The Turkish Hypertension Consensus Report (THCR) was first published in 2015 and subsequently updated in 2019 to provide practical guidance for clinicians involved in the diagnosis and management of hypertension in outpatient clinical settings. The report was prepared as a joint initiative of the Turkish Society of Cardiology, the Turkish Society of Internal Medicine, the Turkish Society of Endocrinology and Metabolism, the Turkish Society of Nephrology, and the Turkish Society of Hypertension and Renal Diseases. In recent years, substantial changes have occurred in the definition and staging of hypertension, and various professional organizations have proposed different blood pressure thresholds and cardiovascular risk scoring systems in their guidelines. These developments necessitated a further update of the consensus report. In addition to the original five societies, the Turkish Academic Geriatrics Society and the Turkish Association of Family Physicians contributed to the preparation of the 2025 update of the THCR. In the updated 2025 report, “normal blood pressure” was defined as systolic blood pressure (SBP) <120 mmHg and diastolic blood pressure (DBP) <80 mmHg, based on measurements obtained in outpatient clinical settings. SBP values of 120–139 mmHg or DBP values of 80–89 mmHg were classified as “elevated blood pressure,” whereas SBP ≥140 mmHg or DBP ≥90 mmHg was defined as “hypertension.” Hypertension was categorized as Stage 1 (SBP 140–159 mmHg or DBP 90–99 mmHg) and Stage 2 (SBP ≥160 mmHg or DBP ≥100 mmHg). In addition to office blood pressure measurements, the use of home and ambulatory blood pressure monitoring in the diagnosis of hypertension was emphasized. Laboratory investigations were updated and categorized into baseline tests and additional tests aimed at detecting target organ damage in hypertensive patients, and the diagnostic criteria for secondary hypertension were revised. Age- and frailty-based treatment thresholds and blood pressure targets were defined independently of comorbidities for three subgroups: patients aged 18–79 years (treatment threshold ≥140/90 mmHg; target 120–130/70–80 mmHg), patients aged ≥80 years (threshold ≥140 mmHg; target 130–140 mmHg), and frail patients (threshold ≥160 mmHg; target 140–150 mmHg). Immediate initiation of combination antihypertensive therapy was recommended for all patients with SBP/DBP ≥140/90 mmHg (Stage 1 and Stage 2 hypertension). In the elevated blood pressure treatment subgroup (SBP 130–139 mmHg, DBP 80–89 mmHg), antihypertensive therapy was recommended if blood pressure remained uncontrolled despite three months of lifestyle modification in the presence of diabetes mellitus (age > 40 years, diabetes duration >10 years, diabetes-related complications, or additional risk factors such as obesity or active smoking), chronic kidney disease (albuminuria >30 mg/day or spot urine albumin-to-creatinine ratio > 30 mg/g), established cardiovascular disease (coronary artery disease, peripheral artery disease, heart failure), stroke, or increased cardiovascular risk as assessed by SCORE2 (>15%) or SCORE2-OP (>20%). A stepwise combination treatment algorithm was provided based on angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide or thiazide-like diuretics, and mineralocorticoid receptor antagonists (MRAs). The algorithm includes initiation with low- or full-dose dual therapy (“ACEI or ARB + CCB” or “ACEI or ARB + diuretic”) as the first step; escalation to full-dose dual therapy (for those started on low doses) or to low- or full-dose triple therapy (ACEI or ARB + CCB + diuretic) as the second step; escalation to full-dose triple therapy as the third step; and use of quadruple therapy (ACEI or ARB + CCB + diuretic + MRA) as the fourth step. Monotherapy was recommended primarily in selected clinical situations, including patients aged >80 years, frail patients, those with elevated blood pressure, and patients with orthostatic hypotension. Overall, seven new sections were added to the 2025 report: frailty assessment in hypertension, resistant hypertension, isolated systolic hypertension, isolated diastolic hypertension, orthostatic hypotension, hypertensive emergencies, and recommendations addition, four supplementary files were provided, addressing key considerations for patients and physicians during manual aneroid and ambulatory blood pressure measurements, medications and substances that may increase blood pressure, definitions of frailty and fitness and their implications for antihypertensive therapy, and non-cardiovascular drugs that may lower blood pressure below target levels during antihypertensive treatment. Although the evidence-based recommendations presented in this report are applicable to most hypertensive outpatients, clinical decision-making by the treating physician remains essential for the delivery of individualized, patient-centered care.

