Objective: This study aimed to evaluate the impact of integrating electrocardiography (ECG) devices into a hospital information system (HIS) on paper use, cost outcomes, and data accessibility in outpatient clinical settings. Methods: This retrospective observational study was conducted using outpatient data collected between 2017 and 2025. The pre-integration period (2017) was compared with the post-integration period (2018–2025). Outpatient visit volumes, total ECG examinations, repeat ECG rates, paper consumption, and associated costs were analyzed. ECG devices were integrated into the HIS via an HL7-based interface, enabling data transfer to the Picture Archiving and Communication System (PACS) and national health platforms. Data were analyzed using descriptive statistical methods and presented as counts and percentages. Results: In 2017, a total of 661,329 outpatient visits and 43,548 ECG examinations were recorded, with a repeat ECG rate of 20%. Following integration, ECG data became digitally accessible through the HIS and PACS. Paper-based processes were completely eliminated, resulting in the avoidance of paper-related costs in subsequent years. During the early post-integration period (2018–2021), repeat ECG rates ranged between 19% and 21%, whereas in the later period (2022–2025), they declined to a range of 9.9–11.2%. Conclusion: Integration of ECG devices into the HIS eliminates paper-based processes, reduces operational costs, and enhances data accessibility for both healthcare professionals and patients. However, digital integration alone may not be sufficient to reduce repeat testing. These findings highlight the importance of integrated digital systems in improving efficiency and accessibility in healthcare delivery.
Objective: Acute cardiogenic shock (CS) developing in the setting of chronic heart failure is associated with high mortality and requires rapid hemodynamic intervention. This study aimed to evaluate the early outcomes of patients who received short-term mechanical circulatory support with the CentriMag® system for refractory CS and to assess the effectiveness of this strategy as a bridge therapy. Methods: This retrospective, single-center study included 30 consecutive patients who had been listed for heart transplantation and underwent CentriMag® short-term ventricular assist device (VAD) implantation due to the development of CS between September 2010 and December 2013 in our hospital. CS was defined as persistent low cardiac output despite inotropic therapy and intra-aortic balloon pump support. The primary endpoints were survival to hospital discharge and successful bridging to recovery, durable support, or heart transplantation. Secondary endpoints included hemodynamic and laboratory improvement as well as device-related complications. Results: The mean age of the patients was 32.7±15.2 years, and 70% were male. The mean left ventricular ejection fraction was 20.1%±4.0%. The most common etiologies of CS were idiopathic dilated cardiomyopathy (36.7%) and ischemic cardiomyopathy (26.7%). The most frequent post-operative complications were arrhythmia (36.6%), acute kidney injury (40%), and infection (33.3%). The mean duration of support was 33 days (range, 4–185). Eight patients (26.7%) were successfully bridged to heart transplantation and four (13.3%) to durable VAD support, while the 30-day survival rate was 60%. Conclusion: The CentriMag® short-term VAD provided effective hemodynamic stabilization, improved end-organ function, and enabled bridging to durable support or heart transplantation in a substantial proportion of patients with refractory CS. Despite the high complication rates inherent in this critically ill population, the survival outcomes were more favorable compared with conventional therapy. The CentriMag® system appears to be a reliable bridge-to-decision or bridge-to-transplant option for patients with advanced heart failure presenting with acute CS.
Peripartum cardiomyopathy (PPCM) is a major cause of heart failure in late pregnancy and the postpartum period, whereas takotsubo cardiomyopathy (TCM) is rare but may occur under severe stress. Differentiation between these conditions is challenging due to overlapping clinical features. A 30-year-old woman with an in vitro fertilization pregnancy presented at 34 weeks of gestation with dyspnea and intrauterine fetal demise. Echocardiography revealed severe left ventricular dysfunction (ejection fraction, 25%). Following surgical intervention and standard heart failure therapy, ventricular function improved rapidly, with the ejection fraction reaching 50% within one month. Despite pregnancy-related risk factors suggesting PPCM, the rapid recovery of left ventricular function favored a diagnosis of TCM. This case highlights the importance of careful clinical and imaging assessment and emphasizes that rapid ventricular recovery in late pregnancy should raise strong suspicion for TCM, even when classical PPCM risk factors coexist.
