Objective: Although left ventricular hypertrophy frequently accompanies end-stage renal disease, heart failure (HF) with reduced ejection fraction (EF) is also observed in a subset of patients. In those patients kidney transplantation (KT) is generally avoided due to an increased risk of mortality in addition to the risks associated with HF. This prospective study was designed to follow patients with HF who were being prepared for KT.

Methods: Twenty-five patients with HF due to uremic cardiomyopathy (UC) who had suitable donors (Group 1), 22 patients with HF who could not undergo KT due to a lack of kidney donors (Group 3), and 25 KT candidates with normal ventricular function (Group 2) were included in the study. Left ventricular ejection fraction (LVEF), left atrial diameter (LAD), mitral annular systolic velocity (Sm), left ventricular global longitudinal strain (GLS), and left ventricular mass index (LVMI) values were recorded across four sessions, from pre-transplant to six months post-transplantation. Endomyocardial biopsy was performed for detailed examination of the myocardium in patients in Group 1 and Group 3, and cardiac magnetic resonance imaging (MRI) was performed in all three groups before transplantation.

Results: In Group 1, LVEF, Sm, and left ventricular global longitudinal strain (LV-GLS) increased significantly, while LAD and LVMI decreased, all reaching normal levels. In contrast, no changes were observed in Group 3 and Group 2 (P < 0.01 for LVEF, P < 0.01 for GLS, P < 0.01 for LAD, and P < 0.01 for LVMI measurements). No differences in cardiac MRI and biopsy findings were observed between Group 1 and Group 3.

Conclusion: Since myocardial function improved significantly and normalized in all patients with HF, it has been demonstrated that UC can be substantially reversible when treated with KT.

Objective: Recent studies have demonstrated the positive effects of sacubitril/valsartan and dapagliflozin on cardiac prognosis and performance. These drugs have the potential to be misused as doping agents by professional athletes. This study aimed to evaluate the effects of sacubitril/valsartan and dapagliflozin on athletic performance.

Methods: In this study, swimming performance was assessed in three groups of rats divided into control, sacubitril/valsartan, and dapagliflozin groups. Echocardiography, weight, and rotarod performance were also evaluated during follow-up.

Results: In comparisons between the sacubitril/valsartan and control groups, a statistical difference was observed in the 13th, 19th, and 20th swimming sessions. For total and median swimming times, the P values were 0.115 and 0.015, respectively. In comparisons between the dapagliflozin and control groups, a statistical difference was observed starting from the 10th swimming session, with P values of < 0.001 for both total and median swimming times. In a three-group analysis, statistical differences were observed from the ninth swimming session until the end of the experiment. Additionally, rotarod results showed a significant difference for both sacubitril/valsartan and dapagliflozin compared to baseline (P < 0.001 and P = 0.011, respectively).

Conclusion: This study demonstrated a limited positive effect of sacubitril/valsartan on athletic performance, while the impact of dapagliflozin on athletic performance was particularly significant.

Objective: Limited information is available regarding the associations between upper extremity function, activities of daily living (ADLs), and functional capacity in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate the associations between upper extremity function, ADLs, and functional capacity in patients with HFrEF.

Methods: This cross-sectional study included 31 patients with HFrEF. Demographic, anthropometric, and clinical data were recorded. Upper extremity function and ADLs were evaluated using the 6-Minute Pegboard and Ring Test (6PBRT) and the Glittre Activities of Daily Living Test (TGlittre), respectively. The 6-Minute Walk Test (6MWT) was administered to measure functional capacity. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral oxygen saturation (SpO2), dyspnea, and fatigue were assessed at the beginning and end of each test.

Results: The 6PBRT was significantly correlated with TGlittre (rho = -0.718, P < 0.001) and
6-minute walk distance (6MWD) (r = 0.546, P = 0.001). A significant correlation was also found between TGlittre and 6MWD (rho = -0.810, P < 0.001). Changes in HR, SBP, and dyspnea were significantly different across the 6PBRT, TGlittre, and 6MWT (P < 0.05).

