Objective: Moderate-intensity exercise modulates the immunological response in cardiac tissue. Meteorin-like protein (METRNL) is a myokine secreted by muscle cells during exercise and is involved in immune response regulation. However, the effects of metrnl on mast cells and plasma cells in cardiac tissue are not fully understood. This study was designed to assess the effects of exogenous metrnl infusion on the cardiac mast cells and plasma cells. In addition, serum levels of musclin, an exercise-responsive factor, were evaluated during the effects of moderate-intensity exercise on cardiac immune cells.

Method: Twenty-seven female rats were randomly divided into three groups (n = 9 each): control (deionized water), exercise (moderate-intensity swimming exercise) and metrnl (1 µg/day). For histological studies, hematoxylin-eosin, toluidine blue and methyl green-pyronin staining were performed on heart tissues. Musclin levels were measured in serum samples using the ELISA method.

Results: Metrnl infusion increased cardiac mast cell and plasma cell numbers in female rats like moderate-intensity exercise. In addition, the increase in cardiac mast cell count was greater in the exercise group, whereas musclin concentration decreased in female rats subjected to moderate-intensity exercise.

Conclusion: Our data suggest that moderate-intensity exercise’s effects on the cardiac immune system may be mediated by musclin downregulation and metrnl-dependent upregulation of cardiac mast cells and plasma cells. Thus, exercise-induced metrnl may affect the cardiac immune response by modulating cardiac immune cells.

Objective: Despite the reality that percutaneous coronary intervention (PCI) lowers mortality following acute myocardial infarction (AMI), older patients (≥ 75 years) are still at high risk of mortality. The purpose of this study was to evaluate the prognostic significance of the HALP score, which reflects the inflammatory and nutritional status, in this population.

Method: We retrospectively included 128 elderly patients who underwent PCI at our institution, between 2019 and 2022. The primary endpoint of the study was long-term, all-cause mortality. The study population was categorized into two distinct groups based on survival status: survivors and non-survivors. A multivariable Cox regression analysis was conducted to identify independent predictors of long-term all-cause mortality.

Results: The median follow-up time was 49.9 (35.6–62.74) months. In multivariable analysis, the HALP score and CRP independently predicted all-cause mortality at long-term follow-up (hazard ratio (HR): 0.96, 95% confidence interval (CI): 0.94–0.99, P = 0.003; HR: 1.04, 95% CI: 1.01–1.07, P = 0.020; respectively). Receiver operating characteristic curve analysis identified 26.252 as the optimal HALP score cut-off for predicting mortality (area under the curve (AUC): 0.764; 95% CI: 0.672–0.855; P < 0.001), with 73% sensitivity and 70.3% specificity. The HALP score demonstrated a higher AUC value, indicating better discriminative power compared to its individual components. In Kaplan-Meier analysis, patients with HALP score< 26.252 had a higher mortality during follow-up (log rank P < 0.0001).

Conclusion: The HALP score is an independent predictor of long-term all-cause mortality in older AMI patients following PCI.

Objective: Heart failure with preserved ejection fraction (HFpEF) is a leading clinical syndrome, accounting for more than 50% of hospitalizations due to heart failure. The Heart Failure Association Pre-test assessment, Echocardiography and natriuretic Peptides, Functional testing and Final etiological diagnosis (HFA-PEFF) algorithm, used for the diagnosis of HFpEF, also has prognostic value. The primary purpose of this work was to explore the relationship between the HFA-PEFF score and right ventricular (RV) echocardiographic parameters.

Method: 127 patients diagnosed with HFpEF between January 2021 and November 2024, with adequate transthoracic echocardiography (TTE) images, were retrospectively evaluated. Patients were categorized into three prognostic risk groups based on their HFA-PEFF scores: low (0–2), intermediate (3–4) and high (5–6). RV function was assessed using Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular S’ velocity and RV free wall longitudinal strain (RVFW GLS). The relationship between the HFA-PEFF score and RV parameters was evaluated using One-way ANOVA and Spearman correlation analysis.

Results: Patients with high HFA-PEFF scores showed significant deterioration in TAPSE and RV GLS values. A moderate negative correlation was observed between HFA-PEFF score and RVFW GLS (r = 0.50, P < 0.001), while a mild negative correlation was found with TAPSE (r = -0.35, P < 0.001).