Objective: The decline in estrogen levels in menopause accelerates atherosclerosis through endothelial dysfunction, inflammation, and metabolic alterations. This process may contribute to increased cardiovascular risk in the postmenopausal period and to the development of more advanced coronary lesions. The J-CTO score is a widely used tool for assessing chronic total occlusion (CTO) lesion complexity and predicting procedural success. This study aimed to evaluate the association between menopause duration and CTO lesion complexity using the Japanese CTO (J-CTO) score. Methods: This retrospective observational study included 60 postmenopausal women with known menopausal status who underwent percutaneous coronary intervention for CTO at a tertiary center between January 2021 and December 2025. Patients were categorized into two groups according to J-CTO score: Low complexity (J-CTO <2) and high complexity (J-CTO ≥2). Demographic, clinical, laboratory, and angiographic data were obtained from hospital records. Missing data regarding menopausal age, duration of menopause, and obstetric history were completed by telephone interviews. The relationship between menopausal characteristics and J-CTO score was evaluated. Results: Of the 60 patients included in the study, 32 (53.3%) had low-complexity CTO lesions and 28 (46.7%) had high-complexity CTO lesions. There were no significant differences between the groups in age, body mass index, menopausal age, duration of menopause, or parity (p>0.05). Although menopause duration tended to be longer in the high-complexity group, the difference did not reach statistical significance (20.5 vs. 15, p=0.094). The high-complexity group had significantly higher rates of diabetes mellitus (p=0.039), hyperlipidemia (p=0.031), previous coronary artery disease (p=0.007), and prior CABG (p=0.034). Hemoglobin levels were lower (p=0.038), while urea and creatinine levels were higher p<0.001), and glomerular filtration rate was lower (p<0.001) in the high-complexity group. Angiographically, CTO length >20 mm (p=0.006), presence of calcification (p=0.048), and blunt stump morphology (p=0.012) were more frequent in the high-complexity group. Procedural success was significantly lower in the high-complexity group (p=0.041). Correlation analysis showed no significant association between menopausal age or menopause duration and J-CTO score. Conclusion: In this cohort of women with CTO, menopausal age and menopause duration were not significant determinants of CTO lesion complexity. Rather, lesion complexity was more closely associated with traditional cardiovascular risk factors, impaired renal function, and adverse angiographic characteristics. Although our study did not demonstrate a statistically significant association between menopause duration and CTO lesion complexity, the observed trend toward longer menopause duration in the high-complexity group may still be clinically relevant.
Objective: The SYNTAX score quantifies coronary lesion complexity and guides revascularization in coronary artery disease (CAD). Readily available biomarkers that reflect lesion burden may improve preangiography risk stratification. This study evaluated whether calculated serum osmolality is associated with lesion complexity in stable CAD. Methods: Adults undergoing elective coronary angiography between January and December 2023 were retrospectively analyzed. Serum osmolality was calculated as 2×[Na + ]+[BUN/2.8]+[Glucose/18]. Patients were classified as having a low (≤22) or moderate-high (>22) SYNTAX score. Variables identified by least absolute shrinkage and selection operator (LASSO) regression were tested in multivariable logistic regression. Results: A total of 281 patients were included; 195 (69.4%) had a low SYNTAX score, and 86 (30.6%) had a moderate-high SYNTAX score. Median osmolality was significantly higher in the moderate-high group than in the low-score group (293.2 vs. 288.1mOsm/kg; p<0.001). In multivariable analysis, serum osmolality was the strongest independent predictor of a high SYNTAX score (OR, 1.123; 95% CI, 1.070–1.184; p<0.001), along with age, chronic obstructive pulmonary disease, and lipid parameters. Receiver operating characteristic analysis revealed an area under the curve of 0.75 (95% CI, 0.69–0.81). Conclusion: Calculated serum osmolality, a simple and universally available parameter, is independently associated with angiographic lesion complexity in stable CAD and may contribute to preangiography risk stratification and revascularization planning.