Objective: ST-elevation myocardial infarction (STEMI) is one of the leading causes of mortality worldwide. Current guidelines recommend primary percutaneous coronary intervention (PPCI) using drug-eluting stents as the standard management for these patients. Stent-free percutaneous coronary intervention (PCI) using drug-coated balloons (DCB) has been suggested as a novel approach to avoid stent-related complications. This study aimed to assess the efficacy and safety of using DCB in STEMI patients.

Method: We compared STEMI patients who presented during the period between 2019 and 2023 and underwent primary PCI using DCB to those treated with drug-eluting stents (DES) in terms of in-hospital and six-month major adverse cardiac events (MACE).

Results: A total of 128 STEMI patients who underwent primary PCI using DCB were compared to 128 matched patients managed using DES. Small-vessel culprit lesions (< 3 mm) and distal lesions were significantly more frequent in the DCB group compared to the DES group. DCBs were used in major epicardial vessels in around 55% of patients and in side branches in almost 45% of cases. Regarding MACE, either in-hospital or within six months, there was no significant difference between the two groups. Moreover, at six-month follow-up, MACE, reinfarction, and repeat revascularization were numerically lower but statistically non-significant in the DCB group. Subgroup analysis showed that in-hospital MACE and reinfarction rates were statistically significantly higher when DCBs were applied to large vessels (> 3 mm) and in cases of in-stent thrombosis (P = 0.014 and 0.001, respectively).

Conclusion: Drug-coated balloons appear non-inferior to DES during primary PCI in terms of MACE, including mortality and reinfarction, even in major epicardial coronaries. However, it should be used cautiously in certain lesion subsets, especially large vessels (> 3 mm) and in-stent thrombosis.

Objective: The no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is a significant clinical issue associated with poor cardiovascular outcomes. This study aimed to develop and compare multiple supervised machine learning algorithms, including the recently introduced Kolmogorov–Arnold Network (KAN), to predict the occurrence of the no-reflow phenomenon in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Method: This prospective, single-center study included 890 consecutive STEMI patients undergoing primary PCI. The Synthetic Minority Over-sampling Technique (SMOTE) was utilized to address class imbalance during training. Feature selection using analysis of variance (ANOVA) F-statistics and validation of feature independence (Variance Inflation Factor [VIF] < 5) identified ejection fraction (EF), baseline troponin level, stent length, B-type natriuretic peptide (BNP) level, and total ischemic time as the most influential predictors.

Results: The KAN and Extreme Gradient Boosting (XGBoost) models achieved the highest predictive accuracy (area under the curve > 0.98, F1 > 0.95), outperforming traditional models such as logistic regression and decision tree classifiers (DeLong test, P < 0.001). Feature selection improved efficiency and reduced runtime by 20–40%, while Shapley Additive exPlanations-based (SHAP-based) explainability confirmed that the predictions were physiologically consistent: higher EF and lower BNP reduced the probability of no-reflow, whereas longer stent length and ischemic time increased it. The superior performance of KAN and XGBoost underscores the importance of modeling nonlinear relationships and multidimensional interactions among clinical, laboratory, and procedural variables.

Conclusion: These findings suggest that KAN may serve as a reliable analytical framework for exploring complex cardiovascular outcomes. However, further multicenter and externally validated studies are needed to confirm its generalizability and potential role in clinical risk assessment.

Objective: This study aimed to determine whether the atherogenic index of plasma (AIP) can predict critical multivessel coronary artery disease (MVD) in patients presenting with non–ST-segment elevation myocardial infarction (NSTEMI).

