Objective: This study evaluated the most effective scoring system for predicting new-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI). Identifying the best predictive tool may help clinicians select the most appropriate personalized treatment based on individual risk scores to prevent NOAF complicating AMI.
Method: A total of 2,206 patients diagnosed with AMI between June 2021 and January 2023 were included in this study. After excluding cases with missing data, univariable and multivariable analyses were conducted on 1,672 patients to assess the association between baseline characteristics and the development of atrial fibrillation. The CHA2DS2-VASC (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke/TIA/thromboembolism, Vascular disease, Age 65-74 years, Sex category), C2HEST (Coronary artery disease, Chronic obstructive pulmonary disease, Hypertension, Elderly [age ≥ 75], Systolic heart failure, Thyroid disease), HAT2CH2 (Hypertension, Age > 75, Stroke/TIA, Chronic obstructive pulmonary disease, Heart failure), SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery), GRACE 2.0 (Global Registry of Acute Coronary Events), and SYNTAX II scores were calculated for each patient.
Results: Receiver operating characteristic (ROC) analysis showed that the SYNTAX score (SxS) had the highest predictive value for NOAF during AMI, with an area under the curve (AUC) of 0.785 (95% confidence interval [CI]: 0.767-0.802, P < 0.001), followed by the SYNTAX II score (SxSII) with an AUC of 0.747 (95% CI: 0.728-0.765, P < 0.001), and the GRACE 2.0 risk score (RS) with an AUC of 0.740 (95% CI: 0.721-0.758, P < 0.001). It was shown that the modified scores (created by incorporating hemoglobin A1c [HbA1c] levels), the primary independent predictive parameter in this study, into the existing risk models demonstrated higher predictive value for NOAF (C-statistic: 0.784-0.794).
Conclusion: Combining HbA1c levels with SxS yielded the highest diagnostic performance for predicting NOAF during AMI. In this study, while SxS outperformed other risk models, the GRACE 2.0 and SxSII scores also demonstrated relatively strong predictive value and were superior to the CHA2DS2-VASC, C2HEST, and HAT2CH2 scores for predicting NOAF in the setting of AMI.

Objective: Coronary artery calcification (CAC) and osteoporosis are common age-related conditions that may share underlying mechanisms such as inflammation and lipid dysregulation. Lipoprotein(a) [Lp(a)] has been suggested as a potential contributor to both processes. This study aims to investigate the relationship between CAC, bone mineral density (BMD), and Lp(a) levels in a statin-naive elderly population.

Method: This retrospective study included 310 patients aged ≥ 55 years who underwent coronary computed tomography angiography and Lp(a) measurement. CAC was assessed visually, and BMD was measured using vertebral Hounsfield units. Patients were stratified into three groups according to Lp(a) levels: ≤ 30, 30–49, and ≥ 50 mg/dL. Propensity score matching was performed for age and sex.

Results: Patients with CAC had higher Lp(a) levels [36.4 ± 33.2 vs. 21.7 ± 27.8 mg/dL, P < 0.001], lower high-density lipoprotein cholesterol (HDL-C) [52.6 ± 14.6 vs. 57.5 ± 17.9 mg/dL, P = 0.010], and lower BMD [152.9 ± 50.2 vs. 169.1 ± 51.0 HU, P = 0.009]. In multivariate analysis, both Lp(a) and HDL-C were independent predictors of CAC. Low BMD and CAC prevalence increased stepwise across Lp(a) strata: in patients with Lp(a) ≤ 30 mg/dL, low BMD was present in 28.9% and CAC in 52.6%; in those with Lp(a) 30–49 mg/dL, 37.2% and 66.7%; and in those with Lp(a) ≥ 50 mg/dL, 58.6% and 80.3%, respectively (P = 0.002 and P = 0.001).

Conclusion: Elevated Lp(a) is associated with both CAC and low BMD. Lp(a) ≥ 50 mg/dL may serve as a shared biomarker to identify individuals at risk for concurrent vascular and skeletal deterioration.

Objective: Patients with type 2 diabetes mellitus (T2DM) and non-ST-elevation myocardial infarction (NSTEMI) are at increased risk of incomplete revascularization and adverse outcomes. Simple biomarkers to predict residual disease burden and prognosis are clinically valuable. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score reflects inflammation and nutritional status. This study evaluated the association of the HALP score with the residual Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (rSS) and 12-month major adverse cardiovascular events (MACE) in T2DM patients with NSTEMI.

