Artificial intelligence (AI) is rapidly becoming an integral part of everyday clinical practice, including cardiology and cardiovascular surgery. As AI increasingly influences diagnostic and therapeutic decisions, physicians are expected to interact with these systems in a critical, safe, and ethically grounded manner. This narrative review aims to explore how AI can be systematically integrated into undergraduate and residency medical education, with a particular focus on curriculum design, teaching strategies, assessment models, and educational infrastructure, while considering the context of the Turkish medical education system. A narrative synthesis of international medical education literature, policy documents, and institutional reports was conducted without quantitative meta-analysis. The review was guided by the principles of human-in-the-loop clinical reasoning, ethical AI use, and patient safety. Effective integration of AI into medical education requires a longitudinal and staged curriculum spanning preclinical, clinical, and residency training. Assessment strategies must explicitly address AI-assisted decision-making and be supported by transparent institutional policies governing AI use in examinations, as well as by secure, regulation-compliant digital infrastructure. Educational approaches should encourage learners to critically appraise and contextualize AI outputs rather than accept them uncritically. The reviewed literature supports a competency-based educational framework that integrates AI literacy, ethical reasoning, and context-aware clinical judgment. AI education should be viewed as a core clinical competency that strengthens rather than replaces human judgment. Particularly in high-risk cardiovascular disciplines, a standardized, ethics-centered, and competency-based educational framework is essential to prepare future physicians for AI-augmented healthcare environments.

Objective: Air pollution is a major global public health concern and has increasingly been linked to cardiovascular diseases, including acute coronary syndrome (ACS). This study investigated the temporal association between air pollution and ACS case counts in Amasya, northern Türkiye.

Method: In this retrospective study, the medical records of 6,185 ACS patients treated at a single hospital were analyzed, including cases of ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris. Environmental air pollutant levels, including particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5), nitric oxide (NO), and nitrogen oxides (NOx) were collected, and their temporal correlations with ACS case counts were evaluated. Seasonal variations in both the number of hospital admissions for ACS and pollutant concentrations were also analyzed.

Results: Seasonal analysis revealed a significantly higher number of hospital admissions for acute coronary syndrome during winter compared with other seasons in this single-center study conducted in northern Türkiye (P < 0.05). Levels of particulate matter (PM10 and PM2.5) were also elevated in winter, with PM2.5 showing a moderate positive correlation with STEMI case counts (r = 0.38, P = 0.0005) and a strong positive correlation with NSTEMI case counts (r = 0.55, P < 0.0001). Nitrogen oxides (NO and NOx) also increased during winter but did not show significant correlations with overall ACS case counts.

Conclusion: Targeted public health strategies are required to mitigate pollution exposure, particularly during high-risk seasons. Further research using more accurate and higher-resolution pollution metrics and longitudinal data is warranted to deepen our understanding of the cardiovascular impacts of specific pollutants and to support the development of effective intervention strategies.

Objective: Transthoracic echocardiography (TTE) is widely used for cardiac evaluation in acute ischemic stroke (AIS), but it may miss intracardiac thrombi that can be detected by transesophageal echocardiography (TEE). The stress hyperglycemia ratio (SHR), which adjusts admission glucose for baseline glycemia, has emerged as a novel biomarker in cardiovascular disease. However, its association with intracardiac thrombus undetected by TTE in AIS remains unclear.

Method: This retrospective study included 486 AIS patients who underwent TEE despite negative baseline TTE findings. Demographic, laboratory, and echocardiographic data were evaluated. Logistic regression and receiver operating characteristic (ROC) analysis were used to assess independent associations with intracardiac thrombus.

Results: TEE detected thrombus in 64 patients (13.2%). Patients with thrombus had higher SHR (0.99 ± 0.42 vs. 0.84 ± 0.27, P < 0.001), glucose, C-reactive protein (CRP), and creatinine levels, and lower ejection fraction. In univariable analysis, SHR showed a strong association with intracardiac thrombus (odds ratio [OR] = 3.68, P < 0.001) and remained independently associated after multivariable adjustment (OR = 2.39, 95% confidence interval: 1.11–5.17, P = 0.027), along with CRP, paroxysmal atrial fibrillation, and male sex, while ejection fraction was inversely associated with thrombus presence. The model demonstrated good discriminative performance (area under the curve: 0.796).

