Objective: Atherosclerosis, a major contributor to coronary artery disease (CAD), is characterized by chronic arterial inflammation. Pentraxin 3 (PTX-3), a biomarker of inflammation, serves as an indicator of both atherosclerosis and the progression of CAD. The aim of this study was to investigate the association between PTX-3 levels and the presence and severity of CAD, as determined by coronary computed tomography angiography (CCTA).
Method: In this study, 94 participants (54 with CAD and 40 controls) underwent CCTA and coronary artery calcium scoring (CACS) using computed tomography. PTX-3 levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. CAD patients were categorized based on CCTA findings and further subdivided into three groups according to their CACS: Group I (CACS < 100), Group II (CACS 100-299), and Group III (CACS ≥ 300).
Results: Serum PTX-3 levels were significantly higher in the CAD group. A PTX3 cut-off value of 5.80 ng/mL predicted CAD with 68% sensitivity and 66% specificity. A strong positive correlation was observed between CACS and PTX-3 levels (r = 0.521, P < 0.001). In high-risk patients with a CACS ≥ 300, PTX-3 levels were significantly higher than those in low- and intermediate-risk groups a CACS < 300. However, no significant difference in PTX-3 levels was observed between the normal coronary group and the low- and intermediate-risk groups. Furthermore, no correlation was found between the degree of coronary artery stenosis and PTX-3 levels.
Conclusion: Pentraxin 3 might serve as a valuable biomarker for the diagnosis and severity of CAD.

Objective: There remain conflicting recommendations regarding revascularization strategies for patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD). This study aimed to compare the long-term outcomes of different revascularization strategies.
Method: Patients with similar characteristics were categorized into three groups: immediate complete revascularization (ICR), staged complete revascularization (SCR), and non-complete revascularization (NCR). The SCR group was further divided based on the time interval between the index and staged procedures: SCR ≤ 24 hours and SCR > 24 hours. Cardiac composite outcomes included the total number of cardiac deaths and recurrent myocardial infarction during the follow-up period.
Results: Out of 14,511 screened patients, 316 were included in the analysis. The results showed a significant difference in risk between SCR and ICR (hazard ratio [HR] (95% confidence interval [CI]): 0.27 (0.15-0.47); P = 0.001). There was no significant difference between NCR and SCR (HR (95% CI): 1.06 (0.61-1.84); P = 0.832). The SCR group was divided into two groups based on the time interval from the first to the second procedure (time interval [TI] ≤ 24 hours in the SCR1 group, and TI > 24 hours in the SCR2 group). The frequency of cardiac composite outcomes was lower in SCR1 compared to SCR2 (16.7% vs. 47.1%; P = 0.038).
Conclusion: Our findings support the use of ICR and SCR completed within 24 hours due to their favorable long-term outcomes in patients with MVD and NSTEMI.

Objective: The aim of this study was to assess visual and semi-quantitative outputs of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for diagnostic purposes in infective endocarditis (IE) and determine whether increased spleen or bone marrow FDG uptake secondary to infection can aid in the diagnosis of IE.
Method: Patients who underwent F-18 FDG PET/CT examinations for a preliminary diagnosis of IE between July 2020 and January 2024 were analyzed. IE diagnostic criteria were used to confirm diagnoses, categorizing patients into an IE-positive group and a control group (IE excluded). Demographics and imaging-related data, including mean standardized uptake value (SUVmean) and/or SUVmax for lesions, liver, spleen, and lumbar vertebrae, were recorded. Spleen hypermetabolism and bone marrow hypermetabolism (BMH) were defined as spleen-to-liver or bone marrow-to-liver ratios exceeding 1, respectively. Visually assessed FDG uptake was scored from 0 to 3, forming the uptake score, which was dichotomized into low and high uptake groups.
Results: The study included 48 IE patients and 21 control patients. Lesion SUV, uptake score, spleen hypermetabolism, and BMH demonstrated significant differences between the groups. For distinguishing IE, a high uptake score showed a sensitivity of 85.42% and an overall accuracy of 84.06%, while lesion SUVmax (> 3.5) achieved the highest specificity (95.24%) and positive predictive value (96.77%).
Conclusion: Visual detection of uptake exceeding blood pool values on F-18 FDG PET/CT images, coupled with an SUV greater than 3.5, appears to distinguish IE patients with high accuracy. Additionally, increased bone marrow FDG uptake was strongly associated with IE.

