Objective: Contrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired acute renal failure. The increased use of contrast material in diagnostic and interventional cardiac catheterization procedures has made CIN a frequently encountered problem in clinical cardiology practice. Our study aims to understand the role of inflammatory biomarkers in patients developing CIN and to evaluate the relationship of inflammation with the Mehran Score (MRS) and SYNTAX (SYNERGY Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) Score (SS).

Methods: The study was conducted retrospectively, including a total of 2,161 patients who presented to the cardiology clinic with acute coronary syndrome-unstable angina (USAP), Non-ST-Elevation Myocardial Infarction (NSTEMI), and ST-segment Elevation Myocardial Infarction (STEMI). Patients were divided into three groups: USAP (n = 477), NSTEMI (n = 612), and STEMI (n = 604). The relationship between the Pan-Immune Inflammation Value (PIV) and MRS and SS was evaluated.

Results: In patients developing CIN, the intergroup (USAP, NSTEMI, and STEMI) evaluation showed that PIV (1925.24 [794.93 - 8412.79] vs. 2178 [1016.06 - 3273.56] vs. 2262.97 [1076.97 - 4384.98], respectively), MRS (6.74 ± 1.91 vs. 7.43 ± 3.99 vs. 7.6 ± 3.08, respectively), and SS (33.57 ± 21.32 vs. 35.36 ± 9.97 vs. 36.19 ± 11.57, respectively) values were higher in the STEMI group than in the other two groups. A correlation was detected between PIV, MRS, and SS in all groups.

Conclusion: Pan-Immune Inflammation Value was elevated in patients who developed CIN after acute coronary syndrome. It also correlated with the MRS and SS, suggesting that due to its affordability and ease of assessment PIV can be a valuable biomarker for the follow-up of CIN in this patient group.

Objective: This study investigated the clinical significance of coronary artery tortuosity (CAT) in chronic coronary syndrome (CCS) using Gensini scores.

Method: This retrospective single-center study involved 388 patients undergoing coronary angiography for chest pain, excluding those with acute coronary syndromes or prior coronary interventions. Demographic, clinical, and angiographic data were collected and categorized based on the presence or absence of CAT.

Results: Analysis of 388 patients revealed that CAT was associated with older age (P < 0.001), female gender (P < 0.001), lower rates of smoking (19.3% vs. 29.6%, P = 0.025), and hypertension (53.5% vs. 38.7%, P = 0.05). There was a slightly higher, nearly significant, prevalence of diabetes in the CAT group (22.8% vs. 14.5%, P = 0.051). Furthermore, CAT correlated with diastolic dysfunction (P = 0.04) and was inversely related to the severity of coronary atherosclerosis, as indicated by lower Gensini scores correlating with higher CAT scores (P = 0.039 and P = 0.049, respectively). Univariate analysis confirmed CAT’s association with older age (P < 0.001), female gender (P < 0.001), hypertension (P = 0.004), diabetes (P = 0.039), diastolic dysfunction (P = 0.003), and Gensini score (P = 0.012). Multivariate analysis further identified significant correlations with age (P = 0.001), female gender (P < 0.001), and Gensini score (P = 0.049).

Conclusion: Our findings indicate that older age and female gender predict presence of CAT in CCS patients. The lower Gensini scores associated with CAT may possibly be due to a reduced atherosclerotic plaque burden in these patients. Further research into this relationship could inform the development of treatment and management strategies for coronary atherosclerosis.

Objective: The Intermountain Risk Score (IMRS), calculated using age, gender, complete blood count (CBC), and simple laboratory analyses, is an easy-to-use and cost-effective tool developed to predict mortality. In our study, we aimed to determine whether the IMRS could predict mortality in patients admitted to the hospital with a diagnosis of acute pulmonary edema.

Methods: A total of 371 patients who were admitted with a diagnosis of pulmonary edema, were included in our study. The IMRS of the patients was determined using a calculation tool, and the patients were divided into three groups based on the determined value: low, moderate, and high IMRS.

Results: The patients included in our study comprised 208 women and 163 men, with an average age of 68.7 years. There was a statistically significant difference between the patient groups concerning both 1-month and 1-year mortality rates. Additionally, there was a significant difference in IMRS between patients who developed in-hospital, 1-month, and 1-year mortality and those who survived. In the Receiver Operating Characteristic (ROC) analysis, a cutoff value of 15.5 for the IMRS predicted both 1-year and 1-month mortality. In the Kaplan-Meier analysis, the highest mortality risk was observed in the high IMRS group and the lowest mortality risk in the low IMRS group.