Conclusion: SHR is associated with intracardiac thrombus missed by TTE but detected by TEE in AIS. SHR may enhance risk stratification and help guide selective use of TEE.

Objective: Exercise intolerance is a hallmark of heart failure (HF), and skeletal muscle abnormalities and abdominal obesity are important noncardiac factors contributing to this limitation. This study aimed to investigate the mediating roles of skeletal muscle strength and waist-to-height ratio (WtHR) in the relationship between muscle mass and exercise capacity in individuals with HF.

Method: This cross-sectional study included 110 patients with HF aged over 18 years who were classified as New York Heart Association (NYHA) functional class II or III. Exercise capacity, skeletal muscle mass, muscle strength, and WtHR were assessed using the six-minute walk test, a Tanita device, a Jamar hydraulic handgrip dynamometer, and a tape measure, respectively. Mediation effects were evaluated using the bootstrapping method with a 95% confidence interval and parallel multiple mediation models. Mediation was considered significant when the intervals did not include zero.

Results: A significant correlation was observed between muscle mass and exercise capacity, with both muscle strength and WtHR acting as partial mediators in this relationship. After adjusting for age, sex, and NYHA class, the mediating effect of WtHR was greater (30.6%) than that of muscle strength (17.9%). Despite these mediating effects, muscle mass maintained a direct effect of 51.5% on exercise capacity.

Conclusion: In individuals with HF, muscle mass is associated with exercise capacity both directly and indirectly through muscle strength and WtHR. Assessing these characteristics together may help account for the impact of abdominal obesity, which is associated with reduced exercise capacity in this population.

Objective: Complete atrioventricular (AV) block complicates management decisions, particularly regarding temporary pacemaker (TP) insertion. Lactate, an anaerobic byproduct, may reflect inadequate cardiac output and help guide this decision. We analyzed the prognostic value of lactate in patients with complete AV block.

Method: We retrospectively evaluated the medical records of adult patients presenting with complete AV block to our coronary care unit. Initial and subsequent venous blood lactate levels were analyzed for associations with adverse in-hospital outcomes, defined as renal injury, cardiac mortality, or the need for TP prior to permanent pacemaker implantation.

Results: The study included 140 patients (46.4% female; median age: 76 years, range: 32–96). Poor outcomes were observed in 22.9% of patients (n = 32), who exhibited significantly higher initial lactate levels (median: 3.1 vs. 2.0 mmol/L; P < 0.001). A lactate cutoff > 1.8 mmol/L predicted poor outcomes with 90.6% sensitivity and 43.5% specificity. Elevated baseline and follow-up lactate levels remained significant predictors, with 83.3% sensitivity and 85.5% specificity compared to normal baseline and follow-up lactate levels.

Conclusion: Increased lactate levels are independent determinants of poor in-hospital outcomes in patients with complete AV block. Lactate measurement may aid decision-making regarding TP even in hemodynamically stable patients. However, these results are hypothesis-generating, and prospective studies are needed to confirm clinical utility.

Objective: Methemoglobinemia is a potentially serious complication of local anesthetic use during cardiac implantable electronic device (CIED) implantation. Although it is mostly asymptomatic, limited awareness may delay diagnosis and treatment.

Method: This prospective observational study included 126 patients undergoing CIED implantation under local anesthesia. Prilocaine 2% was used in all procedures. Arterial blood gases and methemoglobin levels were evaluated at baseline and at 60 and 120 minutes after the procedure. A fractional methemoglobin level > 1.5% was defined as methemoglobinemia. Patients were categorized into three groups based on 60-minute fractional methemoglobin (FMetHb) levels: ≤ 1.5%, 1.5–3%, and > 3%. Clinical parameters, anesthetic dosage, and outcomes were compared between groups.

