Artificial intelligence (AI)-enabled echocardiography has demonstrated strong agreement with expert measurements across a broad range of cardiac functional parameters. However, the transition from technical validation to clinical impact remains incomplete. This structured narrative review employed a systematic literature search to identify the principal structural barriers to AI integration in echocardiography and to develop an expert-informed, evidence-grounded perspective on the priorities for responsible implementation by 2030. The methodological heterogeneity of the included studies, including retrospective and prospective designs, diverse outcome measures ranging from measurement agreement to workflow implementation, and multiple AI application domains, precluded quantitative pooling. Therefore, qualitative synthesis was selected as the primary prespecified analytical approach. PubMed/MEDLINE was searched for studies published between January 2015 and January 2026 addressing clinical AI applications, real-world validation, implementation science, and governance. Forty-six studies meeting predefined inclusion criteria underwent qualitative synthesis. Five interdependent domains were identified: reproducibility across clinical settings, generalizability beyond development datasets, the lack of outcome-focused evidence, regulatory and governance immaturity, and insufficient trust among clinicians and patients. Automated measurements of left ventricular function, strain, and valvular disease severity demonstrate close agreement with expert assessments. However, few studies have shown that AI-assisted echocardiography translates into improved patient outcomes. Based on the available evidence, the principal translational barrier appears to be not algorithmic capability itself, but rather the structural requirements necessary for accountable clinical integration. An expert-informed, evidence-grounded roadmap emphasizing decision-level reproducibility, rigorous external validation, outcome-linked evidence generation, continuous lifecycle governance, and human-centered design is proposed to guide the integration of AI into echocardiography and to support the development of a more durable and accountable clinical infrastructure by 2030.

Objective: Myocardial contraction fraction (MCF) is a volumetric index of myocardial shortening that relates left ventricular stroke volume to myocardial volume. In patients with severe aortic stenosis (AS), left ventricular ejection fraction (LVEF) may remain preserved despite advanced myocardial remodeling. This study aimed to evaluate the prognostic value of MCF for predicting 1-year cardiac death in patients undergoing transcatheter aortic valve implantation (TAVI).

Method: This retrospective, single-center study included 419 consecutive patients with severe AS who underwent TAVI at a tertiary center. MCF was calculated by dividing stroke volume by left ventricular myocardial volume and multiplying the result by 100. Left ventricular myocardial volume was derived by dividing left ventricular myocardial mass by the myocardial density, which was assumed to be 1.05 g/mL. The primary endpoint was 1-year cardiac death. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal MCF cutoff value, and the patients were divided into low- and high-MCF groups according to this threshold.

Results: The ROC-derived MCF cutoff value for predicting 1-year cardiac death was 24%, with an area under the curve of 0.783 (95% CI, 0.716–0.851), a sensitivity of 78.1%, and a specificity of 71.8%. Patients with MCF≤24% had lower LVEF and stroke volume index values, higher myocardial mass index and pulmonary artery pressure values, and larger left ventricular diameters than those with MCF>24%. One-year cardiac death occurred in 32 patients (7.6%) and was significantly more frequent in the MCF≤24% group than in the MCF>24% group (18.7% vs. 2.5%; P < 0.001). In univariable Cox regression analysis, MCF≤24% was strongly associated with 1-year cardiac death. In multivariable analysis, higher MCF, evaluated as a continuous variable, remained independently associated with a lower risk of 1-year cardiac death.

Conclusion: Reduced MCF was associated with adverse left ventricular remodeling and increased
1-year cardiac death after TAVI. MCF may provide additional prognostic information beyond conventional echocardiographic parameters in patients with severe AS undergoing TAVI.

Objective: Mitral balloon valvuloplasty remains an established first-line treatment for appropriately selected patients with rheumatic mitral stenosis. However, predictors of long-term restenosis and the additional value of periinterventional transesophageal echocardiography remain incompletely defined.