Method: This retrospective study included 210 diabetic patients. Participants were stratified into three groups based on rSS (0, 1–8, > 8). HALP scores were calculated from admission laboratory values, and outcomes were followed for 12 months. Associations between HALP and rSS were assessed using Spearman correlation and multivariable regression. Receiver operating characteristic (ROC) analysis identified a HALP cut-off value for predicting high rSS. The prognostic value for MACE was evaluated using Cox regression and Kaplan-Meier analysis.

Results: HALP scores were significantly lower in patients with rSS > 8 (P < 0.001) and were negatively associated with rSS (β = -0.344, P < 0.001). The optimal HALP score cut-off for predicting rSS > 8 was 2.96, with 78% sensitivity and 77% specificity. Patients with HALP ≤ 2.96 had a higher prevalence of rSS > 8 (43.7% vs. 6.5%) and experienced more MACE over 12 months (29.6% vs. 13.7%, P = 0.005). In Cox analysis, a low HALP score (≤ 2.96) was an independent predictor of MACE, along with age and C-reactive protein (CRP) levels (hazard ratio = 1.916, P = 0.045).

Conclusion: Lower HALP scores are associated with higher residual disease burden and worse outcomes. The HALP score may serve as a practical tool for risk stratification in patients with diabetic NSTEMI.

Objective: Erectile dysfunction (ED) and cardiovascular disease share common vascular pathologies, particularly endothelial dysfunction and atherosclerosis. Growing evidence indicates that ED may serve as an early indicator of underlying cardiac abnormalities, particularly diastolic dysfunction (DD), even in the absence of clinically apparent cardiovascular disease.

Method: This prospective, single-center study included 87 patients with ED, matched with 53 healthy controls based on age and body mass index. The severity of ED was assessed using the International Index of Erectile Function (IIEF) and categorized as mild, moderate, or severe. Diastolic dysfunction was evaluated according to established guidelines.

Results: Patients with ED exhibited significant impairments in left ventricular diastolic function, including reduced E/A and e′ velocities, prolonged isovolumetric relaxation time (IVRT), and left atrial (LA) enlargement. A correlation was observed between the severity of ED and worsening right ventricular (RV) diastolic indices, specifically reduced RV e′ and elevated RV E/e′ ratios. Notably, LA enlargement and prolonged IVRT emerged as independent predictors of ED.

Conclusion: Erectile dysfunction is independently associated with subclinical biventricular DD, even in the absence of overt cardiovascular disease. Echocardiography may help detect subclinical cardiac dysfunction in men with ED and improve cardiovascular risk assessment.

Objective: Infective endocarditis (IE) is a severe and potentially fatal infection associated with significant morbidity and mortality. Early identification of patients at high risk of adverse outcomes is essential for improving clinical management and prognosis. This study aimed to evaluate the prognostic value of various inflammatory indices, with a particular focus on the peak C-reactive protein/albumin ratio (CAR), in predicting in-hospital mortality among IE patients.

Method: This retrospective, single-center study included IE patients admitted between June 2020 and June 2023. The primary outcome was in-hospital mortality. For all patients, inflammatory indices, including peak serum CAR levels, were calculated, and their association with mortality was assessed.

Results: Of 165 patients, 62 (37.6%) experienced in-hospital mortality. Non-survivors had significantly higher peak CAR levels (8.1 vs. 5.0, P < 0.001) and elevated levels of other inflammatory indices compared to survivors. Peak CAR demonstrated the highest discriminatory ability for predicting in-hospital mortality, with an area under the curve (AUC) of 0.764, outperforming other indices. Multivariate analysis confirmed that peak CAR was an independent predictor of mortality (adjusted hazard ratio = 1.16, 95% confidence interval: 1.10-1.23, P < 0.001). Net reclassification improvement and integrated discrimination improvement analyses further supported the superior reclassification and discrimination capabilities of peak CAR.

Conclusion: Peak CAR is a significant prognostic marker for in-hospital mortality in IE patients compared to traditional inflammatory indices. Incorporating peak CAR into clinical practice may improve risk stratification and guide treatment decisions.

Objective: The electrocardiogram is a crucial, cost-effective, and noninvasive tool for assessing the risk of cardiac morbidity and mortality. The frontal QRS-T angle is a marker of ventricular repolarization. This study investigated whether the frontal QRS-T angle could predict mortality in hemodialysis patients over a seven-year follow-up period.

Method: The study included 110 patients undergoing regular hemodialysis. Frontal QRS-T angles greater than 90 degrees were classified as wide. Patients were categorized based on the width of the QRS-T angle and the presence or absence of mortality. Electrocardiogram (ECG) parameters measured included the QRS, T axis, TP/QT ratio, fragmented QRS, TPe/QTc ratio, and the frontal QRS-T angle, defined as the absolute difference between the frontal QRS and T axes.

