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Background: Pulmonary hypertension (PH), a progressive multisystemic disorder characterized by right ventricular failure and hepatic congestion, significantly alters platelet dynamics and liver function. This study evaluated the ability of the platelet–albumin–bilirubin index (PALBI), a marker of the hepatic–cardiac axis, to discriminate between PH patients and healthy individuals and to predict 360-day all-cause mortality and heart failure-related hospitalizations (HFH).Methods and Results: This retrospective study included 3,432 individuals (1,520 PH patients, identified based on high-risk echocardiographic parameters to reflect real-world clinical practice). PH patients had higher PALBI scores than healthy controls (−2.08 vs. −2.50; P=0.001). For disease discrimination, PALBI had an area under the curve (AUC) of 0.748 (cut-off −2.27; sensitivity 77%, specificity 80%), outperforming the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein. In the PH cohort (21.5% mortality; 36.4% HFH), PALBI was an independent predictor of 360-day mortality and HFH (odds ratios 1.24 [P=0.003] and 1.18 [P=0.006], respectively). PALBI (cut-off −1.98) outperformed estimated glomerular filtration rate, age, and NLR in predicting mortality; when combined with N-terminal pro B-type natriuretic peptide, mortality prediction accuracy rose by 15.6%. Kaplan–Meier analysis confirmed a significant stepwise decline in survival across PALBI tertiles (P<0.001). In Group I PH, the AUC for the combination of PALBI+REVEAL risk score was 0.064 higher than that for the REVEAL risk score alone (P<0.05).Conclusions: PALBI is a robust, cost-effective prognostic tool for PH. It independently predicts short-term mortality and HFH, offering enhanced risk stratification for high-risk patients in clinical settings.

Aims: Pulmonary arterial hypertension (PAH) remains associated with substantial morbidity and mortality despite therapeutic advances. The glucose-to-lymphocyte ratio (GLR), a composite marker reflecting metabolic and inflammatory status, has not been well studied in PAH. This study aimed to investigate the association of GLR with PAH presence and baseline severity markers in treatment-naive patients. Methods: This retrospective study included 72 treatment-naive PAH patients and 58 healthy controls. Risk was categorized using REVEAL Lite 2 risk score. GLR's discriminatory performance was compared with neutrophil-to-lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP) using receiver operating characteristic (ROC) analysis and pairwise DeLong test. Correlation and logistic regression assessed associations with severity markers. Results: GLR levels were significantly higher in PAH patients, especially in high-risk cases. GLR showed strong discriminatory performance for PAH presence (area under the curve [AUC] 0.962, 95% CI 0.929-0.988), with optimal cut-off 38.43 (94.4% sensitivity, 86.2% specificity). In adjusted logistic regression, GLR remained independently associated with PAH (odds ratio [OR] 1.73, 95% CI 1.40-2.14; p<0.001). GLR correlated negatively with 6-minute walk distance and positively with N-terminal pro-B-type natriuretic peptide, right atrial area, and systolic pulmonary artery pressure (all p<0.001). Conclusion: GLR was significantly associated with treatment-naïve PAH presence and baseline severity markers. GLR may serve as a simple adjunctive biomarker for baseline PAH evaluation, though prospective validation is required.