Method: This retrospective, single-center study included 555 patients who underwent percutaneous mitral balloon valvuloplasty for rheumatic mitral stenosis between January 2010 and January 2025 at Mehmet Akif Ersoy Heart Center, İstanbul, Türkiye. Patients were divided according to the presence or absence of restenosis at the 1-year follow-up. Restenosis was defined as a mitral valve area <1.5 cm². Procedural success was defined as less than moderate mitral regurgitation at the end of the procedure and the absence of transseptal puncture-related complications. Clinical, echocardiographic, procedural, and laboratory variables were analyzed to identify predictors of restenosis and procedural success.

Results: Restenosis occurred in 94 patients (17%). The mean age of the overall cohort was 47.81±12.29 years, and 467 patients (84.1%) were female. Patients with restenosis had higher preprocedural systolic pulmonary artery pressure, postprocedural transmitral gradient, postprocedural systolic pulmonary artery pressure, and preprocedural Wilkins score. In multivariable analysis, only the preprocedural Wilkins score remained an independent predictor of restenosis (OR: 1.907, 95% CI: 1.339–2.718, P < 0.001). Post-balloon transmitral gradient and postprocedural left atrial pressure ≥12 mmHg were associated with procedural success. Periinterventional transesophageal echocardiography was not associated with restenosis or procedural success.

Conclusion: In patients undergoing percutaneous mitral balloon valvuloplasty for rheumatic mitral stenosis, the preprocedural Wilkins score was the only independent predictor of 1-year restenosis. Routine periinterventional transesophageal echocardiography did not significantly influence procedural success or long-term restenosis rates. These findings suggest that, in appropriately selected patients, percutaneous mitral balloon valvuloplasty can be safely and effectively performed under transthoracic echocardiographic guidance without routine periinterventional transesophageal echocardiography.

Objective: Left atrial appendage occlusion (LAAO) is widely used for stroke prevention in patients with atrial fibrillation who are unsuitable for long-term anticoagulation. However, whether clinical outcomes differ according to indication phenotype (bleeding-dominant versus ischemic-dominant) remains unclear. This study aimed to evaluate the association between indication phenotype and clinical outcomes following LAAO and to determine whether phenotype provides incremental prognostic value beyond traditional risk factors.

Method: In this retrospective single-center study, patients undergoing LAAO were classified as having either a bleeding-dominant or ischemic-dominant indication phenotype. The primary outcome was all-cause mortality. The secondary outcome was a net clinical benefit composite consisting of death, recurrent stroke, or major bleeding. Associations were assessed using Kaplan–Meier and Cox analyses, and the proportional hazards assumption was tested using Schoenfeld residuals. Sensitivity analyses were performed after excluding major bleeding from the composite outcome.

Results: A total of 109 consecutive patients were included. During a median follow-up of approximately 10 months, all-cause mortality occurred in 25.7% of patients, while the net clinical benefit composite occurred in 29.4%. No statistically significant association was observed between indication phenotype and mortality (adjusted hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.38–2.62) or the composite outcome (adjusted HR 0.73, 95% CI 0.30–1.78). However, the wide confidence intervals reflect the limited sample size and event burden.

Conclusion: Among patients undergoing LAAO, no statistically significant differences in short-term clinical outcomes were observed according to indication phenotype. Age emerged as the most consistent determinant of risk. Given the modest sample size, limited number of events, and relatively short follow-up duration, these findings should be interpreted cautiously and considered hypothesis-generating.

Objective: Current clinical guidelines for non-ST-segment elevation myocardial infarction (NSTEMI) emphasize the duration of dual antiplatelet therapy (DAPT) based on scores such as the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score and the Dual Antiplatelet Therapy (DAPT) score. However, these anatomical and clinical models often overlook the "inflammatory gap,” namely the contribution of systemic inflammation to both thrombotic and hemorrhagic risk. Although traditional models focus primarily on anatomical complexity, systemic inflammation may serve as a silent driver of adverse outcomes. We aimed to evaluate, using an artificial intelligence (AI)-enhanced approach, the incremental prognostic value of the inflammation-based Modified Glasgow Prognostic Score (mGPS) over a 36-month follow-up period, with particular emphasis on capturing non-linear interactions between biological markers and long-term outcomes.