Objective: Hemorrhagic complications continue to be a major clinical challenge among individuals with atrial fibrillation (AF) receiving direct-acting oral anticoagulants (DOACs). This research sought to evaluate and contrast the accuracy of various risk assessment models in forecasting bleeding incidents within this specific patient cohort. Methods: We enrolled 447 subjects diagnosed with AF who were prescribed DOAC therapy (including apixaban, dabigatran, edoxaban, or rivaroxaban). By retrospectively reviewing institutional electronic health records, we computed the ORBIT, ATRIA, and HEMORR 2 HAGES risk indices for each participant. The main outcome measures were defined as the occurrence of clinically relevant minor or major hemorrhages. Consequently, we analyzed how accurately these scoring systems could foresee the specified endpoints. Results: The cohort’s average age stood at 75.6±10.1 years, comprising predominantly women (62.2%). During a 12-month observation period, 6.7% of the participants (n=30) encountered one or more major hemorrhagic events. When forecasting severe bleeding, the ATRIA, ORBIT, and HEMORR 2 HAGES frameworks exhibited comparable predictive accuracies without any statistically notable variations. Upon conducting a multivariate logistic regression, independent variables linked to a heightened likelihood of bleeding encompassed prior hemorrhagic episodes (odds ratio [OR]: 3.101, p=0.019) and the presence of heart failure (OR: 2.028, p=0.009). In addition, anemia emerged as a significant factor (OR: 0.366, p=0.049), alongside elevated evaluations in both the HEMORR 2 HAGES (OR: 1.535, p=0.006) and ORBIT (OR: 1.849, p<0.014) scales. Conclusion: Both the ORBIT and HEMORR 2 HAGES models proved to be valuable independent indicators for future hemorrhagic complications. Integrating these tools into routine cardiovascular care can optimize therapeutic strategies and enhance the overall safety of AF patients on anticoagulation.
Hypertension is one of the most prevalent chronic diseases, and with advances in technology, various digital solutions have long been explored for its management. Mobile applications, telemedicine systems, digital blood pressure monitoring devices, and, more recently, artificial intelligence-assisted systems are intended to achieve effective blood pressure control, prevent adverse outcomes, and improve cost-effectiveness.
Objective: We examined whether children with type 1 diabetes mellitus (T1DM) demonstrated early, subclinical electrical alterations on electrocardiography by evaluating dispersion indices, ventricular repolarization markers, and electrophysiological balance measures. Methods: In this prospective case–control study, 20 children with T1DM and 20 age- and sex-matched healthy controls underwent transthoracic echocardiography and 12-lead electrocardiogram (ECG). We quantified P-wave, QTc, and Tp–e dispersion; Tp–e/QT and Tp–e/QTc ratios; and electrophysiological balance indices (QT/QRS and QTc/QRS). Relationships between ECG indices and clinical variables (diabetes duration and glycated hemoglobin [HbA1c]) were assessed. Results: Conventional echocardiographic parameters were normal in both groups. Compared with controls, children with T1DM had higher P-wave dispersion, QTc dispersion, and Tp–e dispersion (all p<0.001), whereas Tp–e-based ratios and electrophysiological balance indices were similar between groups. Diabetes duration correlated positively with P-wave dispersion (r=0.489, p=0.029), and HbA1c correlated inversely with QT/ QRS (r=-0.475, p=0.034). Conclusion: Pediatric T1DM may be accompanied by subtle ECG abnormalities despite preserved conventional echocardiographic findings. Increased dispersion indices support early electrical heterogeneity, and the association between electrophysiological balance and glycemic control suggests an effect of metabolic burden on myocardial electrical stability.