Conclusion: This study indicates that upper extremity function is associated with ADLs and functional capacity in patients with HFrEF. The 6PBRT requires lower cardiopulmonary demand than TGlittre and 6MWT in this patient population.

Objective: This study aimed to investigate the relationship between mortality and the frontal QRS-T angle (FQRS-TA), obtained by calculating the absolute difference between the QRS and T waves electrocardiographically (ECG), in patients diagnosed with ischemic stroke (IS).

Methods: This research is a retrospective and cross-sectional study. The diagnosis of IS was confirmed through brain imaging and physical examination. Patients with sinus rhythm were included in the study. The FQRS-TA was measured by calculating the absolute difference between the QRS-axis and the T-axis, as automatically measured on the ECG. Patients were divided into two groups: those who died within five years and those who survived, and the groups were compared.

Results: A total of 322 patients with IS were included in the study, of whom 290 survived, and 32 died. Age, creatinine level, PR interval, QRS duration, corrected QT (cQT) value, and FQRS-TA value were found to be higher in the deceased group. Cox regression analyses were performed to examine the association between predictors of stroke-related mortality. Age [hazard ratio (HR): 1.091, 95% (1.045-1.140), P < 0.001], high-density lipoprotein (HDL) [HR: 0.914, 95% (0.875-0.955), P < 0.001], and FQRS-TA [odds ratio (OR): 1.011, 95% (1.003-1.019), P = 0.007] were associated with mortality. A FQRS-TA of 68 degrees or higher was associated with cumulative mortality in the Kaplan-Meier survival analysis (log rank [Mantel-Cox] test: P = 0.001).

Conclusion: In this study, increased FQRS-TA was found to be associated with mortality in patients with IS. ECG parameters are simple and time-efficient measurements that can provide important prognostic information. To the best of our knowledge, this research is the first study to examine the relationship between FQRS-TA and mortality in patients with IS.

Objective: Coronary artery disease (CAD) is the leading cause of morbidity and mortality globally. The growing interest in natural language processing chatbots (NLPCs) has driven their inevitable widespread adoption in healthcare. The purpose of this study was to evaluate the accuracy and reproducibility of responses provided by NLPCs, such as ChatGPT, Gemini, and Bing, to frequently asked questions about CAD.

Methods: Fifty frequently asked questions about CAD were asked twice, with a one-week interval, on ChatGPT, Gemini, and Bing. Two cardiologists independently scored the answers into four categories: comprehensive/correct (1), incomplete/partially correct (2), a mix of accurate and inaccurate/misleading (3), and completely inaccurate/irrelevant (4). The accuracy and reproducibility of each NLPC’s responses were assessed.

Results: ChatGPT’s responses were scored as 14% incomplete/partially correct and 86% comprehensive/correct. In contrast, Gemini provided 68% comprehensive/correct responses, 30% incomplete/partially correct responses, and 2% a mix of accurate and inaccurate/misleading information. Bing delivered 60% comprehensive/correct responses, 26% incomplete/partially correct responses, and 8% a mix of accurate and inaccurate/misleading information. Reproducibility scores were 88% for ChatGPT, 84% for Gemini, and 70% for Bing.

Conclusion: ChatGPT demonstrates significant potential to improve patient education about coronary artery disease by providing more sensitive and accurate answers compared to Bing and Gemini.

Objective: Atrial fibrillation (AF) is a common arrhythmia associated with a five-fold increased risk of stroke. Family physicians (FPs) serve as the primary contact point for patients seeking healthcare. While many surveys have assessed FPs’ knowledge on AF across various countries, no such study has been conducted in Türkiye. This study aimed to evaluate the level of knowledge and approach to AF of FPs in Türkiye.

Methods: An online survey consisting of 38 multiple-choice questions was administered to 326 consenting physicians. The survey addressed demographic characteristics, AF diagnosis, risk factors, treatment approaches, counseling, consultation options, and levels of anxiety related to AF. Descriptive characteristics of the responses were analyzed.