Conclusion: In HFpEF patients with poor prognosis as identified by the HFA-PEFF score, there was a marked deterioration in RV parameters, particularly RVFW 2D GLS and TAPSE. These findings suggest that incorporating RV parameters into HFpEF diagnostic and prognostic algorithms might provide additional clinical value.

Objective: The aorta, particularly in its proximal segments, expands during systole to store blood, which is subsequently released into the peripheral circulation during diastole, morphologically and histologically. This function, referred to as the “Windkessel effect,” ensures continuous and regular blood flow in the peripheral circulation. Thoracic Endovascular Aortic Repair (TEVAR) was introduced in the literature as a treatment for Type B aortic dissections (TBAD). In patients who undergo TEVAR, the placement of a stent graft in the proximal segments of the aorta, which are responsible for the highest capacity of blood storage and elasticity, may disrupt this function. Consequently, this alteration may lead to increased afterload and, over the long term, impair left ventricular systolic function. Previous studies have demonstrated that measurements of left ventricular global longitudinal strain (LVGLS) can detect early systolic dysfunction before any significant changes in left ventricular ejection fraction (LVEF) occur. The aim of this study was to compare preoperative and postoperative LVGLS measurements in patients who underwent TEVAR, thereby illustrating changes in LVGLS associated with the procedure.

Method: Patients who underwent TEVAR for TBAD or Thoracic Aortic Aneurysm (TAA) were included in the study. Patients with malignancy, advanced valvular pathology, end-stage chronic kidney disease, liver failure or heart failure, were excluded. Preoperative data, including comorbidities, medication use, blood parameters, electrocardiography findings, transthoracic echocardiography images and LVGLS values, were recorded. These parameters were then compared with the values obtained at the postoperative three-month outpatient follow-up.

Results: After the TEVAR procedure, a significant decrease in LVGLS was observed (P < 0.001). A strong correlation was found between the change in mean arterial pressure (MAP) and the reduction in LVGLS (P = 0.555, P = 0.017). Postoperatively, significant increases were noted in systolic blood pressure (SBP) and MAP (both P < 0.001). No significant differences were observed in other parameters, before and after the procedure.

Conclusion: In our study, a significant increase in SBP and MAP, along with a notable decrease in LVGLS values, were observed following the TEVAR procedure. A significant and strong correlation was identified between the increase in MAP and the decrease in LVGLS.

Objective: The effects of radiofrequency catheter ablation (RFCA) and direct current cardioversion (DCCV) on left atrial (LA) mechanical function and atrial myopathy are not fully understood. In this study, we aimed to compare the changes in myocardial deformation after catheter ablation and electrical cardioversion procedures, in patients with atrial fibrillation (AF).

Method: In this study, we retrospectively analyzed echocardiographic parameters of left ventricular and left atrial function and strain measurements with two-dimensional speckle tracking echocardiography (STE), before and after the procedure in patients who underwent RFCA or DCCV for atrial fibrillation.

Results: LA reservoir strain (LARS) significantly improved after the procedure in the ablation group (Apical four chamber view LARS 15.1 ± 8.2, 19.6 ± 7.1 P < 0.001, respectively). The Apical four chamber view LARS value also showed a significant improvement after the procedure, compared to the pre-procedure in patients who underwent DCCV (Apical four chamber view LARS 12.2 ± 6.2, 17.3 ± 8.1 P < 0.001, respectively). There was no significant difference in strain change between the groups (P = 0.7).

Conclusion: In our study, the improvement in the reservoir strain of patients who underwent RFCA was similar to DCCV group. These findings suggest that restoration of sinus rhythm by RFCA, despite the expense of fibrosis in the lesion areas, improves left atrial reservoir function.