Objective: Traditional driving imposes substantial cognitive and physical demands on drivers, often contributing to stress, fatigue, and increased cardiovascular risk. Semi-autonomous driving technologies may alleviate these burdens. We aimed to evaluate the effects of semi-autonomous driving on autonomic nervous system activity and anxiety by comparing heart rate variability (HRV) and validated anxiety measures with manual driving. Methods: Forty-five healthy adults underwent HRV analysis using Holter monitoring while driving the same route under manual and semi-autonomous conditions. Frequency-domain (Low-frequency [LF]/high-frequency [HF] ratio), time-domain (standard deviation of NN intervals [SDNN], root mean square of successive differences [RMSSD], percentage of successive RR intervals that differ by more than 50ms [pNN50]), and non-linear indices (sample entropy, detrended fluctuation analysis [DFA] α1) were assessed. Mean heart rate, maximum heart rate, and minimum heart rate were also analyzed. Anxiety was evaluated with the State-Trait Anxiety Inventory (STAI; range 20–80) and a 10-point Visual Analog Scale (VAS). Results: There were 22 male and 23 female participants. The mean age was 34.7±6.9 years. Semi-autonomous driving was associated with significantly lower LF/HF ratio compared with manual driving (1.7±0.5 vs. 2.9±0.7, p<0.001). Time-domain HRV indices improved, with higher SDNN (61.5±10.1 vs. 43.6±8.9 ms), RMSSD (47.8±8.3 vs. 29.1±6.8 ms), and pNN50 (23.5±6.2% vs. 12.9±4.6%; all p<0.001). Non-linear measures showed increased sample entropy (1.41±0.27 vs. 1.14±0.22, p<0.01) and reduced DFA α1 (1.04±0.13 vs. 1.18±0.15, p<0.01). Mean heart rate decreased from 82.4±9.1 to 75.8±8.3 bpm (p<0.001). Anxiety outcomes paralleled these findings: VAS scores were lower (3.7±0.8 vs. 6.1±1.0, p<0.001) and STAI-State decreased (38.4±6.1 vs. 47.1±6.5, p<0.001), while STAI-Trait remained unchanged (43.5±6.8 vs. 45.0±7.3, p=0.12). Conclusion: Semi-autonomous driving reduced sympathetic dominance and anxiety while enhancing parasympathetic activity and HRV complexity. These findings suggest potential psychophysiological benefits of semi-autonomous driving, warranting confirmation in larger and more diverse populations.
Objective: Coronary artery disease (CAD) is a major cause of global mortality. Multivessel disease (MVD) is linked to poorer clinical outcomes. Insulin resistance (IR) is a key factor in CAD progression. The triglyceride-glucose (TyG) index and atherogenic index of plasma (AIP) are emerging biomarkers related to IR and cardiovascular risk. Their role in predicting CAD severity is not fully established. This study aimed to evaluate the prognostic value of TyG and AIP indices in assessing CAD severity and distinguishing MVD from single-vessel disease (SVD). Methods: This retrospective study involved 244 patients undergoing coronary angiography from January 2022 to January 2024. Patients were classified into MVD (n=116) and SVD (n=128) groups. Data on demographics, cardiovascular risk factors, and metabolic parameters were collected. TyG and AIP indices were calculated. Logistic regression and receiver operating characteristic (ROC) curve analyses assessed their predictive value for MVD. Results: Patients in the MVD group were older than those in the SVD group (64.9±8.3 vs. 60.1±7.8 years; p<0.001) and had a higher prevalence of diabetes mellitus (56.9% vs. 31.3%; p<0.001). In multivariable analysis, the TyG index (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 2.75–16.35; p<0.001) and AIP (OR: 1.66; 95% CI: 1.22–2.24; p=0.001) were identified as independent predictors of MVD. ROC analysis demonstrated that the TyG index had superior diagnostic accuracy compared with AIP (area under the curve: 0.718 vs. 0.643). Conclusion: TyG and AIP indices are useful biomarkers for CAD severity assessment. The TyG index demonstrated greater predictive accuracy. These indices may enhance clinical risk stratification and treatment decisions. Prospective studies are needed to validate these findings across populations.
