Objective: Patients with severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD) represent a particularly fragile subgroup undergoing transcatheter aortic valve replacement (TAVR). Comparative outcome data for balloon-expandable valves (BEV) and self-expanding valves (SEV) in this population remain scarce.

Method: This retrospective single-center study evaluated 246 consecutive subjects with left ventricular ejection fraction (LVEF) < 50% who underwent transfemoral TAVR between January 2015 and June 2025. Clinical, echocardiographic, and procedural characteristics were compared between BEV (n = 96) and SEV (n = 150) recipients. Long-term all-cause mortality served as the primary endpoint.

Results: Individuals treated with BEV were older (78.8 ± 7.9 vs. 75.7 ± 9.8 years; P = 0.019) and demonstrated higher EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) values (24.9 ± 6.2% vs. 22.2 ± 15.8%; P = 0.01). Periprocedural and in-hospital clinical outcomes, including mortality, vascular complications, and pacemaker requirement, were comparable between groups. SEV implantation yielded lower post-procedural transvalvular gradients (mean 7.8 ± 4.0 mmHg vs. 9.6 ± 4.1 mmHg; P = 0.001). Although crude mortality was observed more frequently among BEV patients (50.0% vs. 36.0%; P = 0.041), Kaplan–Meier survival curves showed no survival difference (log-rank P = 0.92). In multivariable Cox regression, predictors of long-term mortality included older age (hazard ratio [HR] 1.05; P = 0.007), chronic obstructive pulmonary disease (COPD) (HR: 2.64; P < 0.001), coronary artery disease (HR: 2.08; P = 0.018), lower serum albumin (HR: 0.63; P = 0.011), and lower hemoglobin (HR: 0.84; P = 0.023); valve type was not predictive.

Conclusion: In patients with LVSD undergoing TAVR, BEV and SEV provided comparable procedural and long-term outcomes. Although SEV yielded lower postoperative gradients, valve type did not affect survival. Future studies with larger samples and higher use of new-generation devices are warranted to refine valve selection in this high-risk group.

Objective: Advanced age is a well-recognized risk factor for atherosclerotic cardiovascular disease (ASCVD). Given the ongoing debate regarding the initiation of statin therapy in elderly individuals, identifying those with underlying coronary artery disease (CAD) who may benefit from lipid-lowering treatment is essential. This study aimed to identify predictors of CAD in statin-naïve adults aged ≥ 70 years with elevated low-density lipoprotein cholesterol (LDL-C), with particular emphasis on risk assessment, cumulative LDL-C burden, and lipoprotein(a) [Lp(a)] levels.

Method: The analysis included consecutive patients aged ≥ 70 years with LDL-C ≥ 160 mg/dL, available Lp(a) measurements, no prior history of ASCVD or diabetes, who underwent evaluation for CAD by coronary imaging or functional stress testing. Global ASCVD risk was estimated using the Systematic Coronary Risk Estimation 2–Older Persons (SCORE2-OP) and the Spanish Familial Hypercholesterolemia Cohort Study (SAFEHEART) risk scores.

Results: A total of 202 patients were included (mean age 76 years; 68.3% female). CAD was diagnosed in 30.7% of participants. In multivariable analysis, male sex (odds ratio [OR]: 2.109), Lp(a) level (OR: 1.012 per mg/dL), and cumulative LDL-C (OR: 1.155 per g/dL) were independently associated with CAD. The highest CAD prevalence was observed among individuals with cumulative LDL-C ≥ 14 g/dL and Lp(a) ≥ 50 mg/dL. While the SCORE2-OP algorithm failed to predict CAD, the SAFEHEART risk score was significantly associated with CAD.

Conclusion: In statin-naïve elderly individuals with elevated LDL-C levels, male sex, cumulative LDL-C exposure, and high Lp(a) levels were independently associated with CAD. These findings underscore the potential utility of incorporating cumulative LDL-C and Lp(a) into risk stratification for older adults.

Objective: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis; however, early mortality risk stratification remains challenging. The Naples Prognostic Score (NPS), which integrates inflammatory and nutritional markers, has shown promise in cardiovascular disease prognosis. This study investigated the relationship between preprocedural NPS and 30-day mortality in patients undergoing TAVI.