Method: In this retrospective analysis, patients diagnosed with NSTEMI who underwent coronary angiography between January and December 2024 were evaluated. Based on angiographic findings, patients were classified according to the number of major epicardial vessels with significant stenosis, and MVD was defined as critical involvement of all three major vessels. The AIP was calculated as log (triglyceride/high-density lipoprotein [HDL]-cholesterol). Multivariable logistic regression analysis was used to identify independent predictors of MVD, and receiver operating characteristic (ROC) curve analysis was performed to assess diagnostic accuracy.

Results: Of the 1,216 patients included in the study, 302 (24.8%) had MVD. Those with critical MVD had significantly higher AIP values than those without MVD (0.74 ± 0.28 vs. 0.59 ± 0.26, P < 0.001). In multivariable analysis, AIP remained an independent determinant of MVD (odds ratio: 3.132, 95% confidence interval: 1.626–6.030, P = 0.001). Diabetes mellitus, higher hemoglobin A1c (HbA1c), and elevated low-density lipoprotein (LDL)-cholesterol levels were also independently associated with MVD. AIP demonstrated moderate discriminative ability for predicting MVD, with an area under the curve (AUC) of 0.689 and sensitivity and specificity of 65.6%.

Conclusion: AIP was independently associated with the presence of critical MVD in patients with NSTEMI. Given its simplicity, affordability, and accessibility, AIP may serve as a practical indicator of atherogenic burden and help identify patients who are more likely to have multivessel coronary involvement.

Objective: Soluble stromelysin-2 (sST2) and galectin-3 have been found to be associated with prognosis in patients with heart failure (HF). However, there is no study evaluating the clinical importance of sST2 and galectin-3 in HF classification according to ejection fraction (EF). In the present study, we aimed to assess the diagnostic value of sST2 and galectin-3 in HF classification based on EF.

Method: Forty-one heart failure patients with reduced ejection fraction (HFrEF), 41 with mildly-reduced EF (HFmrEF), 41 with preserved EF (HFpEF), and 41 healthy controls were included in the study. EF ≤ 40% was defined as HFrEF, 41-49% as HFmrEF, and ≥ 50% as HFpEF. Levels of sST2 and galectin-3 were measured, and comparisons were performed.

Results: There were significant differences among the groups in terms of sST2 (P < 0.001) and galectin-3 (P = 0.007) levels. Post hoc analysis demonstrated that patients with HFmrEF and HFrEF had significantly higher sST2 (P = 0.001 and P = 0.001, respectively) and galectin-3 (P = 0.043 and P = 0.007, respectively) levels compared to the control group, whereas the HFpEF and control groups were similar in terms of sST2 and galectin-3 levels (P = 0.645 and P = 0.436, respectively). In correlation analysis, sST2 and galectin-3 levels were positively correlated with B-type natriuretic peptide (BNP) (r = 0.240, P = 0.002 and r = 0.172, P = 0.028, respectively) and negatively correlated with EF (r = -0.403, P < 0.001 and r = -0.295, P < 0.001, respectively).

Conclusion: sST2 and galectin-3 levels were higher in patients with HFrEF and HFmrEF compared to the control group, and these markers increased as EF decreased. However, these markers did not differ between patients with HFpEF and the control group.

Objective: The objective of this study is to investigate the prognostic significance of QTc dispersion (QTcd) in patients with acute methadone poisoning and its association with critical clinical outcomes, including mortality, Intensive Care Unit (ICU) admission, intubation, and hospital stay duration.

Method: A retrospective cross-sectional analysis was performed using medical records from 311 individuals who presented with acute methadone toxicity to the Emergency Department of Loghman-Hakim Hospital Poison Center, Tehran, Iran between March 20, 2023 and June 1, 2023. Eligibility was based on a confirmed record of methadone ingestion supported by a positive urine drug screen. To calculate QTcd, the longest and shortest corrected QT (QTc) intervals recorded across the 12-lead electrocardiogram (ECG) were identified, and their difference was taken. The final study population included 100 patients, categorized into prolonged QTcd (QTcd > 60 ms, n = 50) and non-prolonged QTcd (QTcd ≤ 60 ms, n = 50) groups.