Conclusion: Our research results show that the IMRS strongly predicts both short-term and long-term mortality in patients hospitalized with a diagnosis of acute pulmonary edema.

Objective: Postoperative junctional ectopic tachycardia (JET) is usually a self-limiting condition; however, when combined with atrioventricular dissociation and postoperative ventricular dysfunction, it may increase morbidity and mortality. This study aimed to determine the overall incidence of JET following congenital heart surgery, to identify patient and procedure-related risk factors, and to evaluate the clinical impact of JET on outcomes.

Methods: The records of 2,814 patients who underwent cardiac surgery over a five-year period were reviewed retrospectively to identify those with JET. For each patient diagnosed with JET, two controls who underwent surgery during the same period were selected to compare possible risk factors and outcomes.

Results: The incidence of JET following congenital heart surgery was 2.66% in this large cohort. Univariate analyses revealed statistically significant associations between JET and factors such as young age, small body weight, high vasoactive inotropic score, operations involving the ventricular septum, surgical complexity score, increased cardiopulmonary bypass time, delayed sternal closure, extracorporeal membrane oxygenation (ECMO) requirement, and increased risk of postoperative JET. In multivariate analysis only the association between surgeries involving the ventricular septum, ECMO requirement, and increased risk of JET persisted. Compared to controls, patients with JET experienced prolonged intubation times, longer stays in the intensive care unit and hospital, more frequent unplanned re-interventions, and higher mortality rates.

Conclusion: Junctional ectopic tachycardia can lead to serious hemodynamic consequences in patients following congenital heart surgery and is associated with poorer clinical outcomes. Both patient and procedure-related factors contribute to the overall risk of developing JET. Identifying associations and predictors of JET can help improve patient outcomes.

Objective: We aimed to assess the real-world label adherence of non-vitamin K antagonist oral anticoagulant (NOAC) dosing patterns, including apixaban, edoxaban, and rivaroxaban, in Turkish patients with atrial fibrillation.

Methods: This was an observational, prospective, cross-sectional, multicenter study. Patients with atrial fibrillation (AF) who were prescribed NOACs within the last 4 months were recruited from 34 cardiology clinics in Türkiye. Baseline data were initially collected, and patient awareness was evaluated at 3-4 weeks.

Results: A total of 903 patients were enrolled in the study. The mean age was 72.84 ± 10.17 years. We found that 140 (15.5%), 721 (79.8%), and 42 patients (4.7%) were prescribed off-label low, on-label, and off-label high dosing, respectively. The age of the patients in the on-label group was significantly lower than that of those in the off-label low and off-label high groups (both P < 0.001). Female patients were more frequently observed in the off-label high group (P = 0.019). The body mass index values of the patients in the off-label high-dose group were significantly lower than those in the other groups (P < 0.001). The perception of income levels also revealed significant differences between the groups (P = 0.010). Furthermore, the HAS-BLED scores (the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol Concomitantly) were significantly lower in the on-label group than in the other groups (P < 0.001). Similarly, the CHA2DS2-VASc [the Congestive Heart Failure, Hypertension, Age ≥75 (Doubled), Diabetes, Stroke (Doubled), Vascular Disease, Age 65-74, and Sex Category (Female)] scores were significantly lower in the on-label group than in the off-label group (P < 0.001).

Conclusion: The clinical impact off-label NOAC prescriptions may vary. Therefore, raising clinician awareness about proper NOAC dosing could aid in improve the outcomes.

Objective: Integrating heart failure (HF) guideline recommendations into clinical practice takes time and is often suboptimal in real-life settings. Physician-related factors may be significant barriers to the adoption of these guidelines. This survey aims to assess the current opinions of cardiologists practicing in Türkiye regarding the management of heart failure with reduced ejection fraction (HFrEF).

Methods: The survey comprised 22 questions and was published on the SurveyMonkey platform.

