Objective: Malignant pericardial effusion (MPE) is associated with poor prognosis and frequently presents as cardiac tamponade. While cytology is the diagnostic gold standard, its sensitivity is limited. Computed tomography (CT) attenuation, measured in Hounsfield Units (HU), may reflect fluid composition and assist in the non-invasive differentiation of MPE.

Method: This retrospective, single-center study included 102 patients who underwent percutaneous pericardiocentesis and thoracic CT. Patients were classified as having malignant or non-malignant effusion based on pathological findings. CT attenuation was measured at three standardized axial levels. Diagnostic performance was assessed using multivariate logistic regression and receiver operating characteristic (ROC) analysis. Two predictive models were compared: Model 1 (clinical and laboratory variables) and Model 2 (Model 1 + CT attenuation).

Results: MPE was diagnosed in 44 patients (43.1%). CT attenuation values were significantly higher in the MPE group (median 24.4 HU vs. 9.3 HU, P < 0.001). On multivariate analysis, male sex, elevated pericardial fluid protein, low glucose, and high lactate dehydrogenase were independent predictors of MPE. CT attenuation also emerged as an independent predictor when added to the model (Model 2) (odds ratio [OR] = 1.076, 95% confidence interval [CI]: 1.026-1.128, P = 0.003). The inclusion of CT attenuation improved the model's diagnostic performance (area under the curve [AUC]: 0.893 for Model 2 vs. 0.860 for Model 1). Model 2 demonstrated superior diagnostic performance (AUC = 0.893), with a CT attenuation cut-off of 16.45 HU yielding a sensitivity of 88.2% and a specificity of 78.3%.

Conclusion: CT attenuation provides incremental diagnostic value in identifying MPE when combined with conventional clinical and biochemical parameters. In settings where rapid diagnosis is critical, its non-invasive and reproducible nature may support early detection of malignant conditions.

Objective: Hypertrophic cardiomyopathy (HCM) is a common hereditary cardiac disorder. Clinical presentations in the Turkish population may differ from those observed in other countries. This study aimed to evaluate the relationship between the sudden cardiac death (SCD) risk score and long-term mortality in low-risk HCM patients and to identify predictors of long-term mortality. Additionally, it investigated the clinical characteristics and outcomes of HCM patients at a tertiary cardiology center.

Method: Between 2004 and 2021, a total of 340 HCM patients without implantable cardioverter defibrillators were followed at a single tertiary cardiology center in Türkiye. This was a retrospective study. The HCM Risk-SCD score was used to integrate demographic and clinical variables to estimate the predicted five-year risk of death. Patients with an HCM Risk-SCD score of less than 4% were divided into three equal tertiles, ranging from low to high SCD scores. These tertiles were then compared.

Results: Our study identified older age [hazard ratio (HR) 95% confidence interval (CI): 1.048 (1.018-1.080)], a history of cerebrovascular accident [HR 95% CI: 3.675 (1.158-11.656)], and elevated neutrophil count [HR 95% CI: 1.450 (1.250-1.681)] as independent risk factors for long-term mortality in the cohort with HCM Risk-SCD < 4%. The receiver operating characteristic (ROC) curve demonstrated that the optimal HCM Risk-SCD threshold for predicting long-mortality in the overall study cohort was > 1.79, with 55% sensitivity and 55% specificity (area under the curve (AUC): 0.60, 95% CI: 0.52-0.69, P < 0.001). No statistically significant difference in long-term mortality was observed among the tertiles in the Kaplan-Meier analysis (P = 0.296).

Conclusion: Advanced age, cerebrovascular accident, and elevated neutrophil count are independent predictors of long-term mortality in patients with an HCM Risk-SCD score < 4%. Patients classified as low risk should undergo further evaluation using complementary tools to help prevent SCD.

Objective: Prosthetic valve endocarditis (PVE) is a serious complication following heart valve surgery, presenting considerable diagnostic and therapeutic challenges. Despite advances in treatment, systemic embolism remains a major adverse event associated with poor outcomes. This study aimed to identify predictors of in-hospital systemic embolism in patients with PVE and to evaluate treatment outcomes.