Objective: This study aimed to evaluate the concordance between prenatal and postnatal diagnoses in pregnant women with detected fetal cardiac anomalies and to present the perinatal outcomes of these pregnancies. Methods: A total of 9,755 fetal echocardiographic examinations performed at our hospital’s perinatology clinic between January 2019 and May 2025 were retrospectively analyzed. Ninety-two fetuses with structural cardiac anomalies identified during these examinations were included in the study. Maternal demographic characteristics, prenatal ultrasound and echocardiographic findings, the presence of accompanying extracardiac or genetic anomalies, pregnancy outcomes, and postnatal echocardiography results were examined. The concordance between prenatal and postnatal cardiac diagnoses in live-born infants was analyzed. Results: The mean gestational age at diagnosis was 23.07±4.15 weeks. Septal defects were the most common cardiac anomalies (45.7%), followed by conotruncal defects (18.5%) and left-sided obstructive lesions (15.2%). Due to severe cardiac and/or associated extracardiac or genetic anomalies, pregnancy was terminated in 10 cases (10.9%). Prenatal and postnatal cardiac diagnoses were consistent in 72 of the 82 live births (87.8%), whereas inconsistencies were detected in 10 cases (12.2%). These inconsistencies were most commonly associated with small or muscular ventricular septal defects. Eleven deaths were observed in the postnatal period. Conclusion: Prenatal diagnosis of fetal cardiac anomalies is important for the early detection of associated structural and genetic anomalies. Accurate diagnosis supports informed decision-making regarding the continuation or termination of pregnancy. Furthermore, early diagnosis of severe cardiac defects allows delivery to be planned in well-equipped centers and enables rapid postnatal intervention, which may positively influence neonatal outcomes. These findings emphasize the importance of prenatal echocardiography and a multidisciplinary approach in the perinatal management of congenital heart disease.
Objective: The primary goal in the treatment of abdominal aortic aneurysms (AAA) is to reduce long-term morbidity and mortality by preventing aneurysm rupture. This study aimed to evaluate the effect of aneurysm morphology before endovascular aneurysm repair (EVAR) in AAA on prognosis, compare the changes in aneurysm morphology after mid- and long-term follow-up after EVAR with extensive randomized studies, and evaluate the treatment efficacy. Methods: A total of 75 patients who were evaluated with pre-operative computed tomography angiography (CTA) with a preliminary diagnosis of AAA in our institution and had a perioperative digital subtraction angiography examination and at least one post-operative follow-up CTA examination >12 months were included in the study. Additional interventions were recorded during the procedure, complications, endoleak types, demographic data, and changes in aneurysm morphology. The results were compared with the data in the literature. Results: The mean follow-up period was calculated as 37 months. A mean decrease of 4.5 mm was detected in AAA diameter. A mean reduction of 4 mm in thickness was observed in accompanying common iliac artery (CIA) aneurysms (p=0.016). Complications were observed in 32% of the patients. The most common complication was Type 2 endoleak, which was observed in 25% of the patients. We did not observe a significant difference in pre-operative and post-operative mean thrombus thickness (p=0.588). Endoleak rate was increased in patients with bilateral CIA aneurysms accompanying AAA (p=0.044). While there was no significant effect of changing the AAA diameter in those with increasing thrombus diameter, it was observed that the aortic diameter decreased in those with decreasing thrombus diameter (p=0.012). Conclusion: Our 10-year experience with EVAR shows that many complications may occur after stent grafting. Caution should be exercised regarding Type 2 endoleaks. Lifelong follow-up is necessary to prevent aneurysm rupture after EVAR.
Objectives: Chronic kidney disease (CKD) is a significant global health concern affecting millions of individuals worldwide. Cardiac arrhythmias are highly prevalent in CKD patients, with sudden cardiac death (SCD) representing a substantial cause of mortality, accounting for approximately 25% of all deaths in this patient group. Our hypothesis was that hemodialysis (HD) patients have an increased risk of cardiac arrhythmias and SCD. Methods: This single-center observational study enrolled 219 participants: 109 patients undergoing HD and 110 in the control group. A 12-lead resting electrocardiogram (ECG) was performed before and after dialysis in all patients on HD and once in the control groups. Results: The T peak-T end (Tp-e) interval duration (p=0.001), Tp-e/QT ratio (p=0.001), and Tp-e/corrected QT (QTc) ratio (p=0.001) were significantly higher in the HD patients than in the control group. There was no significant difference in Tp-e dispersion (p=0.806) between the groups. Correlation analysis revealed significant correlations between parathyroid hormone levels and the Tp-e interval (p=0.001), Tp-e/ QT ratio (p=0.017), Tp-e/QTc ratio (p=0.006), and QTc interval (p=0.020) in HD patients. QT, QTc, and Tp-e durations, as well as QT/QRS, QTc/QRS, Tp-e/QT, and Tp-e/QT ratios, were found to be higher in post-dialysis ECGs than in pre-dialysis ECGs. Conclusion: The resting ECG findings were analyzed in patients with HD and a predisposition to arrhythmias, and SCD was identified in this cohort.