Results: A total of 177 cardiologists (mean age: 39.5 years; 73.3% male) participated in the survey. Of these, 38.7% worked in a training and research hospital, and 10.2% were specialists in HF. The threshold EF value to define HFrEF was ≤ 40% for 80.1% of the cardiologists. While 52.6% of physicians considered angiotensin receptor-neprilysin inhibitor (ARNi) treatment the most effective medication for HF, 62.7% would initiate HF treatment with an angiotensin-converting enzyme inhibitor (ACEi) instead of ARNi due to reimbursement and cost issues. More than half of the cardiologists (52.3%) stated that adding another class of HF medication is more important than up-titrating those already prescribed. Although 69.5% of the study participants indicated prescribing all four classes of HF medications during the initial hospitalization is feasible, most cardiologists preferred a sequential approach starting with ACEi/ARNi, followed by beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 inhibitors (SGLT2i).

Conclusion: This survey highlights significant discrepancies between guideline recommendations and the real-life clinical practice of cardiologists in Türkiye. These results suggest that there is a need for organized action by healthcare providers to improve the implementation of guideline recommendations.

Although guidelines strongly recommend low levels of low-density lipoprotein cholesterol (LDL-C) in patients with acute coronary syndrome (ACS), these goals are not achieved in many patients. We present expert recommendations for the in-hospital and post-discharge management of lipid-lowering therapy in ACS patients in Türkiye. A group of expert cardiologists comprising members of the Turkish Society of Cardiology and leading lipidologists who have all worked in national cardiology lipid working groups for at least 4 years, considered the optimal approach to lipid management in ACS patients in Türkiye, taking into account Turkish healthcare infrastructure and issues from real-world practice. Novel standardized algorithms covering the first year after an ACS event were developed. The main elements of the proposed approach are summarized. The in-hospital strategy includes lipid profile assessments and commencement of statin therapy, including appropriate measures for patients with possible familial hypercholesterolemia or with a history of recurrent cardiovascular events. The role of a specially-trained nurse, use of a patient follow-up card, and the provision of patient information and referrals to affiliated healthcare professionals, are covered. The post-discharge strategy covers follow-up visits to monitor the patient’s progress and recommends timepoints at which modifications to treatment (based on LDL-C levels) should be made. A country-specific approach to lipid management in ACS patients in Türkiye is proposed. Further work is needed to determine the best way to implement the strategy, and to validate the recommendations and their application in daily practice.

Coronary artery bypass graft (CABG) surgery is one of the main treatment procedures for revascularization. Diagnosing postoperative complications can be difficult. One rare complication is the iatrogenic connection of the graft to the venous system, causing distal ischemia due to an arteriovenous shunt. This condition may lead to heart failure and fatal arrhythmias. Anti-arrhythmic drug-resistant ventricular arrhythmias, which can occur immediately after coronary artery bypass surgery, are sometimes related to the procedure itself. We describe the invasive management of an iatrogenic anastomosis between the left internal mammary artery (LIMA) and the great cardiac vein (GCV), which led to life-threatening ventricular arrhythmias.

The development of acute humoral rejection (AMR) in transplanted organs remains a highly relevant and unresolved issue. This study presents a clinical case of heart transplantation (HT) in a patient with hypertrophic cardiomyopathy transitioning to a restrictive phenotype amid chronic lymphocytic myocarditis. Following HT, the patient developed nosocomial pneumonia, necessitating a reduction in immunosuppressive therapy. On the 12th day post-transplantation, the patient experienced a sudden hemodynamic collapse, which proved fatal. Autopsy examination revealed acute humoral rejection with a predominance of CD16+ cells in the infiltrate, exhibiting high expression of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Spike protein on the endothelium and CD16+ cells. Further investigation is required to clarify the role of SARS-CoV-2 in potentially exacerbating AMR development.

Solitary fibrous tumors (SFTs) are rare neoplasms originating from fibroblastic mesenchymal cells. This case report details a 43-year-old female patient with cardiac SFT, a rarity in the medical literature, who presented with palpitations and a known malignancy. Supraventricular tachycardia was diagnosed in the emergency department, and a subsequent echocardiography revealed a giant mass in the left atrium after sinus rhythm restoration. The mass, causing symptomatic severe mitral stenosis, necessitated surgical intervention. Pathological examination of the surgical specimens confirmed the diagnosis of SFT. Cardiac masses are extremely rare in clinical practice, and the literature on SFTs is primarily limited to case reports. More research is needed due to the scarcity of information on managing this condition.