Method: This retrospective, single-center study included 96 patients diagnosed with mechanical PVE between 2012 and 2024. Diagnoses were established based on the modified Duke criteria. Data on demographics, comorbidities, clinical presentation, imaging findings, and treatment strategies were collected and analyzed. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were employed to identify risk factors.

Results: The study cohort had a median age of 52.4 years (range 22-82). Systemic embolic events occurred in 39 patients (40.6%), with stroke being the most common manifestation (26%). Multivariate analysis identified vegetation size as the only independent predictor of systemic embolism (odds ratio [OR]: 2.34, P = 0.037). ROC analysis determined a vegetation size threshold of 2 cm², with 66% sensitivity and 78% specificity. Elevated erythrocyte sedimentation rate (ESR) and a prior history of stroke were also associated with increased embolic risk. Among 31 patients who underwent surgery, early intervention did not significantly reduce embolism rates compared to delayed surgery. Successful treatment was associated with a lower risk of embolism (P = 0.045).

Conclusion: Larger vegetations, elevated ESR, and a prior history of stroke are key risk factors for systemic embolism in PVE. Early identification of high-risk patients and implementation of individualized management strategies are essential to improve clinical outcomes. Further multicenter studies are warranted to refine treatment protocols.

Objective: Autosomal dominant polycystic kidney disease (ADPKD) is a complex, progressive condition that primarily involves the kidneys but may also affect other systems, namely the cardiovascular system. It is characterized by the growth of cysts, leading to decreased renal function and finally, to chronic kidney disease. While renal symptoms are the primary focus of treatment, cardiovascular complications play a significant role in morbidity and mortality and there is a paucity of information regarding the risk of arrhythmias in these patients. The evaluation of myocardial repolarization was conducted through a variety of methodologies, including Tp-e, QTc and QT interval assessment. An increasing amount of data suggests that malignant ventricular arrhythmias are linked to a higher Tp-e/QT ratio.

Method: This case-control study of 31 adult patients diagnosed with ADPKD was conducted between May 2021 and April 2024. Control group patients were selected using propensity score matching and were considered to minimize confounding factors. All participants underwent electrocardiography and transthoracic echocardiography studies.

Results: Patients with ADPKD had substantially higher QTc intervals, Tp-e intervals, Tp-e/QT ratio and Tp-e/QTc ratio, than the control group (all P = 0.001). Correlation analysis revealed significant negative correlations between estimated glomerular filtration rate (ml/min./1.73 m2) and QTc interval (P = 0.002), Tp-e interval (P = 0.003), Tp-e/QT ratio (P = 0.042) and Tp-e/QTc ratio (P = 0.021) in patients with ADPKD.

Conclusion: According to resting ECG findings, patients with ADPKD were predisposed to sudden cardiac death.

Objective: To enhance the results in pediatric cardiac intensive care patients, it is essential to determine the personnel, organisation and equipment status that require improvement. This study aimed to evaluate the current status in the units where pediatric cardiac intensive care patients are admitted, in Türkiye.

Method: The study was carried out by means of an online questionnaire form delivered to the chief physicians of intensive care units. The number of patients admitted in the intensive care unit, scope of the surgeries, the number and specialities of physicians and staff who are involved, their roles in patient care, as well as the use of monitorisation methods were defined. Descriptive statistics were applied to the results.

Results: The intensive care units are most commonly found in educational institutions and there is a high rate of subspecialty training clinics. The majority of the units are medical and surgical mixed units (76%) and pediatric-only (96%). Pediatric intensive care specialists are most often asserted as the primary responsible physician (48%). The average number of surgeries and annual number of admitted patients are variable among the institutions. Interventional procedures are performed (92%) and cardiac mechanical support systems are used (84%) in the vast majority of the institutions.

Conclusion: There is great heterogeneity in patient volumes, personnel status and organisation styles of the units in which pediatric cardiac intensive care patients are admitted. In the future, all these types of patients should be cared for in pediatric-only units and physicians specialized in Pediatric Intensive Care should be present in the teams caring for these patients.

