multivariate analysis, the HALP score was significantly associated with good collateral circulation (OR: 3.762, 95% CI: 2.182−6.486, p < 0.001). The optimal cutoff of 3.509 demonstrated good diagnostic performance with 90.7% sensitivity and 66.7% specificity (AUC: 0.885). Conclusions: HALP score is significantly associated with coronary collateral circulation development in CTO patients. This simple, cost‐effective biomarker appears promising for risk stratification in this population based on this preliminary analysis, though prospective validation is needed before clinical application.

Background: COVID‐19 has been associated with significant cardiovascular complications, yet the long‐term cardiovascular consequences and prognostic biomarkers in moderate versus severe disease remain incompletely characterized. This study aimed to evaluate longitudinal cardiovascular changes, identify mortality predictors, and assess the discriminative performance of fractional exhaled nitric oxide (FeNO) and endothelin‐1 (ET‐1) in hospitalized COVID‐19 survivors. Methods: This prospective cohort study enrolled 480 hospitalized COVID‐19 patients (240 moderate, 240 severe by WHO criteria) who survived to discharge between June 2020 and December 2023. Baseline and 1‐year echocardiography, inflammatory biomarkers including FeNO and ET‐1, and clinical outcomes were assessed. Multivariable Cox regression identified mortality predictors, and ROC analysis evaluated biomarker discriminative performance. Results: Severe COVID‐19 patients demonstrated significant baseline right ventricular dysfunction with reduced TAPSE (16.63 ± 2.43 vs. 20.36 ± 3.68 mm, p < 0.001) and impaired RVPA coupling (0.60 ± 0.14 vs. 0.88 ± 0.45, p < 0.001). Progressive cardiovascular deterioration occurred over 1 year, with pulmonary artery pressure increasing 17.8% in severe versus 7.1% in moderate disease. Two‐year mortality was 16.9% overall. Independent mortality predictors included hypertension (HR 3.02), hyperlipidemia (HR 2.51), diabetes (HR 2.23), and left atrial volume index (HR 1.08 per mL/m ² ). FeNO and ET‐1 predicted mortality specifically in severe disease (HR 1.028 and 1.035, respectively) and demonstrated excellent discriminative ability (AUC 0.892 and 0.865) for identifying severe COVID‐19. Conclusions: Moderate and severe COVID‐19 survivors exhibit progressive cardiovascular deterioration, particularly affecting right ventricular function. FeNO and ET‐1 serve as severity‐specific prognostic biomarkers and demonstrate excellent discriminative performance, supporting their integration into risk stratification protocols for COVID‐19 survivors.

Background/Objectives: The only intravenous P2Y12 inhibitor used in the management of acute and chronic coronary syndromes is cangrelor. Previous studies have demonstrated the efficacy of cangrelor. However, limited real-world data are available for cangrelor usage. This study aimed to investigate the use of cangrelor in large-volume percutaneous coronary intervention (PCI) centers in Türkiye, and examine the indications, patient characteristics, bleeding, and ischemic events. The efficacy and safety of cangrelor in this high-risk group were evaluated. Methods: This study was conducted retrospectively in 14 high-volume centers in Türkiye with extensive cangrelor experience. Cangrelor indications, patient clinical characteristics, periprocedural and postprocedural treatments, in-hospital and follow-up bleeding, ischemic events, and mortality were analyzed. Results: This study recruited 411 patients (mean age: 63.8 ± 12.7 years; 76% male). The most common conditions in which cangrelor is used in Türkiye are cardiogenic shock, intubation and nausea/vomiting, where P2Y12 cannot be used adequately due to impaired oral intake. The incidence rate of any bleeding within 48 h was 6.4% (n = 26), with major bleeding accounting for 1.7% of all cases (n = 7). The bleeding rates were similar between patients aged p = 0.326), as well as between patients with chronic kidney disease (CKD) and those without CKD (6.3% vs. 7.9%, p = 0.600). Conclusions: This is the first multicenter, large-cohort study to examine cangrelor use in Türkiye, providing real-world evidence for the efficacy and safety in high-risk patients with complex clinical features and lesion characteristics.