Anatolian Journal of Cardiology最新文献

Background: Sex-related differences in the safety profiles of direct oral anticoagulants (DOACs) remain insufficiently understood. This study aimed to evaluate sex-specific differences in the most frequently reported hemorrhagic and thrombotic adverse events (AEs) associated with DOAC therapy using data from the Food and Drug Administration Adverse Event Reporting System (FAERS).

Methods: A retrospective pharmacovigilance analysis was conducted using FAERS reports from each DOAC's approval date through 2024. Only cases in which a single DOAC was designated as the primary suspect and the report was submitted by a healthcare professional were included. Six major AEs were evaluated: gastrointestinal hemorrhage, intracerebral hemorrhage, pulmonary embolism (PE), deep vein thrombosis, ischemic stroke, and myocardial infarction (MI). Dabigatran served as the reference comparator. Reporting odds ratios (RORs) with 95% CIs were calculated to identify disproportionate reporting signals.

Results: Hemorrhagic and thrombotic AE patterns demonstrated notable sex differences. Gastrointestinal hemorrhage risk was higher with apixaban (ROR = 2.32, P < .001, 95% CI: 2.20-2.45) and edoxaban (ROR = 2.95, P < .001, 95% CI: 2.54-3.42) compared with dabigatran, while female dabigatran users reported these events more frequently (P < .001). Intracranial hemorrhage was reported more often among males using dabigatran and rivaroxaban (P = .003 and P = .004). All DOACs were associated with increased MI reports (e.g., apixaban ROR = 2.37, P < .001, 95% CI: 2.08-2.71), particularly among males. Conversely, PE and ischemic stroke were more frequently reported in female rivaroxaban users (P < .001 and P = .018).

Conclusions: Significant sex-specific differences exist in DOAC safety profiles. Recognizing these patterns may inform individualized anticoagulant selection and enhance pharmacovigilance-driven personalized medicine.

The triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance (IR) asso-ciated with atherosclerosis, endothelial dysfunction, and cardiovascular disease (CVD). Chronic total occlusion (CTO) presents major clinical challenges, especially in patients undergoing percutaneous coronary intervention (PCI). This narrative review explores the role of the TyG index in predicting CTO development and adverse cardiovascu-lar outcomes. A literature review of studies assessing the association between the TyG index and CTO, PCI outcomes, and contrast-induced nephropathy (CIN) was conducted. Pathophysiological mechanisms linking IR, TyG, and CTO progression were evaluated, and the predictive utility of the TyG index in risk stratification and post-PCI complica-tions was analyzed. Multiple studies show that a higher TyG index is strongly associated with increased CTO risk, poor collateral circulation, CIN, and adverse outcomes after PCI. Elevated TyG values were independently predictive of impaired collateral formation in diabetic and non-diabetic patients, with stronger effects in metabolically vulnerable subgroups. Individuals with higher TyG levels had a greater likelihood of developing CIN, with analyses confirming its role as an independent predictor. Long-term prognosis in CTO patients was also worse with elevated TyG, with higher rates of major adverse car-diovascular events. The TyG index demonstrated consistent predictive capability com-pared with other metabolic markers, supporting its potential as a low-cost tool for risk stratification. The TyG index is a cost-effective biomarker for predicting adverse out-comes in CTO patients. Its incorporation into clinical assessment may improve early risk identification and support individualized PCI planning.

Background: Hypertrophic cardiomyopathy (HCM) is a complex myocardial disorder with heterogeneous clinical presentations and structural manifestations. This study aimed to assess the distribution, clinical characteristics, and diagnostic approaches in a regional cohort of patients with HCM.

Methods: Patients diagnosed with HCM at a tertiary cardiomyopathy clinic between October 2021 and November 2024 were retrospectively analyzed. Patients were classified into obstructive, latent obstructive, non-obstructive, or apical phenotypes based on clinical and imaging findings. Comprehensive demographic, clinical, and imaging data were collected for detailed analysis, providing valuable insights into the phenotypic diversity of HCM.

Results: The cohort included 701 patients with a median age of 53 years of whom 68% were male. The phenotypic distribution comprised 9.3% apical, 38.1% non-obstructive, 32.5% resting obstructive, and 20.1% latent obstructive HCM. Implantable cardioverter-defibrillator implantation was more common in obstructive phenotypes, particularly in the latent obstructive group. Although late gadolinium enhancement (LGE) was more frequently observed in apical HCM, post-hoc analysis showed no significant difference in prevalence across subgroups. In contrast, LGE extent was significantly greater in the apical group. Genetic testing, performed in 32% of patients, revealed a 44% positivity rate, with MYBPC3 and MYH7 being the most commonly detected mutations. The overall mortality rate was 2.8%, with heart failure identified as the leading cause of death.

Conclusion: In this large regional cohort of HCM patients, obstructive and non-obstructive phenotypes were predominant, with a notable burden of genetic mutations and a low overall mortality rate primarily driven by heart failure. These findings emphasize the clinical heterogeneity of HCM and highlight the importance of comprehensive diagnostic evaluation.

Background: Atrial septal defect closure can be performed surgically or via transcatheter intervention, yet comparative outcomes remain inconsistent between children and adults. This review synthesizes observational evidence to evaluate procedural success, complications, and periprocedural characteristics across both populations.

Methods: A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines was conducted, including 36 observational studies published through 2024. Study quality was assessed using the Newcastle-Ottawa Scale. Random effects models were applied, with subgroup analyses by age and procedure type. Publication bias was examined using funnel plots and Egger's test.

Results: The pooled procedural success rate was 95% (95% CI: 92%-97%; I² = 90.2%). Among children, raw procedural success was 87% (1445/1656) for transcatheter closure and 99% (505/510) with surgery. In adults, transcatheter closure achieved 97% (95% CI: 90%-99%), whereas surgery reached 98% (95% CI: 70%-100%). Transcatheter closure resulted in shorter hospitalization (mean difference: -3.86 days, 95% CI: -6.03 to -1.69; P = .0004) and fewer major complications (risk ratio: 0.58, 95% CI: 0.39-0.86; P = .006). Sensitivity analysis restricted to high-quality studies (n = 12) remained consistent. Egger's regression did not indicate significant publication bias (P = .069).

Conclusion: Both approaches provide high closure success, yet transcatheter intervention offers lower complication rates and faster recovery, particularly in anatomically suitable patients. These findings support individualized treatment selection based on age, anatomy, and institutional experience.