Objective: This study aimed to determine the frequency of methemoglobin development and identify associated factors in patients undergoing Implantable Cardioverter-Defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT) procedures with the local anesthetic prilocaine.
Method: Data from 64 patients were analyzed. The patients' methemoglobin levels before and after the procedure were measured and compared. The relationships between the results and factors such as creatinine, hemoglobin, BMI, and the amount of prilocaine used were examined. Exclusion criteria included: age under 18 years, pregnancy, breastfeeding, malignancy, chemotherapy, hemoglobin chain disorders, liver failure, and renal failure (GFR <60 ml/min), chronic obstructive pulmonary disease, other hypoxic lung diseases and smoker patients.
Results: Methemoglobin levels were significantly higher in the first hour after the procedure (p < 0.001). Oxygen saturation levels were significantly lower during the first hour post-procedure (p < 0.001). In the group with elevated methemoglobin levels after the procedure, creatinine levels were significantly higher (p < 0.001), while BMI (p < 0.001) and hemoglobin levels (p < 0.001) were significantly lower. No significant relationship was found with ALT levels (p = 0.425).
Conclusion: While significant methemoglobin elevation was observed following ICD/CRT procedures with prilocaine, clinically significant methemoglobinemia cases are rare. A significant relationship was identified between methemoglobin elevation and BMI, hemoglobin, and creatinine.

The no-reflow (NR) phenomenon, a complication of percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. Identifying reliable predictors of NR is crucial for risk stratification and improving clinical outcomes. The C-reactive protein (CRP) to albumin ratio (CAR), a marker of systemic inflammation, has been proposed as a potential predictor of NR. This systematic review and meta-analysis aimed to evaluate the relationship between CAR and NR following PCI. A comprehensive literature search was conducted in the Cochrane, Embase, and PubMed databases, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Studies assessing the predictive value of CAR for NR were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using Cochrane’s Q and I² statistics. Four studies comprising a total of 2,068 patients were included. The pooled analysis showed a significant association between elevated CAR and an increased risk of NR (OR: 2.34; 95% CI: 1.19–4.60; P = 0.01; I² = 96%). Elevated CAR is associated with an increased risk of NR after PCI, indicating its potential as a prognostic biomarker. However, the high heterogeneity among studies highlights the need for large-scale research to confirm its clinical applicability.

Antihypertensive pharmacological treatment, based on currently available drugs, has been shown to reduce the cardiovascular risk profile of treated hypertensive patients by lowering elevated blood pressure. However, the cardiovascular risk in treated hypertensive patients remains elevated. This highlights the need to develop new antihypertensive drugs capable of normalizing the risk associated with high blood pressure. This paper aims to review new antihypertensive drugs for the treatment of drug-resistant hypertension. In particular, it focuses on the results obtained with non-steroidal mineralocorticoid receptor antagonists, aldosterone synthase inhibitors, brain renin-angiotensin blockers, hepatic angiotensinogen inhibitors, atrial natriuretic peptides, and endothelin-1 receptors antagonists.

Cardiac amyloidosis is a rare systemic condition characterized by the extracellular accumulation of amyloid proteins in the heart. These proteins can be deposited in various cardiac structures, including the valves, endocardium, myocardium, and pericardium. This abnormal protein deposition can disrupt normal heart function, leading to a range of symptoms and complications, such as heart failure, arrhythmias, and even sudden cardiac death. The diagnosis of cardiac amyloidosis is typically suspected based on characteristic clinical features, electrocardiogram abnormalities, and echocardiographic findings, which prompt further evaluation and confirmation. We present the case of a 57-year-old woman hospitalized with significant exertional dyspnea, hypotension, lower extremity edema, and proteinuria. The aim of this case report is to enhance clinicians' understanding of this condition and to reduce the interval between symptom onset and diagnosis, thereby potentially improving the prognosis for affected patients.

Cardiac myxomas are the most common primary tumors of the heart and can cause systemic embolization, particularly when located in the left atrium. We present a rare case of a left atrial myxoma resulting in total occlusion of the infrarenal abdominal aorta. A 60-year-old man was admitted to the hospital with back pain, paresthesia in the lower extremities, and subsequent development of paraplegia. Computed tomography revealed total occlusion of the infrarenal aorta. Emergent surgery was performed, and the intraoperative specimen removed from the aorta was histologically identified as myxomatous material. Transthoracic echocardiography revealed a mass located in the left atrium. Despite a second surgery for the removal of the cardiac mass, embolic episodes caused by the myxoma could not be prevented. Prompt diagnosis and timely treatment are essential to improve clinical outcomes by preventing embolization-related complications.