Results: This retrospective study included 100 consecutive patients with acute methadone poisoning. The mean QTcd was 64.26 ± 24.55 ms, significantly higher than in the normal population (P < 0.001). Comparison of the two groups revealed no meaningful variation in demographic factors, methadone intake, or time elapsed before Emergency Department (ED) admission (all P > 0.05). Pulse rate was notably higher among individuals with prolonged QTcd (P = 0.03), but there were no significant differences in other vital signs. Hospital stay duration, ICU admission (n = 8), need for intubation (n = 6), and mortality (n = 4) were comparable across both groups.

Conclusion: This study indicates that QTcd did not predict major clinical outcomes such as mortality, ICU admission, or intubation.

Objective: With the growing elderly population worldwide, the number of annual surgical procedures has risen substantially, leading to an increase in the demand for preoperative cardiology consultations. In parallel, recent years have witnessed remarkable innovations in cardiology driven by advances in artificial intelligence (AI) and machine learning (ML). In this study, we aimed to evaluate the performance of three widely used AI models: ChatGPT-5, Deepseek-V3, and Gemini 2.0 Pro, in assessing the necessity of cardiology consultation in preoperative patients and to explore the potential contribution of guideline-augmented prompting in this context.

Method: A council consisting of seven cardiologists and seven anesthesiologists was formed. Each physician evaluated 20 preoperative patient scenarios and provided recommendations on whether a separate cardiology consultation was necessary. For each case, the majority decision of the council was accepted as the reference standard. The same scenarios were presented to the three AI models, and their responses were recorded. Subsequently, the AI models with the highest concordance were integrated into the decision framework using guideline-augmented prompting, and the cases were re-evaluated.

Results: Although there was no statistically significant difference, ChatGPT-5 and Gemini 2.0 Pro showed higher concordance than Deepseek-V3 in preoperative consultation decisions (κ = 0.706 and κ = 0.681, respectively; 85% accuracy). Following the integration of guidelines into ChatGPT-5 and Gemini 2.0 Pro, the models were re-evaluated and demonstrated improved performance (κ =0.898, 95% accuracy).

Conclusion: ChatGPT-5, Deepseek-V3, and Gemini 2.0 Pro demonstrated effectiveness in assessing the necessity of cardiology consultation in preoperatively evaluated patients. Moreover, the integration of guideline-augmented prompting was shown to improve the accuracy and reliability of AI model performance.

Transcatheter aortic valve implantation (TAVI) has proven to be a safe and effective treatment, particularly in patients with aortic stenosis and moderate to high surgical risk scores. One potential complication after TAVI is bradyarrhythmia due to high-grade atrioventricular block, which may necessitate permanent pacemaker (PM) implantation. We present a case of a patient with symptomatic intermittent pauses and severe aortic stenosis who underwent permanent PM implantation via the coronary sinus prior to TAVI, due to a history of mechanical tricuspid and mitral valve replacements. The subsequent TAVI procedure was successful, and the patient remained stable without periprocedural complications.

Noonan syndrome is a genetic disorder that can present with a wide range of clinical manifestations, making diagnosis challenging. This article presents the case of a 29-year-old male who presented with chest pain and ST-segment elevation, initially raising suspicion for acute coronary syndrome. However, coronary angiography revealed only ectasia of the coronary arteries, with no other pathological findings. A detailed physical examination and echocardiography revealed a pulmonary murmur, pectus excavatum, and café-au-lait spots. Additionally, both echocardiography and cardiac magnetic resonance imaging (MRI) showed localized left ventricular hypertrophy. Genetic testing identified a heterozygous missense variant in the PTPN11 gene, leading to the diagnosis of Noonan syndrome. This case highlights the importance of thorough physical examination and multimodal imaging in the diagnosis of Noonan syndrome.