Results: Methemoglobin levels > 1.5% were observed in 80.2% of patients. Three patients required treatment, and all recovered fully. Patients with FMetHb > 3% received higher anesthetic doses (P < 0.001). Differences in drug dose and pCO2 were observed between groups. Among the clinical parameters, the prilocaine dose demonstrated the strongest predictive value for methemoglobinemia, with an optimal cut-off of ≥ 24.50 mg identified by receiver operating characteristic (ROC) analysis (area under the curve: 0.693, P < 0.001).

Conclusion: Methemoglobinemia may occur more frequently than expected following CIED implantation. Early recognition and stratification using practical thresholds, such as FMetHb > 3%, may support timely management and improve clinical outcomes.

Objective: The aim of this study was to present our single-center experience with transcatheter re-intervention for residual patent ductus arteriosus (rPDA), with particular emphasis on anatomical features and technical approaches.

Method: We retrospectively reviewed six patients (median age 2.9 years; range, 1.2–16) who underwent transcatheter closure of rPDA between January 2021 and May 2025. Re-intervention was performed for persistent residual shunting in the presence of previously implanted foreign material, based primarily on hemodynamic and anatomical considerations; infective endarteritis and hemolysis were considered additional potential risks. Procedural records, angiographic findings, device selection, and outcomes were analyzed.

Results: Five patients had undergone prior transcatheter patent ductus arteriosus (PDA) closure and one had surgical ligation. Among the transcatheter cases, persistent shunting was due to delayed malposition (n = 2), incomplete occlusion (n = 2), and a non-thrombosed coil (n = 1). In two patients, the original Amplatzer Duct Occluder II (ADO II) device was malpositioned toward the pulmonary artery; therefore, a second device was deployed encompassing the prior occluder. In one patient, a non-thrombosed coil with persistent central flow created a “stent-like” configuration, and closure was achieved by implanting a new device with its discs covering the coil. In the surgical case, both the residual ductus and an adjacent aortopulmonary collateral artery were successfully occluded with a single device. Complete closure was achieved in all patients without complications.

Conclusion: In this single-center case series, transcatheter re-intervention for residual PDA was feasible even in the presence of malpositioned prior devices. Careful anatomical evaluation and individualized procedural planning enabled successful closure of residual shunts.

Mitral annular calcification (MAC) is a complex structural abnormality often associated with severe mitral stenosis, regurgitation, or both. Mitral valve surgery carries greater risk especially in elderly patients with MAC, making transcatheter mitral valve replacement (TMVR) an emerging alternative. We report the case of an 84-year-old woman with a history of surgical bioprosthetic aortic valve replacement and recurrent hospitalizations due to severe MAC-related mitral valve disease. She was deemed inoperable by the heart team. Detailed multimodal imaging, including multidetector computed tomography (MDCT), revealed extensive MAC with acceptable neo-left ventricular outflow tract (neo-LVOT) dimensions and an acute aorto-mitral angle. Thus, TMVR was successfully performed via a transseptal approach using a 30.5 mm balloonexpandable Myval transcatheter heart valve (THV). Post-procedural imaging confirmed optimal valve position, no paravalvular leak, and no LVOT obstruction. The patient was discharged in stable condition. This is the first reported case from Türkiye of TMVR in MAC using the Myval THV, contributing to the growing worldwide experience. This report also emphasizes the role of advanced imaging in guiding patient selection and procedural planning and illustrates the feasibility of the Myval THV for valve-in-MAC in challenging mitral anatomy.

Tricuspid regurgitation (TR) is associated with poor prognosis and increased morbidity, especially in patients with high surgical risk and limited treatment options. We present the case of a 70-year-old male with a history of mitral valve replacement and prior tricuspid valve transcatheter edge-to-edge repair (TV-TEER), who underwent a successful redo TV-TEER due to torrential TR. Post-procedural evaluation revealed a significant reduction in TR severity and clinical improvement. Unfortunately, the patient succumbed to infectious complications and sepsis in the third week of follow-up. Due to the limited data on redo TV-TEER interventions, this case adds to the existing literature and suggests that redo TV-TEER may be a viable alternative to surgery in selected patients.