Method: This study included 456 NSTEMI patients who underwent percutaneous coronary intervention (PCI). mGPS, DAPT, and PRECISE-DAPT scores were calculated for all patients. Prognostic performance was assessed using a Gradient Boosting Machine (GBM)-based machine learning (ML) framework. Analyses focused on improvements in the concordance index (C-index), Net Reclassification Index (NRI), and Integrated Discrimination Improvement (IDI), as well as three-year mortality assessed using Cox proportional hazards modeling to identify residual inflammatory risk. Model calibration was evaluated using the Brier score.

Results: At 36 months, mGPS emerged as the strongest independent predictor of mortality. Compared with patients with mGPS 0, those with mGPS 2 demonstrated a 6.18-fold higher risk of mortality (hazard ratio 6.18; 95% confidence interval 2.95–12.94; P < 0.001). Observed mortality rates increased markedly from 3.2% in the mGPS 0 group to 57.1% in the mGPS 2 group (P < 0.001). While mGPS was not significantly associated with the ischemic DAPT score (P = 0.349), it was strongly associated with high bleeding risk (PRECISE-DAPT ≥ 25), with all patients in the mGPS 2 category classified as high bleeding risk (P < 0.001). Incorporation of mGPS into the baseline AI model significantly improved discriminative performance, increasing the C-index from 0.72 to 0.81 (P = 0.008). Additionally, the model correctly reclassified 46% of patients (NRI 0.46, P < 0.001) and demonstrated significant predictive improvement (IDI 0.08, P = 0.004) compared with traditional scoring systems.

Conclusion: Systemic inflammation, as quantified by mGPS, is a critical biological modifier of cardiovascular risk that may help bridge the "inflammatory gap" in current scoring systems. AI-driven integration of mGPS into conventional clinical scores significantly improves 36-month prognostic reclassification. mGPS appears to function as a biological recalibrator, identifying high-risk individuals who may be misclassified by conventional scoring systems. These findings suggest that mGPS-guided personalized antiplatelet strategies—particularly early DAPT de-escalation in patients with elevated mGPS—may help reduce the high mortality and bleeding risk observed in this vulnerable population by addressing biological fragility in addition to anatomical risk.

Objective: To evaluate the clinical use of instant-messaging e-consultation among cardiologists in Türkiye, self-reported treatment delays attributed to the perceived quality of transmitted data, and variations in medicolegal concern according to professional seniority.

Method: A total of 253 cardiologists completed a cross-sectional online survey covering consultation patterns, acute myocardial infarction (AMI)-related support, types of shared data, data quality-related treatment delays, regulatory awareness, and the 15-item Medicolegal Implications of Digital Consultation in Cardiology Scale (MIDCCS). The primary analysis compared MIDCCS domain scores across seniority groups using the Kruskal–Wallis H test with Holm–Bonferroni correction; a single-item ordinal regression analysis of global concern was exploratory.

Results: Among current users, 86.9% (213/245) reported at least one AMI-related informal support activity: preliminary assessment, 71.5%; triage, 60.1%; catheterization laboratory activation support, 36.4%; and early management, 42.7%. The most frequently shared data type was the ECG (95.2%). A self-reported treatment delay attributed to perceived poor data quality was reported by 23.7% (58/245), most commonly involving ECG photographs. Medicolegal concern differed markedly across seniority groups after correction (P<.001 in every domain), with specialists and faculty members scoring higher than residents. In an exploratory ordinal model, a history of treatment delay was directionally but nonsignificantly associated with greater concern (common OR=1.711; 95% CI, 0.994–2.946). The MIDCCS demonstrated good internal consistency (Cronbach α=0.86).

Conclusion: Although e-consultation was widespread and clinically functional, data quality failures and seniority-related medicolegal concerns indicate important limitations. The findings highlight the need for a secure national e-consultation infrastructure integrated into Hospital Information Management Systems that is KVKK-compliant and end-to-end encrypted, while remaining as fast and user-friendly as WhatsApp.