Objective: Mitral regurgitation (MR) is a critical determinant in patients with hypertrophic cardiomyopathy (HCM). Three-dimensional (3D) echocardiography has transformed the imaging of the mitral valve by enabling real-time, direct visualization. This study aims to determine the frequency of clefts and cleft-like indentations (CLIs) and assess their contribution to MR in HCM patients.
Method: A total of 50 patients with HCM and moderate or severe MR who underwent 3D transesophageal echocardiography (TEE) were enrolled. For the control group, 200 patients with moderate or severe MR but without HCM were selected. The two groups were compared in terms of demographic characteristics, echocardiographic findings, and cardiac magnetic resonance imaging results.
Results: Patients with HCM were younger and had higher regurgitant volumes and effective regurgitant orifice areas compared to the control group. Clefts or CLIs were present in 14 patients (28%) in the HCM group compared to 31 patients (15.6%) in the control group (P = 0.041). Evaluation of MR jet direction in relation to the presence of clefts or CLIs revealed a significant association between anteriorly directed jets and the presence of clefts (P = 0.003).
Conclusion: In this study, the frequency of clefts or CLIs was higher in patients with HCM compared to the control group. Clefts influence the direction of MR jets (anteriorly), whereas CLIs do not. 3D-TEE can aid in the differential diagnosis of HCM in patients with anteriorly directed MR jets. However, using 3D-TEE to identify CLIs alone has no significant impact on the management of MR.

Objective: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a novel group of oral antidiabetic drugs, have demonstrated cardioprotective benefits and positive metabolic effects in patients with diabetes mellitus (DM). The cardiac electrophysiological balance index (ICEB) is an eletrocardiographic ratio that provides information about the equilibrium between left ventricular depolarization and repolarization duration, offering valuable insights into the predisposition to ventricular arrhythmias. The aim of this study is to analyze the potential impact of SGLT2 inhibitors on ICEB.
Method: Patients were prospectively selected from a pool of 2,789 consecutive type 2 DM patients. After exclusions, 174 patients formed the monotherapy group, and 143 age- and sex-matched patients who were switched to SGLT2 inhibitor combination therapy constituted the combination therapy group. All treatment changes were supervised by endocrinologists blinded to the patient groups. Baseline and six-month electrocardiogram (ECG) data of both groups were analyzed. ICEB was defined as QT/QRS, and ICEBc as QTc/QRS.
Results: Although there was no statistically significant difference between the monotherapy and combination therapy groups in terms of baseline ECG parameters, QT (385.05 ± 13.21 vs. 372.32 ± 4.32; P < 0.001), QTc (409.24 ± 8.17 vs. 383.72 ± 7.24; P < 0.001), ICEB (4.15 ± 0.51 vs. 4.03 ± 0.54; P = 0.004), and ICEBc (4.40 ± 0.75 vs. 4.16 ± 0.61; P < 0.0001) values at the six-month mark were significantly lower in the SGLT2 inhibitor group.
Conclusion: SGLT2 inhibitors significantly lower ICEB and ICEBc, potentially reducing ventricular susceptibility to arrhythmias as early as six months into treatment for diabetic patients.

