Anatolian Journal of Cardiology最新文献

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.

Background: Hypothyroidism is a known risk factor for cardiovascular diseases, affecting metabolic pathways such as dyslipidemia, insulin resistance, and visceral fat accumulation. This study aimed to investigate the value of the Body Roundness Index (BRI) and the newly defined BRI/TSH (thyroid-stimulating hormone) ratio (BRITSH) in predicting coronary artery disease (CAD) in patients with hypothyroidism.

Methods: This cross-sectional study included 152 hypothyroid patients, of whom 55 had CAD and 97 served as controls. Data collected included age, sex, body mass index (BMI), waist circumference, BRI, lipid profiles, and TSH levels. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis and logistic regression. A new ratio, BRITSH, was also evaluated.

Results: Patients with CAD had significantly higher BRI values (P < .001). The BRI/TSH ratio was significantly lower in the CAD group (P = .005). Non-high-density lipoprotein (non-HDL) cholesterol levels were also elevated in the CAD group (P < .001). Receiver operating characteristic analysis showed a strong predictive value for BRI (area under the curve [AUC] = 0.86). BRITSH ratio demonstrated a moderate predictive capacity (AUC = 0.67). In multiple logistic regression analysis, BRITSH, age, diabetes mellitus, high-sensitivity C-reactive protein, and non-HDL cholesterol remained independent predictors of CAD, whereas male sex, BMI, and smoking were not.

Conclusion: The new BRITSH ratio, combining body fat and thyroid function, was an independent predictor of CAD. The BRI also showed good ability to identify CAD risk in patients with hypothyroidism. These simple measures may help improve heart risk assessment and could be incorporated into routine care for patients with hypothyroidism.

Background: Transcatheter aortic valve replacement (TAVR) is the standard therapy for severe aortic stenosis, particularly in elderly patients with comorbidities. Simple biomarkers to predict mid-term mortality are still needed. This study evaluated the prognostic value of the preprocedural neutrophil percentage-to-albumin ratio (NPAR) for 2-year all-cause mortality after TAVR.

Methods: A total of 618 patients undergoing TAVR between 2013 and 2023 were retrospectively analyzed. NPAR was calculated as neutrophil percentage × 100 / albumin (g/dL), and patients were classified into tertiles. The prognostic role of NPAR was assessed using Cox regression, Kaplan-Meier survival analysis, and receiver operating characteristic curves.

Results: Baseline characteristics were similar across tertiles, but higher NPAR was associated with elevated inflammation and lower albumin levels. In multivariable Cox analysis, high NPAR independently predicted 2-year mortality (T3 vs. T1: hazard ratio [HR] 2.75, 95% CI 1.77-4.28; P < .001). In a model including both categorical NPAR and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), tertile 3 of NPAR (HR 2.49, 95% CI 1.61-3.85; P < .001) and STS-PROM (HR 1.31, 95% CI 1.12-1.53; P = .001) remained independent predictors, indicating incremental prognostic value of NPAR beyond established surgical risk scores. Kaplan-Meier curves showed the lowest survival in the highest tertile (35.9% mortality at 2 years). Receiver operating characteristic analysis confirmed NPAR had the best discriminatory ability (area under the curve = 0.703).

Conclusion: Preprocedural NPAR is an independent, low-cost, and readily available biomarker for predicting mid-term mortality after TAVR. Its integration into risk models may improve prediction accuracy and help guide patient management.