Background: Non-organic ED patients have cardiac autonomic dysfunction measurable by heart rate variability (HRV). Tadalafil reduces cardiovascular mortality, but exact mechanisms remain unclear. Aim: To evaluate daily tadalafil effects on cardiac autonomic regulation in non-organic ED and identify clinical predictors of HRV response. Methods: In this prospective study, 82 men with non-organic ED (mean age 46.8 ± 5.0 years) received tadalafil 5-10 mg daily. Assessment included International Index of Erectile Function-Erectile Function (IIEF-EF), echocardiography, laboratory tests, and 24-hour Holter ECG. HRV was analyzed via time-domain (standard deviation of NN intervals [SDNN], root mean square of successive differences [RMSSD]) and frequency-domain (low-frequency power [LF], high-frequency power [HF], LF/HF ratio) parameters. Post-treatment recordings were blindly evaluated. Early response to tadalafil was defined as achievement in the severity-adjusted Minimal Clinically Important Difference (MCID) in IIEF-EF or final IIEF-EF score ≥26. Outcomes: Primary: ΔSDNN. Secondary: ΔHF power, ΔLF/HF ratio. Results: IIEF-EF improved significantly (15 to 23, P < .001) and 74.4% were early responders (n = 61). In the overall cohort, SDNN increased (42.39 to 52.39 ms, P < .01), HF power increased (267.86 to 294.44 ms2,P < .001), and LF/HF ratio decreased (2.78 to 2.31, P < .01). Both groups showed HRV improvements without between-group differences (P > .05), suggesting autonomic modulation independent of erectile response. Multivariable regression: diabetes negatively predicted SDNN improvement; higher testosterone, higher baseline IIEF-EF score, and lower BMI predicted greater HF enhancement. Only 1.1% of patients discontinued the treatment (due to dyspepsia). Clinical Implications: Daily tadalafil treatment may enhance parasympathetic modulation in men with non-organic ED regardless of clinical erectile improvement, suggesting a potential mechanism for its observed cardiovascular benefits. Strengths and Limitations: Strengths include rigorous, blinded Holter assessment. Limitations include the lack of a placebo control, short follow-up (28 days), and a small non-responder subgroup. Conclusion: Daily tadalafil enhanced parasympathetic modulation and reduced sympathovagal imbalance independently of erectile improvement.

Background: Right ventricular (RV) dysfunction in chronic kidney disease (CKD) remains underrecognized. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP) reflects RV‐pulmonary arterial coupling, but its relationship with CKD severity is unknown. To evaluate the association between TAPSE/sPAP ratio and CKD stage severity and assess age‐related effect modification. Methods: This cross‐sectional study enrolled 120 participants: 40 patients with stage I–II CKD, 40 with stage III–IV CKD, and 40 healthy controls. All underwent echocardiography and nephrologist evaluation. Proportional odds regression models adjusted for cardiovascular risk factors evaluated the TAPSE/sPAP‐CKD association. ROC analysis assessed discriminatory performance. Age‐stratified analyses (p  < 0.01). Each 0.10‐unit decrease was independently associated with advanced CKD (adjusted OR 2.08, 95% CI 1.49–2.89, p < 0.001). TAPSE/sPAP ratio achieved the highest AUC (0.734, 95% CI 0.625–0.833), outperforming TAPSE alone (AUC 0.615; DeLong p  = 0.049), while statistically comparable to sPAP (AUC 0.715; DeLong p  = 0.400). Age‐stratified analysis revealed excellent performance in patients p  = 0.015). Random forest analysis identified age (35.8%) and TAPSE/sPAP (22.0%) as dominant predictors. Conclusions: TAPSE/sPAP ratio is an independent marker of CKD severity enabling non‐invasive detection of RV‐PA uncoupling, with excellent discriminatory performance in younger but limited utility in older patients, suggesting that age‐specific interpretation and integration with renal biomarkers are recommended.