Method: This retrospective, single-center study analyzed 308 patients aged ≥ 65 years who underwent elective transfemoral TAVI between August 2012 and December 2022. NPS was calculated using the neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, serum albumin, and total cholesterol levels. Patients were stratified into low NPS (0-2) and high NPS (3-4) groups. The primary endpoint was 30-day all-cause mortality.

Results: The mean age was 79.81 ± 7.68 years, and 54.9% patients were female. The high NPS group comprised 191 patients (62.0%), while 117 patients (38.0%) were in the low NPS group. Thirty-day mortality was significantly higher in patients with high NPS (16.8% vs. 4.3%, P < 0.001), representing nearly a four-fold increased risk. NPS demonstrated good discriminative ability for mortality prediction (area under the curve: 0.692, 95% confidence interval: 0.611-0.774, P < 0.001), performing comparably to established surgical risk scores. Independent predictors of mortality included age (odds ratio [OR] 1.067, P = 0.039), neutrophil-to-lymphocyte ratio (OR 1.062, P = 0.048), and pulmonary artery pressure (OR 1.039, P = 0.006).

Conclusion: The Naples Prognostic Score is a significant predictor of early mortality following TAVI and offers a simple, readily available tool for preoperative risk stratification. Patients with high NPS may benefit from enhanced perioperative monitoring and targeted interventions.

Objective: A post-authorization safety study with a prospective design focusing on the safety of edoxaban treatment in Türkiye has not yet been conducted. The Evaluation of Treatment Safety in Patients with Atrial Fibrillation on Edoxaban Therapy in Real-Life in TüRkiye (ETAF-TR) study was designed to evaluate the safety and effectiveness of edoxaban treatment in atrial fibrillation (AF). The baseline results of the ETAF-TR study describe the demographic, clinical, and laboratory characteristics of the study population.

Method: The ETAF-TR study (NCT04594915) is a prospective, national, multicenter, observational, post-authorization safety study conducted in 50 outpatient cardiology clinics.

Results: Overall, 1,053 patients with AF treated with edoxaban for stroke prevention were enrolled in the study between August 2020 and May 2022. The mean age of the study population was 70.1 ± 11.3 years, and 59.0% of the patients were female. Mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke/TIA/thromboembolism, Vascular disease, Age 65–74 years, Sex category) and HAS-BLED scores (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history/predisposition, Labile INR, Elderly, Drugs/alcohol) were 3.5 and 1.6, respectively. Of the 1,053 patients, 843 (80.1%) received standard-dose edoxaban and 210 (19.9%) received reduced-dose edoxaban. Of the 1,053 patients, 38 (3.6%) had off-label use of edoxaban therapy. Among the remaining 1,015 patients, 834 (82.2%) received an appropriate dose of edoxaban and 181 (17.8%) received an inappropriate dose of edoxaban according to the Summary of Product Characteristics (SmPC) criteria.

Conclusion: Edoxaban has been used in a wide spectrum of patients with AF in daily routine practice, with good overall adherence to the SmPC. As the largest national pharmacovigilance study to date, the ETAF-TR study will provide detailed insight into the safety of edoxaban treatment.

Objective: Cytisine is a pharmacological agent widely used for smoking cessation, acting as a partial agonist of the α4β2 nicotinic acetylcholine receptor. While varenicline, a drug with a similar mechanism of action, has been associated with electrocardiographic (ECG) alterations, to our knowledge, the effect of cytisine on ECGs has not yet been studied. This study aimed to evaluate the effects of cytisine use on electrocardiographic parameters, particularly QT, QTc, Tp-e, and the Tp-e/QTc ratio.

Method: A retrospective analysis was conducted on 110 patients who completed a 25-day cytisine regimen for smoking cessation. Patients with known cardiovascular disease, clinically significant arrhythmias, use of QT-prolonging medications, electrolyte abnormalities, or incomplete follow-up data were excluded from the analysis. Standard 12-lead ECGs and serum biochemistry were assessed before treatment and at the one-month follow-up. Statistical analyses included paired tests and correlation analysis.