Results: A total of 37 patients (34%) had a wide frontal QRS-T angle. The mean age was significantly higher in both the wide frontal QRS-T angle group and the deceased group. Ejection fraction was lower and the frontal QRS-T angle was wider in the mortality group (94 [31-113] vs. 33 [16-80], P < 0.001). In univariate and multivariate logistic regression analyses, having a wide QRS-T angle was associated with increased mortality (odds ratio [OR]: 8.08, confidence interval [CI]: 2.75-23.74, P < 0.001). Additionally, the presence of fragmented QRS also increased mortality risk (OR: 11.25, CI: 2.98-42.49, P < 0.001).

Conclusion: Our findings demonstrate the independent prognostic value of the frontal QRS-T angle in patients undergoing hemodialysis, irrespective of ejection fraction status. This suggests that it may serve as a valuable tool in routine cardiovascular risk assessments, contributing to improved management strategies for this high-risk population.

Objective: Limited data exist on the concurrent application of carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG).

Method: This retrospective study collected data from 42 patients who underwent simultaneous carotid endarterectomy and off-pump coronary artery bypass grafting between November 2015 and June 2023 at two affiliated institutions. CEA was performed first via eversion endarterectomy, followed by OPCABG using mostly arterial grafts on a beating heart, primarily with a "no-touch" aortic technique. Patient data were obtained from digital hospital records, and follow-up was completed through electronic systems or phone contact.

Results: Among 1,154 OPCABG patients, 42 (3.6%) underwent simultaneous CEA, with a median age of 72 (range: 59-84); 35 patients (83.3%) were male and seven (16.7%) female. All patients were asymptomatic for carotid disease and diagnosed preoperatively via routine Doppler ultrasound. Complete arterial revascularization without aortic manipulation was achieved in 83.3% of cases, with a mean of 3.66 ± 1.22 distal anastomoses. Early mortality occurred in one critically ill patient (2.4%). One patient (2.4%) experienced a postoperative transient ischemic attack and recovered without neurologic sequelae. Seventeen patients (40.4%) were extubated in the operating room. During follow-up, no patients experienced cerebrovascular events; two patients died due to non-cardiac disease. As all events occurred within the first year, the Kaplan–Meier one-, three-, and five-year stroke-free survival rates were identical at 92.6 ± 4.1%.

Conclusion: Concomitant CEA and OPCABG surgery is considered the optimal strategy for patients with extensive carotid and coronary artery stenosis at experienced centers. It is an achievable treatment that minimizes the risk of postoperative cerebrovascular events and cognitive deficits.

Koroner arter anomalileri, üç ana epikardiyal koroner arterden herhangi birinin anormal kökeni, seyri ya da sonlanması olarak tanımlanır. Genellikle kardiyak şikâyete neden olmazlar ve tesadüfen saptanırlar. Ancak bazı koroner arter anomalileri, miyokard enfarktüsü, bayılma, ventriküler aritmiler ve egzersize bağlı ani kardiyak ölüm riskinde artış ile ilişkili olabilirler. Koroner arter anomalileri içerisinde tek koroner arter anomalisi çok nadir görülür ve tek koroner arter, geniş miyokardiyal beslenme alanı sağlar. Biz burada, akut alt duvar miyokard enfarktüsü ile başvuran hastada sol ön inen koroner arterden (LAD) çıkan sağ koroner arterin (RCA) olduğu tek koroner arter anomalisinde LAD/RCA bifurkasyon lezyonunun Culotte tekniği ile revaskülarize edildiği sıra dışı vakayı sunduk.

A 32-year-old male patient was admitted to the hospital with an ischemic stroke. Transesophageal echocardiography revealed an echogenic structure consistent with a thrombus within the aneurysm of the right atrium, along with a patent foramen ovale (PFO) in the interatrial septum. Cardiac magnetic resonance imaging (MRI) confirmed the presence of a right atrial appendage aneurysm (RAAA) with thrombus formation. Coronary angiography demonstrated occlusion of the circumflex artery. Concurrently, the patient was diagnosed with antiphospholipid syndrome. Given the presence of a PFO, paradoxical embolism was postulated as the etiology for both the coronary and cerebral artery occlusions. Antithrombotic and anticoagulant therapy was initiated, and surgical intervention for the RAAA and PFO was recommended. However, the patient declined surgical treatment, and medical management was continued. The patient has been regularly followed for approximately two years without any complications.