Aim: Artificial intelligence (AI) is fundamentally transforming cardiovascular care, but patient trust remains a primary barrier to clinical integration. This study investigates the “AI Literacy Paradox” among digital-savvy early adopters to identify predictors of trust across varied clinical scenarios, ranging from routine monitoring to critical decisions.Materials and Methods: A cross-sectional survey was conducted with 254 technologically proficient participants (mean age: 39.7 years). Trust was evaluated across 11 cardiovascular scenarios involving medication management, emergency triage, and diagnostic conflicts. Statistical analyses included binary logistic regression to identify predictors, K-means clustering for patient segmentation, and Mann–Whitney U tests to evaluate algorithm aversion.Results: AI knowledge was a strong positive predictor of trust (odds ratio [OR]: 3.522). However, holders of graduate degrees exhibited “informed skepticism,” with 66% lower odds of trust (OR: 0.340), illustrating the AI Literacy Paradox. Significant trust gaps were also identified for women (OR: 0.610) and patients with chronic illnesses (OR: 0.563). Participants demonstrated clear algorithm aversion in high-stakes scenarios, with over 92% preferring physician-led medication management and 87.4% prioritizing physician judgment over AI in diagnostic conflicts. Four distinct user segments were identified, with “Older Educated Female Neutrals” (53.5%) forming the largest group.Conclusions: Trust in AI in cardiovascular scenarios is a multidimensional, segment-specific construct. Higher education levels often lead to critical scrutiny rather than blind acceptance. To ensure successful adoption, AI integration must prioritize hybrid “physician-in-the-loop” models that preserve the human-centric nature of the therapeutic alliance while addressing the specific privacy and safety concerns of diverse user segments.

Aims: The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score is a composite index reflecting inflammatory, nutritional, and hematological status. While it has prognostic value in cardiovascular diseases, its relationship with the development of coronary collateral circulation (CCC) in patients with chronic total occlusion (CTO) remains unclear. This study aimed to investigate the association between the HALP score and the extent of CCC and to determine its predictive value for poor collateral development in patients with stable CAD and CTO. Methods: A total of 241 consecutive patients with stable CAD and at least one CTO were retrospectively included. Participants were categorized into good (Rentrop grades 2-3, n=123) and poor CCC (Rentrop grades 0-1, n=118) groups based on blinded angiographic assessment. The HALP score was calculated from admission blood samples. Independent predictors were identified using multivariate logistic regression, and predictive performance was assessed by receiver operating characteristic (ROC) curve analysis. Results: Patients with good CCC had a significantly higher HALP score than those with poor CCC (p=0.007). The HALP score showed a strong positive correlation with the Rentrop grade (r=0.69, p=0.034). Multivariate analysis confirmed that a lower HALP score was an independent predictor of poor collateral development (OR=0.822, 95% CI: 0.618-0.992, p=0.026), alongside other markers like NLR and NPAR. The ROC analysis demonstrated that a HALP score ?31.2 predicted poor CCC with 78% sensitivity and 82% specificity (AUC=0.822, 95% CI: 0.760-0.878, p=0.024). Conclusion: The HALP score is a powerful and independent predictor of well-developed coronary collaterals in patients with stable CAD and CTO. Derived from routine blood tests, it serves as an integrative biomarker for risk stratification, potentially identifying patients who may benefit from more aggressive management strategies.

Background: Hypertension (HT) constitutes a pervasive global health challenge, standing as a principal contributor to cardiovascular morbidity and mortality. Limited data are available regarding the relationship between neutrophil percentage-to-albumin ratio (NPAR) and nondipper HT. we aimed to investigate whether NPAR is independently associated with nondipper status in newly diagnosed hypertensive patients. Methods: Prospectively, 160 hypertensive patients were included in the study. After a 24-h ABP monitoring assessment, the patients were divided into 2 groups, a dipper group and a nondipper group, and 80 healthy control subjects were enrolled in the study. Baseline laboratory and echocardiographic parameters were measured and then the NPAR was calculated. Results: Levels of white blood cell, neutrophil-to-lymphocyte ratio, and high-sensitivity C-reactive protein (hs-CRP) were significantly higher in patients with nondipper HT than dipper HT and control subjects. Echocardiographic assessments revealed that the left ventricular (LV) wall was thicker and LV mass index was higher in the hypertensive group than the control group. NPAR levels were significantly different among the 3 groups (P < .001) and also the multivariate analysis revealed that higher NPAR and hs-CRP levels were independently associated with a nondipping pattern. Receiver operating characteristic analysis showed that NPAR levels higher than 22.2 can predict nondipping status (P < .001). Conclusions: Our study shows that higher NPAR levels are independently associated with nondipper HT in newly diagnosed hypertensive patients. These findings emphasize the role of inflammation in the pathophysiology of circadian BP variation and suggest that NPAR may serve as a useful tool in identifying hypertensive patients at higher risk for cardiovascular complications.