Objective: Atrial fibrillation (AF) increases thromboembolic risk, and oral anticoagulants (OACs) substantially reduce this risk; however, their safe and effective use requires adequate patient knowledge. We aimed to assess AF- and OAC-related awareness among Turkish patients and to identify predictors of knowledge.

Method: This single-center, cross-sectional survey was conducted between July 1, 2024 and January 1, 2025, and included consecutive adults with non-valvular AF receiving warfarin or direct OACs for at least three months. A structured questionnaire collected data on demographic characteristics, comorbidities, medication use, adherence, and knowledge across six domains: dosing frequency, treatment indication, side-effect awareness, treatment-duration awareness, drug-interaction awareness, and food-interaction awareness. A composite knowledge score (range, 0–6) was calculated. Multivariable linear regression was used to evaluate predictors of knowledge, including age, sex, and education level. Ethics approval was obtained, and all participants provided written informed consent.

Results: A total of 261 patients were included (median age, 67 years; 50.2% women). Hypertension and diabetes mellitus were present in 64.8% and 32.2% of patients, respectively. Direct oral anticoagulants (DOACs) accounted for 72.4% of prescriptions, whereas 27.6% of patients received warfarin. Although 36% of participants had AF for more than six years, only 16.5% could correctly name their arrhythmia. While 92% knew they were taking an anticoagulant, only 75.1% correctly identified the indication for anticoagulation. Knowledge of side effects was limited, with 68% reporting no awareness. Awareness of interactions was poor: 88% reported no knowledge of drug–drug interactions, and 71% were unaware of food interactions. Most patients knew their dosing schedule (92.3%) and reported that they would not double a missed dose (99.6%). Self-reported adherence was high (94% “always” and 4% “often”), and taking medication with meals was associated with better adherence (χ² = 17.0, P < 0.001). The mean knowledge score was 2.8 ± 1.3 (Cronbach’s α = 0.50). Higher educational attainment and female sex were associated with greater knowledge, whereas age was inversely associated with knowledge.

Conclusion: Despite high self-reported adherence, substantial knowledge gaps persist among patients receiving anticoagulation for AF, particularly regarding side effects and drug or food interactions. Targeted, health-literacy-sensitive educational strategies may improve medication safety and clinical outcomes in patients receiving anticoagulation for AF.

Spontaneous coronary artery dissection (SCAD) is a rare but potentially fatal cause of acute coronary syndrome (ACS), often associated with younger individuals and women without traditional cardiovascular risk factors. Carbon monoxide (CO) poisoning, a known cause of systemic hypoxia, has been implicated in various cardiovascular complications; however, its role in triggering SCAD remains scarcely reported. We present the case of a 55-year-old woman who developed SCAD following acute CO poisoning caused by a domestic gas leak. The patient presented with altered mental status and respiratory failure, requiring hyperbaric oxygen therapy. Following stabilization, typical anginal symptoms emerged, accompanied by rising cardiac biomarkers suggestive of myocardial injury. Coronary angiography revealed spontaneous dissections in both the distal left anterior descending artery and the distal right coronary artery without critical flow limitation. The patient was managed conservatively with medical therapy and remained asymptomatic at six-month follow-up. This case highlights the importance of considering SCAD in patients presenting with cardiac symptoms following CO poisoning and underscores the need for vigilance in atypical presentations of myocardial injury.

Takotsubo syndrome is a cardiomyopathy characterized by transient ventricular dysfunction caused by excessive sympathetic discharge, which may potentially lead to a fatal outcome. This case report presents the successful management of a 41-year-old female patient with iatrogenic Takotsubo syndrome complicated by cardiogenic shock. The condition was triggered by the inadvertent administration of norepinephrine, which occurred due to a medication error in which it was mistaken for amiodarone because of look-alike/sound-alike packaging and name similarity. The management strategy focused on the use of mechanical support devices rather than agents that perpetuate the adrenergic discharge underlying the pathophysiology.