Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir最新文献

Objective: Post-authorization safety study focusing on the safety of edoxaban treatment in Türkiye with a prospective design has not been performed yet. The Evaluation of Treatment safety in patients with Atrial Fibrillation on edoxaban therapy in real-life in TüRkiye (ETAF-TR) study is designed to evaluate the safety and effectiveness of edoxaban treatment in atrial fibrillation (AF). The baseline results of the ETAF-TR study describe the demographic, clinical, and laboratory characteristics of the study population.

Method: The ETAF-TR study (NCT04594915) is a prospective, national, multicentre, observational, post-authorization safety study conducted in 50 outpatient cardiology clinics.

Results: Overall, 1,053 patients with AF treated with edoxaban for stroke prevention were enrolled in the study between August 2020 and May 2022. The mean age of the study population was 70.1+-11.3 years, and 59.0% of the patients were female. Mean CHA2DS2-VASc and HAS-BLED scores were 3.5 and 1.6, respectively. Of the 1053 patients, 843 (80.1%) received standard dose edoxaban and 210 (19.9%) received reduced dose edoxaban. Of the 1053 patients, 38 patients (3.6%) had off-label usage of edoxaban therapy. Among the remaining 1015 patients, 834 (82.2%) received the appropriate dose of edoxaban, and 181 (17.8%) received an inappropriate dose of edoxaban according to the summary of product characteristics (SmPC) criteria.

Conclusion: Edoxaban has been used wide spectrum of patients with AF in daily routine practice with a good overall adherence to the SmPC. As the biggest national pharmacovigilance study to date, the ETAF-TR Study will provide detailed insight into the safety of edoxaban treatment. *ETAF-TR Investigators Eyüp Avcı, Çağatay Önal, Ferit Böyük, Salih Kılıç, Serhat Çalışkan, Özkan Vural, Nurullah Çetin, Eren Ozan Bakır, Turgay Işık, Özcan Başaran, Oğuzhan Çelik, Nijad Bakhshaliyev, Ufuk Eryılmaz, Mustafa Çalışkan, Ömer Faruk Baycan, Adem Atıcı, Aysu Oktay, Sinan İnci, Mehmet Erdoğan, Ender Özgün Çakmak, Özge Turgay Yıldırım, Mehmet Ballı, Fazilet Ertürk Sağ, Nihat Söylemez, Fatma Köksal, Mahmut Yılmaz, Veysel Özgür Barış, Şahin Dost, Serhat Sığırcı, Şahin Topuz, Ataç Çelik, Erkan Borazan, Ömer Taşbulak, Gökhan Demirci, Mustafa Ali Yavaş, Demet Menekşe Gerede Uludağ, İrem Müge Akbulut Koyuncu, Mehmet Emre Özerdem, Mustafa Yenerçağ, Deniz Elçik, Bahadır Kırılmaz, Uğur Küçük, Ebru Özpelit, Zeynep Kumral, Turhan Turan, Selim Kul, Veysel Yavuz, Kamil Tülüce, Selcen Yakar Tülüce, Burcu Yağmur, Anar Mammadli, Ersin Sarıçam, Ramazan Düz, Müjgan Tek, Mustafa Kurşun.

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/HDL-cholesterol). Multivariable logistic regression analysis was applied to identify independent predictors of MVD, and ROC curve analysis was performed to assess diagnostic accuracy.

Results: Of 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 HbA1c, and elevated LDL cholesterol levels were also independently associated with MVD. AIP showed moderate discriminative ability for predicting MVD, with an 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 assist in identifying patients who are more likely to have multivessel coronary involvement.

We administered cryoballoon ablation to a 61-year-old female patient for recurrent paroxysmal atrial fibrillation. Contrast-enhanced CT angiography used to assess the patient's pulmonary vein anatomy prior to cryoballoon ablation revealed an accessory pulmonary vein emanating from the left atrial roof. Cryoballoon ablation was successfully performed on this accessory vein, which is rarely seen in the literature for the first time.

Objective: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and has a detrimental impact on psychological well-being. This study aims to determine the prevalence of anxiety and depression in patients with non-valvular AF and to investigate the relationship between these psychological conditions and the treatment regimens administered.

Method: This cross-sectional study included 255 individuals diagnosed with non-valvular AF who were treated between 2021 and 2022. Psychiatric evaluation was conducted using the Beck Depression Inventory and Beck Anxiety Inventory. Multivariate regression analysis was performed to identify predictors of depression and anxiety.

Results: Of the patients included, 62 were on warfarin, 124 were on novel oral anticoagulants (NOACs), and 69 were not receiving any oral anticoagulant (OAC) therapy. Overall, 68.6% had depression and 64.7% had anxiety at a moderate or higher severity level. Although there was no notable variation in anxiety and depression scores between patients on NOACs and those not undergoing OAC treatment, the warfarin group had significantly higher scores than the other two groups. Age, anxiety, C-reactive protein (CRP) levels, and CHA2DS2-VASc scores (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke/transient ischemic attack-Vascular disease, Age 65-74 years, Sex category) all positively correlated with the severity of depression. Anxiety, in turn, was positively associated with age, depression, and CHA2DS2-VASc scores, and negatively associated with ejection fraction. Regression analysis revealed a strong correlation between warfarin treatment and anxiety severity.