Objective: Mental health is directly related to mortality in heart failure (HF) patients. Nevertheless, depression is often underdiagnosed and undertreated in HF patients. We aimed to determine the parameters associated with the absence of depression in hospitalized HF patients.
Method: A total of 143 hospitalized HF patients with reduced ejection fraction were included in this study. The Patient Health Questionnaire-9 (PHQ-9) scale was used for screening depression symptoms. HF patients who scored < 5, defined as patients without depression, were compared with HF patients who scored ≥ 5.
Results: Depression was absent in 65 (45.5%) of the 143 hospitalized HF patients. Diabetes mellitus (P = 0.006) and beta-blocker usage (P = 0.011) were less frequent; New York Heart Association (NYHA) class (P = 0.003) and B-type natriuretic peptide (BNP) levels (P = 0.006) were lower; and estimated glomerular filtration rate (eGFR) levels (P = 0.038) were higher in HF patient without depression in our study. In multivariate analysis, NYHA class [P = 0.003, odds ratio (OR) (95% confidence interval [CI]) 0.426 (0.242-0.751)] and beta-blocker usage [P = 0.045, OR (95% CI) 0.288 (0.085-0.972)] were independently correlated with the absence of depression in hospitalized HF patients. Correlation analysis revealed a significant positive correlation between NYHA class and PHQ-9 score (r = 0.258, P = 0.002).
Conclusion: In our study, 45.5% of the hospitalized HF patients had no depression. Diabetes mellitus and beta-blocker usage were less frequent, NYHA class and BNP levels were lower, and eGFR levels were higher in HF patients without depression. Additionally, NYHA class and beta-blocker usage were independent predictors of the absence of depression in hospitalized HF patients. This study highlights the need for physicians to recognize the strong interaction between depression and HF and to incorporate regular depression screening into clinical practice.

Enhanced Recovery After Surgery (ERAS®) is a multimodal, multidisciplinary care and recovery protocol designed to facilitate faster recovery for patients undergoing surgery during the perioperative period. These programs aim to encourage an earlier return to normal activities by reducing complications. While ERAS® protocols have become standard practice in many surgical specialties, their application in the transcatheter aortic valve replacement (TAVI) procedure is relatively recent. TAVI patients are often high-risk and medically fragile. We believe that managing these patients with a multidisciplinary approach, such as the ERAS® protocol, during the preoperative and postoperative periods will reduce morbidity and mortality, enhance patient satisfaction, and lower hospital costs.

Catheter-based radiofrequency (RF) ablation is a recommended treatment modality for various ventricular arrhythmias. However, challenging sites that may not be accessible due to anatomical reasons, as well as intramural sites, where RF energy penetration may be limited, pose challenges that limit the success rate of RF ablation. Ethanol ablation may be an alternative option for treatment of ventricular arrhythmias that are not amenable to treatment by RF ablation. This report describes two cases of successful venous alcohol ablation for refractory ventricular tachycardia to standard RF ablation procedure. In the first case, a patient with a ventricular tachycardia (VT) originating from intramural outflow tract, having failed an endocardial ablation, underwent a successful ethanol ablation, via a double balloon technique. In the second case, we describe a patient with a history of transcatheter aortic valve replacement and premature ventricular complexes (PVCs) originating from intramural outflow tract. Radiofrequency ablation in this patient was limited by both the far-field appearing signals and the proximity prosthetic valve to the site of these signals. Therefore, this patient also underwent successful ethanol ablation of annular vein with the over the wire system after venography of coronary sinus. No complications were observed in both patients. In conclusion, coronary venous ethanol ablation may be a safe and successful technique for ablation of intramural ventricular arrhythmias in different clinical scenarios.

Pazopanib, a tyrosine kinase inhibitor that targets growth factor receptors, is associated with various side effects, including bradycardia. We report a severe case of symptomatic bradycardia, with a heart rate dropping to 28 beats per minute, in a patient with cardiac angiosarcoma treated with 800 mg/day of pazopanib. Reducing the dosage to 600 mg/day improved the heart rate to 53 beats per minute. This case highlights the risk of severe bradycardia associated with pazopanib, emphasizing the need for vigilant heart rate monitoring.

Managing dual antiplatelet therapy (DAPT) perioperatively is challenging, especially in patients who have recently undergone percutaneous coronary intervention (PCI). Intravenous antiplatelet agents are recommended in these cases. This case series describes the perioperative management of two high bleeding risk patients with recent PCI undergoing cardiac and non-cardiac surgeries using cangrelor monotherapy.