Objectives: The deposition of calcium in the vascular bed can reflect the presence of atherosclerotic lesions, and aortic knob calcification (AKC) has been shown to correlate with a heightened risk of cardiovascular disease (CVD) events. This retrospective research was undertaken with the aim of evaluating the relationship between AKC and the coronary artery calcium score (CACS) by chest X-ray and investigating the possibility of using AKC to predict the risk of CVD. We hypothesized that AKC would be detected more frequently on chest X-rays among patients with severe CACS values. Methods: The study included 282 consecutive patients diagnosed with stable angina pectoris (SAP) who had presented to our cardiology outpatient clinic between 2018 and 2020 and underwent cardiac computed tomography and chest X-ray. Those whose chest X-rays revealed small spots or singular areas of fine calcification were considered to have AKC. CACS values were classified according to the Agatston score and CACS severity was defined as none-mild (<100) or moderate-severe (>100). Results: The mean age of the 282 enrolled patients was 47.5±11.3 years and 169 (59.9%) of the patients were male. CACS values of >100 signifying moderate-severe risk were observed more commonly among patients with diabetes mellitus, hypertension (HT), older age, and smoking habits (p<0.001). Thirty-five patients (12.4%) had AKC on a chest X-ray. Patients with AKC were more likely to be categorized in the moderate-high CACS severity group than those without AKC (p<0.001). Logistic regression analysis demonstrated that HT (odds ratio [OR]: 4.413; 95% confidence interval [CI]: 1.733–11.240; p=0.002) and AKC (OR: 5.619; 95% CI: 2.280–13.848; p<0.001) were independent predictors of moderate-severe CACS values. Conclusion: It is important to establish the risk of CVD in patients with SAP using simple and non-invasive methods. Our study showed that the presence of AKC on chest X-ray is associated with higher CACS values in patients presenting with SAP. Therefore, AKC may be used more frequently for the evaluation of the risk of CVD.
Objectives: Infective endocarditis (IE) remains a significant clinical challenge due to its high morbidity and mortality rates. Prognosis is influenced by patient characteristics, causative microorganisms, complications, and echocardiographic findings. The Barcelona Bio-Heart Failure (BCN Bio-HF) Risk Score, widely used in heart failure, has not yet been evaluated in IE. This study aimed to assess the association between the BCN score and in-hospital mortality in patients with IE. Methods: This retrospective, single-center observational study included 108 patients diagnosed with IE. Patients were divided into two groups based on the occurrence of in-hospital mortality, which was defined as any death occurring during hospitalization. Clinical, demographic, laboratory, and echocardiographic data were compared between the groups. Results: Among 108 patients, 29 (26.9%) experienced in-hospital mortality. Compared to survivors, non-survivors were older (p=0.046) and had a higher prevalence of chronic kidney disease (p=0.041). Staphylococcus aureus and methicillin-resistant strains were more common in the mortality group (p=0.043 and p=0.04, respectively). Echocardiographic findings showed a lower ejection fraction (p=0.03), higher pulmonary artery systolic pressure (p=0.017), and larger vegetation size (p=0.033) in non-survivors. Mechanical complications were also more frequent (p=0.017). Laboratory results revealed lower hemoglobin (p=0.012) and higher levels of WBC (p=0.035), CRP (p=0.01), procalcitonin (p=0.02), NT-proBNP (p=0.008), and BCN Bio-HF risk score (p=0.008) in patients with in-hospital mortality. Conclusion: The BCN Bio-HF risk score showed potential in predicting in-hospital mortality in infective endocarditis by integrating clinical and biomarker data. Future studies should aim to develop IE-specific prognostic models incorporating dynamic clinical variables and novel biomarkers to enhance risk stratification and guide management.