Background The pathophysiology of irritable bowel syndrome (IBS) and masked hypertension (mHT) exhibits shared characteristics, including factors such as anxiety and stress. Consequently, the aim of this study was to investigate the frequency of mHT in patients with IBS. Method Patients diagnosed with IBS in 2020-2023 were re-evaluated using the Rome IV criteria. Patients who did not have sustained HT, as evidenced by repeated in-office blood pressure (BP) measurements and who did not meet the exclusion criteria (chronic renal failure, heart failure, diabetes, cerebrovascular events, pregnancy or puerperium) were included in the study group. A control group was also constituted with the same number of age and gender-matched healthy individuals. The participants were connected to a 24-hour ambulatory BP monitor and the results were analyzed. Results Total 128 participants, including 64 IBS patients and 64 healthy individuals, were included in our study. The age (36.9 ± 7.3 years; 37.3 ± 7.7 years) and gender (62.5% female; 62.5% female) distributions and the baseline clinical characteristics of the study and control groups were similar. The in-office systolic BP measurements of the IBS patients were significantly higher than those of the control group (124.7 ± 5.4 mmHg compared to 121.8 ± 5.2 mmHg, p = 0.02). The IBS patients also had a higher frequency of mHT (n = 21, 32.8% compared to n = 10, 15.6%, p = 0.02), higher 24-hour daytime systolic BP (127.5 ± 7.6 mmHg compared to 124.8 ± 5.22 mmHg, p = 0.02) and higher nighttime diastolic BP (62.2 ± 7.5 mmHg compared to 59.6 ± 6.1 mmHg, p = 0.03) than the control group. The study group included all four sub-types of IBS: diarrhea-dominant (IBS-D), constipation-dominant (IBS-C), mixed type (IBS-M) and unclassified (IBS-U). It was determined that 57.9% of the IBS-C patients, 27.8% of the IBS-M patients, 23.5% of the IBS-D patients and 10% of the IBS-U patients in the study group had mHT. Conclusion To the best of our knowledge, this is the first study demonstrating a relationship between IBS and mHT. The frequency of mHT was higher among patients with IBS compared to healthy controls (p = 0.02). Studies on larger patient groups are needed to evaluate the frequency of mHT for the IBS sub-types. Graphical Abstract

Aims: Pulmonary vein isolation (PVI) by cryoballoon ablation (CB) technology is effective and safe treatment option for atrial fibrillation (AF). CB is performed by large diameter, 15Fr (4.95mm) transseptal sheath that may lead to creation of iatrogenic atrial septal defect (iASD). The objective of this study was to assess the incidence of iASD in patients who had undergone CB. Methods: Patients with AF having undergone Arctic Front® CB ablation and a subsequent transesophageal echocardiography (TEE) examination during post-ablation follow up period were consecutively enrolled. During all CB procedures, 15Fr transseptal sheath (Flex Cath, Medtronic, Minneapolis, MN) was utilized via single transseptal puncture (TsP). Results: Twenty-eight patients (15 females, mean age 55.8+15.5) with paroxysmal (n=24) or persistent (n=4) AF formed study group. iASD was present 11 (39.3%) of them after mean follow-up time of 17.3+6.2 months. The procedural time is significantly longer in patient with iASD (119.0+8.8 minutes, p=0.01). No patients died or suffered from any clinically significant cerebral ischemic event. There was no sign of increase in systolic pulmonary arterial pressure (sPAP). Conclusion: iASD after CB was found to be present in 39.3% of patient during a mean follow-up time of 17.3+6.2 months. The prolonged CB procedural time was the only factor that predicted iASD in our study. No adverse clinic events that might be related to iASD was observed during follow-up period.