Objective: Cardiac resynchronization therapy with left bundle branch area pacing (LBBAP) is a novel resynchronization technique that serves as an alternative to biventricular pacing. This study investigated the predictive value of electrocardiographic Cornell Product (CP) in identifying super-responders to LBBAP among heart failure patients with left bundle branch block (LBBB).

Method: This retrospective study included 32 patients who underwent LBBAP, had a left ventricular ejection fraction (LVEF) ≤ 35%, were in sinus rhythm with LBBB and a QRS duration ≥ 150 ms, and had been receiving optimal medical therapy for at least three months. CP was calculated from baseline 12-lead electrocardiography (ECG) using the following formula: CP (mm x ms) = [(RaVL + SV3) x QRS duration]. Super-response was defined as an increase of at least 15% in LVEF six months after the procedure. Patients were classified as super-responders or non-super-responders, and their clinical, electrocardiographic, and echocardiographic parameters were compared.

Results: Among the 32 patients, 53% (n = 17) were identified as super-responders. The mean age of participants was 65.2 ± 9.9 years, and 46.9% were female. Based on baseline 12-lead ECG, CP was significantly lower in the super-responder group (3788.4 [3222.4-4569.6] mm*ms vs. 5174.0 [4516.4-5296.0] mm*ms, P = 0.044). Additionally, multivariate analysis revealed that systolic pulmonary artery pressure (odds ratio [OR]: 1.08; P = 0.041) and CP (OR: 1.01; P = 0.036) were independent predictors of super-response to LBBAP.

Conclusion: CP, a simple and readily applicable electrocardiographic parameter, can serve as a predictor of which patients will benefit from LBBAP.

Objective: Although the pathophysiological mechanisms responsible for premature ventricular contractions (PVC) are not fully understood, they are primarily thought to occur due to increased automaticity, triggered activity, and reentry. Advanced glycation end products (AGEs) are believed to contribute to these mechanisms. This study aimed to compare AGE levels in patients with and without a PVC rate exceeding 5% in 24-hour Holter monitoring.

Method: Patients were divided into two groups: the PVC case group, defined as having a PVC burden with frequent premature ventricular contractions (≥ 5%) in 24-hour Holter monitoring, and the control group, defined as having rare PVC (< 5%). The patient group consisted of 65 individuals, and the control group also included 65 individuals. For the study, patients' skin AGE levels were measured using a spectrophotometric method.

Results: A significant difference was observed in AGE levels between the two groups. The AGE level was 2.6 (2.1-2.9) AU in the PVC case group, while it was 2.0 (1.7-2.3) AU in the control group (P < 0.001). The receiver operating characteristics curve analysis resulted in an area under the curve value of 0.760 with a 95% confidence interval (CI) of 0.679-0.841 for detecting a PVC burden exceeding 5%. In patients with an AGE level of 2.4 AU, the sensitivity was 61.5%, and the specificity was 80% in detecting a PVC burden above 5%.

Conclusion: Our study showed that AGE levels may be independently and positively associated with a high PVC burden.

Objective: Cardiac rehabilitation (CR) improves survival, reduces hospital readmissions, and enhances quality of life; however, participation remains low due to barriers related to access, awareness, and socioeconomic factors. This study explores the potential of artificial intelligence (AI), specifically ChatGPT, in supporting CR by providing guideline-aligned recommendations and fostering patient motivation.

Method: This cross-sectional study evaluated ChatGPT-4’s responses to 40 questions developed by two cardiologists based on current cardiology guidelines. The questions covered fundamental principles of CR, clinical applications, and real-life scenarios. Responses were categorized based on guideline adherence as fully compliant, partially compliant, compliant but insufficient, or non-compliant. Two expert evaluators assessed the responses, and inter-rater reliability was analyzed using Cohen’s kappa coefficient.

Results: ChatGPT provided responses to all 40 questions. Among the 20 general open-ended questions, 14 were rated as fully compliant, while six were compliant but insufficient. Of the 20 clinical scenario-based questions, 16 were fully compliant, and four were compliant but insufficient. ChatGPT demonstrated strengths in areas such as risk stratification and patient safety strategies, but limitations were noted in managing elderly patients and high-intensity interval training. Inter-rater reliability was calculated as 90% using Cohen’s kappa coefficient.

Conclusion: ChatGPT shows promise as a complementary decision-support tool in CR by providing guideline-compliant information. However, limitations in contextual understanding and lack of real-world validation restrict its independent clinical use. Future improvements should focus on personalization, clinical validation, and integration with healthcare professionals.

Objective: A non-dipping blood pressure (BP) pattern is commonly associated with an increased risk of adverse cardiovascular events. This study aimed to examine the relationship between a non-dipper circadian pattern and the serum uric acid/albumin ratio (UAR) in individuals with hypertension.

Method: This study included 340 consecutive patients who underwent ambulatory blood pressure monitoring (ABPM) from June 2022 to June 2023. Based on the circadian BP pattern obtained from 24-hour ABPM, patients were classified into two groups: dipper and non-dipper. The non-dipper group was defined based on a nighttime blood pressure decline of less than 10%.

Results: UAR levels were significantly higher in patients exhibiting a non-dipper pattern compared to those in the dipper group. Higher UAR rates were independently associated with the presence of a non-dipper pattern, as determined by multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis showed that UAR values above 1.30 had a sensitivity of 66.5% and a specificity of 65.9% for predicting the non-dipper pattern [area under the curve (AUC): 0.738, 95% confidence interval: 0.688 - 0.790; P < 0.001].