Results: No statistically significant changes were observed in QT, QTc, Tp-e intervals, or the Tp-e/QTc ratio following cytisine treatment (all P > 0.05). A modest increase in potassium and a decrease in calcium levels were noted, though both remained within normal limits. No correlation was found between smoking exposure (pack-years) and baseline Tp-e/QTc.

Conclusion: In healthy smokers, approximately one month of cytisine treatment was not associated with statistically significant changes in QT, QTc, Tp-e, or Tp-e/QTc. These results suggest that there is no detectable short-term effect on ventricular repolarization in this population. However, further prospective, randomized, and long-term studies are warranted to confirm these findings, particularly in patients with pre-existing cardiovascular conditions.

Objective: Left ventricular assist devices (LVADs) significantly improve survival in advanced heart failure; however, infectious complications remain an important clinical challenge, with reported sepsis rates ranging from 20–40% within 1–2 years. Early and accurate identification and localization of infections—particularly at the driveline or pump—are essential for guiding treatment.

Method: We retrospectively evaluated fluorine-18 (F18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans of 15 patients with suspected LVAD infection. We assessed the presence and localization of infection (driveline vs. pump), its extent, and compared PET/CT findings with microbiological culture results.

Results: F18 FDG PET/CT demonstrated 100% sensitivity, 66% specificity, 92% positive predictive value, and 100% negative predictive value. Thirteen of 15 patients (87%) had positive PET/CT findings, with a mean SUVmax of 7.73. Infection was localized to the driveline in 10 patients and to both pump and driveline in 3. PET/CT findings were consistent with culture results, which identified Staphylococcus aureus and Pseudomonas aeruginosa as the predominant pathogens.

Conclusion: F18 FDG PET/CT is a highly sensitive, noninvasive modality for detecting and localizing LVAD infections. It aids clinicians in optimizing management strategies—such as device exchange or targeted antibiotic therapy—and may help avoid unnecessary invasive procedures. In cases of pump infection, this imaging modality supports timely interventions, including consideration for heart transplantation.

Objective: Microvascular angina (MVA), a phenotype of ischemia with non obstructive coronary arteries, produces chest pain despite normal epicardial vessels. Central sensitization (CS) may amplify symptoms, but its magnitude in confirmed MVA is unclear.

Method: We conducted a single center cross sectional study. Adults with MVA undergoing coronary angiography and age- and sex matched healthy volunteers completed the Central Sensitization Inventory (CSI), Hospital Anxiety and Depression Scale (HADS), and chest pain questionnaires. MVA required documented ischemia with ≤ 50% epicardial stenosis. The primary outcome was the difference in mean CSI score; secondary outcomes were the proportion with CSI ≥ 40 and correlations between CSI, angina measures, and HADS subscores.

Results: We enrolled 200 participants; 138 (69%) were male; and the mean age was 61 ± 11 years. Mean CSI-Part A was higher in MVA versus controls (43 ± 15 vs. 19 ± 11; P < 0.001), and clinically significant CS was more prevalent (62% vs. 10%). Within MVA, CSI correlated with chest pain intensity (r = 0.58), weekly episode frequency (r = 0.46), HADS-Anxiety (r = 0.51), and HADS-Depression (r = 0.44) (all P < 0.001). In adjusted models, each 10-point increase in CSI was associated with a 0.47 standard deviation rise in pain score (β = 0.47, 95% confidence interval 0.29–0.64; P < 0.001); the model explained 39% of pain-score variance (R² = 0.39).

Conclusion: Central sensitization is highly prevalent and strongly linked to angina burden in MVA, supporting a heart brain contribution to symptom generation. Interventions that reduce central pain amplification may provide meaningful benefit beyond standard anti ischemic therapy.

Objective: Cardiovascular diseases are a leading health problem in Türkiye and worldwide. Digital platforms now offer ways to gauge public awareness through internet searches. This study explores how cardiovascular search trends align with regional epidemiological data in Türkiye and whether such data can indicate awareness and disease burden. Terms were chosen for clinical relevance and “related queries.” Since Google Trends reports relative interest, this is noted as a limitation.

