Anatolian Journal of Cardiology最新文献

Background: Patients with atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI) often require longterm oral anticoagulation (OAC), which may not be appropriate for those at high bleeding risk. Performing left atrial appendage closure (LAAC) during TAVI can reduce the risk of thromboembolism while avoiding the need for prolonged anticoagulation.

Methods: This single-center study included 5 consecutive patients with severe aortic stenosis and AF who underwent same-session TAVI and LAAC between October 2024 and March 2025. All had contraindications to OAC or high bleeding risk. Procedural details and early outcomes were recorded. Technical success was defined according to Valve Academic Research Consortium-3 (VARC-3) (TAVI) and Munich/The Society for Cardiovascular Angiography & Interventions (SCAI) and the Heart Rhythm Society criteria (LAAC). Continuous variables are presented as mean ± SD or median interquartile range (IQR), and categorical variables as n (%).

Results: Mean age was 75.6 ± 8.4 years; 40% were male. The median Society of Thoracic Surgeons score was 6.0% [IQR 5.5-7.0], median CHA₂DS₂-VA was 4 [4-5], and median hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly was 3 [3-4]. All patients received a Meril valve; LAAC devices included Amulet (n = 3) and LAmbre (n = 2). Technical success was achieved in all cases. There were no intra-periprocedural complications, major bleeding (Bleeding Academic Research Consortium ≥3), stroke/transient ischemic attack, or vascular complications. But Kidney Disease: Improving Global Outcomes stage 1 acute kidney injury was observed only in 1 (20%) patient. The median hospital stay was 4 [IQR 3-6] days.

Conclusion: In this study, same-session TAVI and LAAC in AF patients with high bleeding risk were technically feasible and showed an acceptable shortterm safety profile. Larger, prospective studies with longer follow-up are needed to confirm these results.

Background: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality, underscoring the need for improved early detection strategies for preclinical atherosclerosis. This study evaluated comprehensive multimodal cardiovascular risk predictors-clinical, biochemical, and vascular imaging parameters-in dyslipidemic adults without established ASCVD.

Methods: A total of 847 adults underwent standardized clinical assessment, laboratory profiling, and duplex-based vascular imaging, including carotid intima-media thickness (IMT), plaque assessment, flow-mediated dilation (FMD), and ankle-brachial index. Statistical analyses included multivariate logistic regression, receiver operating characteristic (ROC) curve analysis, model calibration metrics, and correlation matrices using Pearson or Spearman tests as appropriate. High-density lipoprotein cholesterol (HDL-C) exhibited a strong inverse correlation with AIP (r = -0.57, P < .001).

Results: Triglycerides (TG) demonstrated a strong positive correlation with the atherogenic index of plasma (AIP) (r = 0.80, P < .001). Moderate correlations were observed between age and left ventricular mass index (r = 0.31, P < .001), age and fibrinogen (r = 0.32, P < .001), HbA1c and TG (r = 0.26, P < .001), and HbA1c and AIP (r = 0.30, P < .001). ASCVD and atherosclerosis total score positivity were independently associated with age, HbA1c, IMT, and FMD in multivariable analyses, while model discrimination remained robust (area under the curve values reported).

Conclusion: Multimodal integration of clinical, biochemical, and vascular imaging markers provides meaningful refinement of cardiovascular risk stratification and may enhance early detection of preclinical ASCVD.

Background: Urinary sodium (UNa) has been increasingly studied in heart failure as a marker of diuretic response, but its prognostic role in acute myocardial infarction (MI) remains unclear. The aim was to evaluate whether admission UNa could provide prognostic information in patients with non-ST-elevation MI (NSTEMI).

Methods: This prospective observational study included 47 selected NSTEMI patients admitted to the coronary care unit. Spot urinary sodium was measured at admission and patients were stratified according to the median UNa value (92 mmol/L). Clinical outcomes, including peak troponin, Global Registry of Acute Coronary Events (GRACE) score, need for in-hospital diuretic therapy, and length of stay, were assessed.