Objectives: To examine the association between the presystolic wave (PSW), an echocardiographic parameter indicative of diastolic dysfunction (DD), and the electrocardiographic diastolic index (EDI), which is calculated using 12-lead electrocardiography (ECG), in hypertensive cases. Methods: The study included 250 consecutive patients diagnosed with hypertension, evaluated in two groups: According to PSW presence. Statistical analyses were conducted to compare demographic data, laboratory parameters, and 12-lead ECG parameters between the groups with and without PSW. Results: PSW was found to be linked to advanced age (p<0.001), systolic blood pressure (p=0.045), diastolic blood pressure (p=0.020), fasting blood glucose (p=0.015), blood urea nitrogen (p=0.044), left ventricular wall thickness (p<0.001), mitral valve late diastolic wave (A wave, p=0.002), mitral valve early diastolic wave (E wave)/early diastolic myocardial wave (E’ wave) ratio (p<0.001), E/A ratio (p=0.031), AVL R amplitude (p=0.003), V1 S amplitude (p=0.020), V5 R amplitude (p=0.004), D1 P wave duration (p=0.017), PQ interval (p=0.011), QRS duration (p=0.015), and EDI (p<0.001). Age, A wave, and EDI (p<0.001) were found to independently predict PSW presence. Conclusion: We determined that, in addition to the echocardiographic assessment of PSW, EDI, an index that can be easily calculated using a 12-lead ECG, may also be a useful parameter for evaluating DD in hypertensive patients.
Objectives: The objective of this study was to evaluate the impact of combining near-infrared spectroscopy (NIRS) and bispectral index (BIS) for monitoring cerebral oxygenation and detecting ischemia during pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods: A prospective, single-center study was conducted between March 01, 2024, and July 01, 2024, involving 50 pediatric patients undergoing congenital heart surgery. Cerebral oxygenation was continuously monitored using NIRS and BIS at 6 time points during surgery: T1 (entry), T2 (immediately after CPB initiation), T3 (deepest hypothermic temperature), T4 (post-rewarming), T5 (end of surgery), and T6 (postoperative intensive care unit [ICU]). Central venous saturation, hematocrit (Htc), temperature, mean arterial pressure (MAP), and lactate levels were also monitored. The primary outcomes included correlations between cerebral oxygenation parameters and neurological outcomes within 3 months. Results: The study was conducted with a total of 50 children cases, of which 56% (n=28) were male, and 44% (n=22) were female. The age of the cases ranged from 6 to 200 months, with a mean 42.4±52.7 months. Weight measurements ranged from 14.2 to 65 kg, with a mean of 16.3±14.3 kg. The average CPB duration was 96.1±34.8 min. The cases had an average ICU stay of 3.2±2 days. Upon reviewing the final status, it was found that there were no mortality among the patients and only three patients experienced transient neurological complications, which resolved without long-term deficits. NIRS values remained stable between 55% and 65% during surgery. BIS monitoring detected no significant decreases, supporting the absence of severe ischemia. Conclusion: Combining NIRS and BIS in pediatric cardiac surgery enhances cerebral perfusion monitoring and enables early detection of ischemic events, potentially reducing postoperative neurological complications. Larger studies are needed to validate these findings and further assess the role of intraoperative parameters such as Htc and MAP in preventing cerebral ischemia.