Method: Google Trends data for five terms (“coronary artery disease,” “heart attack,” “ischemic heart disease,” “stent,” “heart failure”) were collected for Türkiye’s seven regions and 81 provinces between January 2020 and July 2025. Term selection was based on guidelines and related queries; synonyms were not fully reviewed. Data were compared with prevalence, mortality, and disability-adjusted life years (DALYs) from national and global sources. Correlation and regression analyses assessed associations. A prototype Digital Disparity Index (DDI) combined disease burden, search activity, and socioeconomic context.

Results: Search activity correlated with epidemiological indicators, with the strongest associations in the Marmara and Aegean regions (Pearson’s r = 0.68, P < 0.01). Some eastern provinces showed high burden but low search activity. Regression analysis indicated that search interest explained 46% of the variance in prevalence (R² = 0.46, P < 0.01). The DDI highlighted Eastern and Southeastern Anatolia as high-disparity areas.

Conclusion: Internet search data reflect awareness and cardiovascular burden in Türkiye and may support public health planning. The DDI helps identify areas where burden is high but awareness is low. Broader term inclusion, multilingual coverage, and validation with clinical outcomes are needed in future research.

Objective: The aim of this study was to investigate longitudinal changes in biventricular diastolic function and myocardial deformation during pregnancy and the early postpartum period using tissue Doppler imaging (TDI), speckle-tracking echocardiography (STE), and rotational mechanics.

Method: In this prospective observational study, 65 healthy, normotensive women with singleton pregnancies underwent echocardiography at four standardized time points: first trimester (10–12 weeks), second trimester (20–24 weeks), third trimester (36–38 weeks), and early postpartum (6–12 weeks post-delivery). Comprehensive evaluation included conventional Doppler, TDI-derived parameters, longitudinal strain rates, atrial strain, and left ventricular (LV) twist mechanics.

Results: Pregnancy was characterized by a progressive rise in cardiac output and ventricular volumes, with parallel declines in diastolic indices and atrial function. Although LV ejection fraction remained preserved, early diastolic strain rate decreased by 19% (1.59→1.29 s–¹, P < 0.001), lateral Em velocity declined by 20%, and global LV twist was reduced by 20% (17.8°→14.2°, P = 0.002). The mitral E/A ratio progressively decreased, while deceleration time remained prolonged postpartum (203→243 ms, P < 0.001). Atrial strain analysis revealed chamber-specific remodeling: left atrial conduit strain showed near recovery, whereas right atrial parameters showed only partial normalization. Collectively, these findings indicate that diastolic and torsional mechanics did not fully normalize within 6–12 weeks, suggesting heterogeneous recovery trajectories even among healthy pregnancies.

Conclusion: In healthy women, pregnancy-induced myocardial adaptation appears to involve progressive diastolic and deformation changes that may persist into the early postpartum phase. The observation of residual subclinical alterations—despite otherwise physiological remodeling—suggests that longitudinal surveillance could be valuable, even in low-risk populations. Advanced echocardiographic modalities may improve early detection and contribute to refined risk stratification in pregnancy-related cardiac adaptation.

Objective: This study aimed to compare the association of the MAPH score (Mean platelet volume–Age–Persistent atrial fibrillation–Hematocrit) and the CHA₂DS₂-VASc score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke/transient ischemic attack (2 points), Vascular disease, Age 65–74 years, and Sex category (female)) with the presence of left atrial thrombus in patients undergoing atrial fibrillation ablation.
Method: This retrospective cross-sectional study included 258 consecutive patients with atrial fibrillation (AF) who underwent transesophageal echocardiography to assess thrombus status prior to ablation. Based on these findings, patients were categorized according to the presence or absence of left atrial (LA) thrombus.
Results: The mean age of the study population was 55.2 ± 11.7 years, and 53.5% of the participants were female. Patients with LA thrombus were more likely to have ongoing AF during TEE, mild mitral stenosis, elevated C-reactive protein (CRP) and international normalized ratio (INR) levels, and reduced ejection fraction. The median MAPH score was significantly higher in the thrombus group (p < 0.001). In multivariable analysis, ongoing AF (odds ratio [OR]: 3.83), anticoagulant therapy (OR: 14.95), elevated albumin (OR: 1328.5), elevated CRP (OR: 1.38), and elevated INR (OR: 9.09) were independently associated with thrombus presence. The MAPH score demonstrated superior discriminative performance compared to the CHA₂DS₂-VASc score for identifying LA thrombus (p = 0.014).
Conclusion: The MAPH score was significantly associated with LA thrombus and demonstrated superior discriminative ability compared to the CHA₂DS₂-VASc score for detecting LA thrombus. These findings suggest that the MAPH score may serve as a useful marker for identifying existing LA thrombus in patients with AF undergoing pre-procedural evaluation.