Conclusion: UAR is a readily obtainable and calculable biomarker for identifying patients prone to hypertensive patterns that do not decline at night. Thus, hypertensive patients at increased risk for future adverse atherosclerotic events can be identified and closely monitored, allowing for the application of more intensive treatment strategies.

Objective: Determining right atrial pressure (RAP) is an important hemodynamic parameter for calculating right ventricular pressure, commonly measured using right heart catheterization, an invasive procedure. However, non-invasive methods should be prioritized, particularly in pediatric patients. There is a lack of evidence regarding this issue in pediatric and young adult populations compared to adults.

Method: This diagnostic cross-sectional study was conducted to investigate echocardiographic criteria for estimating right atrial pressure in 350 pediatric patients from March 2020 to December 2021.

Results: The mean right atrial pressure was significantly higher in patients with a Caval index of less than 50% (7.89 ± 4.48 mmHg vs. 6.3 ± 3.18 mmHg, P = 0.002) and in those with cyanotic congenital heart disease (CHD) (P = 0.018). There was a significant correlation between a Caval index cut-off point of 50% and a mean RAP cut-off point of 10 mmHg (P = 0.024), with a specificity of 85.7% for a Caval index < 50% in estimating right atrial pressure > 10 mmHg. Additionally, a difference was observed between the tricuspid valve E/E´ ratio with a cut-off point of 7 and the mean right atrial pressure with a cut-off point of 5 mmHg (P = 0.043), with a sensitivity of 70.2% for a tricuspid valve E/E´ratio > 7 in estimating right atrial pressure > 5 mmHg.

Conclusion: This study demonstrated that echocardiographic indices, such as the Caval index and tricuspid valve E/E´ ratio, can be useful in non-invasive estimation of right atrial pressure. However, age-specific reference values and cut-off points for these indices should be considered to improve their accuracy.

Objective: Regular intense exercise may result in cardiac remodeling, which can be identified through echocardiographic examinations. This study aims to highlight how cardiac changes vary based on the type and duration of sports participation.

Method: The study included children aged 8-18 years (n = 241), who were divided into three groups: beginners, dynamic dominant athletes, and static dominant athletes. Cardiac remodeling was categorized into concentric hypertrophy, eccentric hypertrophy, and concentric remodeling based on increased values of left ventricular mass and relative wall thickness.

Results: Mean left ventricular end-diastolic diameters, z-scores, and left atrial diameters were significantly lower in the static group compared to the dynamic group. Among participants, excluding beginners, most common echocardiographic change was an increased z-score in the interventricular septal dimension during diastole (25.3%), followed by an increase in the left atrial diameter in diastole, left ventricular posterior wall thickness in diastole, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter. In both dynamic and static groups, excluding beginners, the most prevalent hypertrophic pattern was eccentric hypertrophy. Overall, 35% of dynamic dominant athletes and 62% of static dominant athletes exhibited some form of remodeling. Additionally, interventricular septum size and left ventricular end-diastolic diameter were associated with the training period.

Conclusion: Our findings indicate that enlargement of the left ventricle and left atrium diameters is more pronounced in dynamic athletes, whereas changes in left ventricular mass are more prominent in static athletes. We believe that monitoring amateur child athletes with an understanding of these changes is important.

The term cardiac implantable electronic devices (CIEDs) encompasses pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, which are well-established treatments for cardiac arrhythmias and heart failure with reduced ejection fraction. Advances in CIED therapy have led to an increasing number of patients with cardiovascular disease (CVD) receiving such devices. In general, low levels of physical activity are associated with a higher risk of cardiac and all-cause mortality in patients with CIED. These patients are considered eligible for exercise programs not only to improve prognosis related to their underlying heart disease but also to facilitate psychological adaptation to living with the device, to enhance evaluation of device performance and, particularly in ICD recipients, to reduce the risk of inappropriate shocks. Studies have shown that exercise training improves physical performance in CIED patients without increasing the risk of adverse events. A comprehensive clinical evaluation, a personalized exercise plan, appropriate device programming, and regular follow-up are essential to ensure that patients can safely engage in effective physical activity tailored to their specific needs. Participation in sports is another consideration for many CIED patients. Recent guidelines recommend encouraging individuals with CIEDs to engage in sports activities, unless contraindicated by their underlying heart conditions. It is generally accepted that low- to moderate-intensity leisure-time sports activities are safe and clinically beneficial for most individuals with a CIED. However, individualized recommendations may vary significantly depending on the patient’s cardiovascular health, the impact of physical activity on their underlying disease, and the type of implanted device.

Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly often associated with other congenital heart defects. Typically diagnosed in childhood, its presence in adulthood is exceptionally rare, especially in patients with hypertrophic cardiomyopathy (HCM). The coexistence of these two conditions can complicate the diagnosis, particularly in patients with left ventricular outflow tract (LVOT) gradient formation. This case series highlights the importance of multimodal imaging in accurately identifying AMVT, differentiating it from other conditions, and determining the various morphologies of AMVT.

Left ventricular pseudoaneurysm is a rare complication, most commonly occurring after myocardial infarction or cardiac surgery. It carries a high risk of spontaneous rupture and may lead to ventricular arrhythmias, heart failure, or thromboembolism. Cases of left ventricular pseudoaneurysm following transcatheter aortic valve implantation (TAVI) are extremely rare, with most requiring emergency surgical intervention. We present a case of a patient who developed ventricular arrhythmia following transfemoral TAVI. Approximately one week after the procedure, the patient presented to the emergency department with ventricular tachycardia and was treated with amiodarone. A diagnosis of left ventricular pseudoaneurysm was established; however, the patient refused surgical treatment. Instead, an implantable cardioverter-defibrillator was placed, and the patient was managed with medical follow-up. The six-month follow-up period was uneventful.