Objective: Increased negative moods such as anxiety, depression and fear of recurrence of cardiac events after a cardiac event, make it difficult to comply with lifestyle recommendations and drug therapy. Conducting screenings for cardiac distress and ensuring appropriate referrals are made constitute a crucial aspect of maintaining a healthy lifestyle post-illness. The Cardiac Distress Inventory has made it possible to assess cardiac patients psychologically and emotionally. The objective of this study was to provide a validity and reliability assessment of the original form Cardiac Distress Inventory (CDI) and short form (CDI-SF), in Turkish.

Method: The inventory was administered face to face to a total of 417 participants (336 CDI/81
CDI-SF) who were hospitalized with the diagnosis of acute coronary syndrome and volunteered to participate in the study. Validity data was assessed using Exploratory Factor Analysis (EFA), Rasch, Confirmatory Factor Analysis (CFA), reliability by McDonald’s Omega (ω), Pearson correlation coefficient and discriminability by Receiver operating characteristic (ROC) analysis.

Results: The two CDI were a high level of reliability. The factor structure and factor loadings of the CDI were not compatible with the original. The goodness of fit estimated by validity (CFA-EFA) was also not confirmed. The values of RMSEA, χ2/df and CFI indices suggest that it is not suitable for Türkiye. However, in the cross-cultural adaptation, validity and reliability study of the CDI-SF, it was concluded that the construct validity and internal consistency were high and could be used as a unidimensional scale. The inventory will be made freely available to clinicians and researchers.

Conclusion: CDI-SF provides a specific, pragmatic and reliable measurement of cardiac distress, adapted to common heart diseases. It serves as an effective screening tool in cardiac clinical management by demonstrating strong psychometric properties.

Infective endocarditis (IE) is a serious and potentially life-threatening bacterial infection of the cardiac epithelium, with a mortality rate of approximately 5% in children. The most common risk factor for IE in this population is congenital heart disease. The American Academy of Pediatric Dentistry acknowledges that certain medical conditions increase susceptibility to infections resulting from bacteremia. Antibiotic prophylaxis is recommended for high-risk patients prior to procedures that could induce bacteremia, with the goal of reducing or preventing transient bacteremia caused by invasive dental treatments. However, the effectiveness of prophylaxis in preventing or mitigating the frequency and severity of bacteremia associated with dental procedures remains controversial. This review explores current approaches to antibiotic prophylaxis in pediatric dentistry for the prevention of IE. While some studies suggest that preoperative antibiotics reduce these risks, others report no significant benefit. Given these uncertainties, maintaining good oral hygiene and promptly treating dental diseases are essential strategies to reduce the risk of bacteremia from routine daily activities. Historically, patients with most forms of congenital heart disease were prescribed antibiotics prior to dental procedures in line with American Heart Association guidelines. Today, however, antibiotics before dental procedures are recommended only for patients with cardiac conditions that pose a high risk for infective endocarditis. The overall health of vulnerable pediatric patients can be improved by reducing the risk of infective endocarditis through interdisciplinary collaboration, particularly between pediatric cardiologists and dentists.

Tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease, is classically associated with decreased pulmonary blood flow. Classical TOF is characterized by antegrade pulmonary blood flow and right ventricular outflow tract obstruction at varying levels. In the modern era, most children with TOF undergo definitive intracardiac repair during infancy, and pulmonary artery hypertension (PAH) is virtually unheard of in postoperative TOF in the absence of major aortopulmonary collaterals. We report the circumstances in which PAH can occur after definitive repair of classical TOF in the modern era.

Variant transthyretin amyloid cardiomyopathy (ATTRv-CM) is a rare disease caused by a genetic mutation in the ATTR gene. Due to the pathogenic mutation, transthyretin tetramers lose their structural stability and misfold, leading to the accumulation of amyloid fibrils in various tissues, particularly in the heart. The clinical progression of ATTRv-CM varies depending on the specific mutation. Data on ATTR gene mutations in Türkiye are limited. This paper presents a case of spontaneous biceps tendon rupture, identified prior to diagnosis, in a patient with ATTRv-CM carrying a heterozygous c148G>A pVal50Leu mutation.