Results: Patients with lower UNa (<92 mmol/L) had significantly higher peak troponin levels (median 1089 vs. 350 ng/L, P = .004) and a greater need for diuretic therapy during hospitalization (70.8% vs. 26.1%, P = .002). Urinary sodium was inversely correlated with peak troponin (r = -0.37, P = .011) and diuretic requirement (r = -0.54, P < .001). In multivariable regression, admission UNa remained an independent predictor of myocardial injury. Receiver operating characteristic analysis showed moderate discriminative ability of UNa for both troponin elevation (area under the curve [AUC]: 0.73) and need for diuretic use (AUC: 0.81).

Conclusion: Admission urinary sodium may serve as a simple, non-invasive adjunctive marker for risk stratification in NSTEMI, reflecting the neurohormonal activation. These findings suggest that UNa may complement established tools such as troponin and GRACE score in early evaluation.

Background: Maintenance hemodialysis (MHD) can lead to hypertrophy of myocardial cells and interstitial fibrosis in patients, which can ultimately culminate in left ventricular hypertrophy (LVH). The objective of this study is to examine the expression of miR-107 in patients undergoing MHD who also present with LVH and to evaluate its predictive value.

Methods: A total of 135 patients with end-stage renal disease who were undergoing MHD were included as the research subjects. Patients were grouped based on left ventricular mass index. Real-time quantitative polymerase chain reaction was used to detect the expression of miR-107 in the serum of the patients. The receiver operating characteristic curve was used to evaluate the diagnostic value of miR-107 in MHD with LVH patients. The Pearson's method was used for correlation analysis. Logistic regression model was used to analyze the risk factors for cardiac hypertrophy in MHD patients.

Results: Serum miR-107 is highly expressed in patients with MHD and LVH, and it may be a potential diagnostic biomarker. miR-107 has relatively high sensitivity and specificity in predicting LVH in patients with MHD. Serum miR-107 is closely related to the serum high-sensitivity C-reactive protein level and echocardiographic characteristics of patients with MHD combined with LVH. MiR-107 correlates with echocardiographic characteristics of MHD patients with LVH. Finally, logistic regression analysis indicated that miR-107 was a risk factor for LVH in MHD patients.

Conclusion: Serum miR-107 may have significant potential in diagnosing cardiac hypertrophy in MHD patients and is a potential biological indicator for cardiac hypertrophy in MHD patients.

Background: Atrial fibrillation (AF) is a major public health issue associated with thromboembolism and mortality. Real-world data from Türkiye are limited despite expanding use of non-vitamin K antagonist oral anticoagulants (NOACs). The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study aimed to characterize the demographic features, risk profiles, treatment patterns, and 2-year clinical outcomes of patients with non-valvular AF (NVAF) in Türkiye.

Methods: TRAFFIC was a national, prospective, multicenter, observational registry enrolling 1659 NVAF patients from 36 centers with 6-monthly follow-up for 24 months. Baseline data included demographics, comorbidities, CHA₂DS₂-VASc, HAS-BLED, AF subtype, European Heart Rhythm Association (EHRA) score, and antithrombotic therapy. Outcomes were ischemic stroke/systemic embolism (SE), major bleeding, and all-cause mortality. Predictors of mortality were evaluated using adjusted Cox regression, and associations of risk scores were explored using univariate Cox models with restricted cubic splines.

Results: Median age was 70 years, 48% female, with intermediate CHA₂DS₂-VASc (most 2-5) and low-to-intermediate HAS-BLED scores (most 0-2). Permanent AF was the most common subtype (48%). Antithrombotic therapy largely reflected risk profiles, with NOACs being the dominant treatment (65%). Over 2 years, all-cause mortality was 8.9%, ischemic stroke/SE 2.4%, and major bleeding 1.3%. In adjusted analysis, age, congestive heart failure, and diabetes mellitus were independent predictors of mortality. Both CHA₂DS₂-VASc and HAS-BLED scores showed threshold effects for mortality and thromboembolic risk but not for bleeding.

Conclusion: TRAFFIC provides contemporary Turkish NVAF data, showing lower event rates than historical cohorts. Outcomes are comparable with international registries; persistent mortality burden highlights the need for AF care beyond anticoagulation.