Adjunctive vein of Marshall ethanol infusion (EIVOM) during atrial fibrillation (AF) ablation has emerged as a promising technique with the potential to significantly improve procedural outcomes. Despite the existing body of evidence, a comprehensive evaluation focusing on mitral isthmus block, AF recurrence, and procedural duration has not yet been conducted. This meta-analysis aims to rigorously assess the benefits of EIVOM combined with radiofrequency ablation (EIVOM-RF) compared with radiofrequency ablation alone (RF-only) in patients undergoing catheter ablation for AF or related arrhythmias. We systematically reviewed both randomized controlled trials and observational studies that compared EIVOM-RF with RF-only approaches, encompassing a total of 1,406 patients in the EIVOM-RF group and 1,849 in the RF-only group. The primary outcomes assessed included the rate of successful mitral isthmus ablation, recurrence of atrial arrhythmias, and overall procedure time. Patients treated with EIVOM-RF demonstrated a significantly lower likelihood of atrial arrhythmia recurrence compared to those receiving RF-only treatment. Furthermore, EIVOM-RF was associated with an impressive increase in the success rate of achieving mitral isthmus block. While total procedure time tended to be longer with EIVOM-RF, this difference was statistically significant and showed considerable variability. These findings compellingly indicate that EIVOM enhances procedural efficacy, albeit at the cost of increased procedural duration. In conclusion, EIVOM combined with RF ablation represents a transformative approach that markedly improves procedural success rates and significantly reduces arrhythmia recurrence in patients undergoing ablation for AF.

Survivors of sudden cardiac death (SCD) should be thoroughly evaluated for primary electrical heart diseases, including early repolarization syndrome (ERS). In some patients, early repolarization patterns may be masked by depolarization abnormalities or may appear intermittently, making diagnosis difficult. In addition to implantable cardioverter-defibrillator (ICD) implantation for secondary prevention, pharmacological agents such as quinidine and phosphodiesterase III inhibitors (e.g., cilostazol) are recommended to prevent or reduce recurrent ventricular fibrillation (VF) episodes. We present the case of a young female SCD survivor with documented VF and ICD implantation, who was admitted after Home Monitoring detected multiple short-coupled premature ventricular contraction-induced (PVC-induced) VF episodes. She was successfully treated with cilostazol.

Left atrial appendage aneurysm (LAAA) is a rare cardiovascular anomaly, with fewer than 200 documented cases. It is often associated with severe complications, such as arrhythmias and thromboembolic events. Recent evidence suggests that viral infections, particularly viral myocarditis, might be an underlying cause of LAAA. We report the case of a 36-year-old woman with a history of asthma who presented with palpitations and atrial tachyarrhythmia two months after a severe upper respiratory infection. Transthoracic echocardiography revealed a large aneurysmal left atrial appendage (LAA) measuring 5.6 × 3.5 cm and a reduced left ventricular ejection fraction of 50%. Cardiac computed tomography confirmed the LAAA and revealed abnormal flow dynamics. Late gadolinium enhancement showed mid-subepicardial hyperenhancement in the posterolateral segments of the left ventricular wall, consistent with a previous myocarditis. The patient underwent a novel, minimally invasive endoscopic thoracoscopic resection of the aneurysm, guided by transesophageal echocardiography. No thrombus was present. The procedure was successfully completed with the aid of cardiopulmonary bypass. This case highlights a potential association between viral myocarditis and LAAA, while also acknowledging the possibility of a congenital and incidentally discovered aneurysm. It underscores the critical role of multimodal imaging in accurate diagnosis and management. The successful minimally invasive surgical resection and subsequent restoration of cardiac function demonstrate the effectiveness of this approach, offering a promising outlook for patients with LAAA. Clinicians should consider viral infections as potential contributors to LAAA development and advocate for early diagnosis and intervention to improve clinical outcomes.