Results: A total of 235 (72.1%) FPs demonstrated moderate or lower level of knowledge. A significant weak negative correlation was found between age and total knowledge score (rho = 0.123, P < 0.026), and a significant difference was identified between working status and knowledge score (P < 0.001). Only 7.1% of FPs reported having access to cardiologists when they needed consultation. Additionally, 81.9% tended to refer patients to a cardiologist for periprocedural management, and 85.9% for cases of minor bleeding. Of the respondents, 86.5% expressed that training on AF and oral anticoagulants (OACs) is absolutely necessary.

Conclusion: Major gaps in FPs’ knowledge and skills regarding AF and anticoagulants were identified. Knowledge levels among FPs can be improved through training sessions, web-based applications, and conferences. FPs can be encouraged and supported to play an active role in AF management, which may enhance patient outcomes, reduce costs for the healthcare system, and share the workload of cardiologists.

Cardiac implantable electronic device (CIED) implantation is a diagnostic and therapeutic method that is being employed on a growing number of patients globally. These devices require long-term follow-up and monitoring, and after implantation, regular follow-ups are conducted at specific intervals. These follow-ups provide crucial information about both the device and the patient, aiding in diagnosis and guiding treatment. These monitoring procedures, which are usually performed in a clinical setting, place a substantial burden on the healthcare system and its personnel. Remote follow-up and monitoring, as discussed in this article, has the potential to replace many in-clinic follow-up/monitoring procedures, meeting the device and patient monitoring needs without compromising safety. Thus, it can alleviate the burden on the healthcare system and its personnel in a cost-effective manner. This article aims to provide a comprehensive exploration of remote follow-up and monitoring for CIEDs.

Hypereosinophilic syndrome (HES) is traditionally described as chronic peripheral eosinophilia with involvement of various organs and systems, including the heart and nervous system. In this report, we describe cardiac involvement and border zone stroke in a patient with idiopathic HES. A 37-year-old woman presented with sudden right-sided weakness and slurred speech, which began four days before admission, accompanied by palpitations, retrosternal exertional chest discomfort, dry cough, and progressive shortness of breath over approximately two months. Preliminary studies showed an increased number of white blood cells with eosinophilia. Further diagnostic investigation revealed apical thrombosis in both ventricles of the heart and moderate left ventricular systolic dysfunction. Magnetic resonance imaging of the brain indicated multifocal infarctions in the anterior and posterior border zones, as well as both cerebellar hemispheres, predominantly on the left side. Consequently, the patient was diagnosed with idiopathic HES and treated with corticosteroids, cyclophosphamide, anticoagulants, and medications for heart failure. She responded well both clinically and hematologically. Our case highlights the importance of multiple imaging modalities in diagnosing eosinophilic endomyocarditis and the impact of timely medical treatment to prevent disease progression.

Severe mitral regurgitation (MR) following surgical repair of the mitral valve poses a significant clinical challenge. Patients who have undergone surgery are typically at high risk for a second operation. This report details the case of a 54-year-old male who underwent aortic valve replacement and mitral valve repair using a 34-ring, 14 years prior. The patient presented with severe MR, severe left ventricular (LV) dilation, and a reduced ejection fraction of 20%. A Sovering 34 ring, characterized by its oval, radio-opaque, and flexible nature and completely encircling the annulus, was used. After comprehensive assessment utilizing cardiac computed tomography (CT) and the Valve-in-Valve (ViV) application, a 32 mm balloon-expandable transcatheter heart valve was chosen. The selected valve was the 32 mm Myval (Meril) valve, the largest size available globally. Following careful alignment (left atrium/left ventricle ratio (LA/LV) ratio 20/80) and under rapid pacing, the valve was successfully implanted within the ring. Subsequent transesophageal echocardiography confirmed the valve’s functionality, and left ventriculography showed no paravalvular regurgitation. The Mitral Valve-in-Ring (MVIR) procedure emerges as a promising therapeutic option for patients with a history of mitral valve repair and severe MR. This procedure is preferred in centers where structural heart interventions are performed by an experienced team.