Conclusion: The findings of this study suggest that warfarin treatment is associated with significant psychological effects in patients with AF. Considering that comorbid psychiatric disorders are linked to unfavorable prognosis and higher mortality, the development of appropriate intervention strategies that address psychological distress as part of the treatment process may provide substantial clinical benefits.

Objective: Originally designed to evaluate stroke risk in individuals with atrial fibrillation unrelated to valvular disease, the CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke/transient ischemic attack/systemic embolism, Vascular disease, Age 65-74 years, and Sex category - female) is now additionally utilized for the prognostic evaluation of cardiovascular diseases. This study aimed to evaluate the predictive role of the CHA2DS2-VASc score for lesion severity and long-term survival outcomes in individuals with peripheral artery disease (PAD).

Method: This retrospective analysis included 784 patients diagnosed with PAD via computed tomography (CT) angiography, consecutively enrolled from two medical centers. The CHA2DS2-VASc score was determined for all participants. Lesion severity was assessed according to the TASC II (Trans-Atlantic Inter-Society Consensus II) criteria, and patients were categorized into TASC-AB (simple) and TASC-CD (complex) lesion groups. Mortality data were obtained from hospital and social security records.

Results: The study included 784 patients (average age: 61.7 +- 9.9 years; 17.2% female). In the regression analysis performed to predict lesion severity, we found that the CHA2DS2-VASc score (P < 0.007) and left ventricular ejection fraction (P = 0.009) were independent predictors. The receiver operating characteristic (ROC) curve indicated that a CHA2DS2-VASc score threshold of 3.5 predicted long-term mortality with 70% sensitivity and 79% specificity (P < 0.001). Kaplan-Meier survival estimates indicated that patients with higher CHA2DS2-VASc scores had significantly lower survival rates over the 60-month follow-up period (P < 0.001).

Conclusion: The CHA2DS2-VASc score was independently associated with both lesion severity and adverse long-term outcomes in individuals with PAD.

Objective: Management of aortic stenosis (AS) requires integrating complex clinical, imaging, and risk stratification data. Large language models (LLMs) such as ChatGPT and Gemini AI have shown promise in healthcare, but their performance in valvular heart disease, particularly AS, has not been thoroughly assessed. This study systematically compared ChatGPT and Gemini AI in addressing guideline-based and clinical scenario questions related to AS.

Method: Forty open-ended AS-related questions were developed, comprising 20 knowledge-based and 20 clinical scenario items based on the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines. Both models were queried independently. Responses were evaluated by two blinded cardiologists using a structured 4-point scoring system. Composite scores were categorized, and comparisons were performed using Wilcoxon signed-rank and chi-square tests.

Results: Gemini AI achieved a significantly higher mean overall score than ChatGPT (3.96 +- 0.17 vs. 3.56 +- 0.87; P = 0.003). Fully guideline-compliant responses were more frequent with Gemini AI (95.0%) than with ChatGPT (72.5%), although the overall compliance distribution difference did not reach conventional significance (P = 0.067). Gemini AI performed more consistently across both question types. Inter-rater agreement was excellent for ChatGPT (κ = 0.94) and moderate for Gemini AI (κ = 0.66).

Conclusion: Gemini AI demonstrated superior accuracy, consistency, and guideline adherence compared to ChatGPT. While LLMs show potential as adjunctive tools in cardiovascular care, expert oversight remains essential, and further model refinement is needed before clinical integration, particularly in AS management.

Objective: Catheter-based ablation is now widely recognized as a beneficial therapeutic option for managing atrial fibrillation (AF). However, the extended duration and pain associated with the procedure may cause patient movements, potentially leading to disruptions in the electro-anatomical mapping systems. Sedative and analgesic agents are used to prevent body movements and manage pain. This study aimed to conduct a comparison between the safety and effects of ketamine and propofol for deep sedation on outcomes in AF patients undergoing radiofrequency ablation.

Methods: This retrospective and single-center study included 108 patients who underwent radiofrequency AF ablation under deep sedation (without intubation) in our hospital. The patients were categorized into two groups based on the anesthetic agent administered for deep sedation: the propofol group and the ketamine group. Procedure duration, success rates, and recovery times were compared.

Results: Of the 108 patients, 54 were in the propofol group and 54 were in the ketamine group. The procedure durations were similar in both groups (propofol group: 135 min (120 - 145) vs. ketamine group: 140 min (120 - 155), p=0.803). The eye-opening time after the procedure was 275 seconds in the propofol group and 266 seconds in the ketamine group (p=0.530). Additionally, no significant variation was detected in the initial measurements of systolic and diastolic blood pressure or heart rate.

Conclusion: In conclusion, there was no significant difference between the propofol group and the ketamine group in terms of outcomes. To the best of our knowledge, this is the first study to assess the efficacy of ketamine and propofol in the radiofrequency AF ablation patient group.