Objectives: Many patients undergo open-heart surgery every year due to valvular heart diseases. In a significant number of these patients, coronary angiography is performed to detect potential complications during the perioperative and post-operative treatment periods. In this study, we aimed to investigate the coexistence of coronary artery disease (CAD) in patients undergoing open-heart surgery for valvular disease and the predictive factors. Methods: Between May 2023 and January 2025, a total of 424 patients who underwent surgery due to valvular pathology were analyzed among 2,500 open-heart surgery patients. The most common types of valvular disease and the presence of CAD were examined based on coronary angiography and echocardiography results. Results: The average age of the patients was 62 years (interquartile range: 53–68). Aortic stenosis (36.6%) was found to be the most common valvular pathology associated with CAD. Overall, 29.5% of patients were diagnosed with CAD, and 70.8% of these patients underwent coronary artery bypass grafting. Factors predicting CAD in patients undergoing surgery for valvular pathology were advanced age, male gender, presence of diabetes, hyperlipidemia, peripheral artery disease, and low glomerular filtration rate. Conclusion: Despite advancements in technology, surgical and percutaneous approaches, and changes in indication spectrum, the coexistence of valvular heart disease and CAD remains high. Therefore, the presence of CAD should always be investigated in patients undergoing valvular surgery.
Objectives: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease in infancy, frequently requiring early surgical repair. Detailed pre-operative imaging is essential for assessing cardiovascular and extracardiac anatomy to guide surgical planning. While conventional invasive catheter angiography (ICA) has traditionally been used for this purpose, computed tomography angiography (CTA) has emerged as a promising non-invasive alternative with lower risk, shorter procedure times, and reduced radiation exposure. Given the vulnerability of pediatric patients, optimizing radiation dose and understanding its determinants – such as body size – are critical. The objective of the study is to compare radiation exposure, contrast agent usage, and procedural duration between CTA and ICA in the pre-operative evaluation of TOF patients under 1 year of age and to evaluate the correlation between patient anthropometric measurements and radiation dose. Methods: This retrospective single-center study included 120 TOF patients who underwent complete surgical repair between 2021 and 2024. Seventy-four patients underwent CTA and 46 underwent ICA. Data on radiation dose, contrast volume, and procedure time were collected. Correlations between effective dose and patient age, weight, height, and BMI were analyzed. Results: CTA significantly reduced effective radiation dose (1.21±0.19 mSv) compared to ICA (5.28±1.71 mSv, p<0.01), required less contrast agent (8.02±2.38 cc vs. 38.8±13.01 cc), and had a shorter procedure time (3.1±0.58 min vs. 21.03±10.79 min; p<0.001). Radiation dose was positively correlated with weight (CTA: r=0.41, p=0.0006; ICA: r=0.52, p=0.0009), height (CTA: r=0.32, p=0.0012; ICA: r=0.24, p=0.0014), and BMI (CTA: r=0.35, p=0.0008; ICA: r=0.39, p=0.0053), while no significant correlation was observed with age. Conclusion: CTA is a safe, non-invasive, and time-efficient imaging modality for the pre-operative evaluation of TOF patients, offering significant reductions in radiation dose and contrast use compared to ICA. The observed correlation between radiation dose and body size underscores the need for individualized imaging protocols in pediatric practice.
Objectives: Pericardiocentesis is a key treatment for pericardial effusion (PE), with the tamponade technique used to extract fluid from the pericardial space. The CALLY index combines the prognostic nutrition index (PNI) and C-reactive protein (CRP) to assess nutritional, immune, and inflammatory status in cancer patients. This study aims to explore how the CALLY index, assessed at admission, relates to predicting in-hospital mortality in patients with PE undergoing pericardiocentesis. Methods: This study is a retrospective observational analysis conducted at a single center. Following the application of exclusion criteria, a total of 204 patients were ultimately included in the study. The study sample was split into two groups based on whether in-hospital mortality was present or not. Results: The primary outcome of the study was that the CALLY index was lower in the in-hospital mortality group than in the survival group. In addition, in the group with in-hospital mortality, the CALLY index of pericardial fluid calculated using pericardial fluid albumin was lower than in the survival group. Univariate logistic regression analysis revealed significant correlations between in-hospital mortality and lactate, the CALLY index, as well as the CALLY index of pericardial fluid. Further analysis of these variables using multivariate logistic regression analysis indicated that lactate, the CALLY index, and the CALLY index of pericardial fluid were independent predictors for the development of in-hospital mortality. Conclusion: This study shows the prognostic importance of the CALLY index and the CALLY index of pericardial fluid for in-hospital mortality in patients with PE undergoing pericardiocentesis.
