Objectives: Diabetes mellitus is a common comorbidity in patients with atrial fibrillation (AF), but the impact of glycemic control on clinical outcomes in this population remains incompletely characterized. This study aimed to compare clinical outcomes between AF patients with poorly controlled versus well-controlled diabetes mellitus. Materials and Methods: We performed a retrospective cohort study using the TriNetX Research Network, a global federated health research platform providing access to electronic medical records across 128 healthcare organizations. Adult patients (18-90 years) with type 2 diabetes mellitus and AF were stratified based on HbA1c levels: poorly controlled diabetes (HbA1c ≥7.0%) and well-controlled diabetes (HbA1c ≤6.9%). After propensity score matching for baseline demographics and comorbidities, cohorts of 332,060 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiogenic shock, heart failure, ventricular tachycardia, acute kidney injury (AKI), cerebrovascular disease, chronic kidney disease (CKD), coronary artery disease (CAD), and hypertension. Outcomes were analyzed using risk analysis and Kaplan-Meier survival analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) over a five-year follow-up period. Results: In this propensity-matched cohort study, patients with poorly controlled diabetes demonstrated significantly higher all-cause mortality compared to those with well-controlled diabetes (26.3% vs. 25.6%; HR: 1.070, 95% CI: 1.060-1.080; p<0.001). Poor glycemic control was associated with increased risk of heart failure (23.1% vs. 22.8%; HR: 1.071, 95% CI: 1.056-1.086; p<0.001), AKI (19.8% vs. 18.3%; HR: 1.132, 95% CI: 1.117-1.148; p<0.001), and CKD (19.4% vs. 17.8%; HR: 1.161, 95% CI: 1.145-1.178; p<0.001). Poorly controlled patients also had higher rates of CAD (18.3% vs. 17.9%; HR: 1.079, 95% CI: 1.062-1.096; p<0.001). Conversely, well-controlled diabetes was associated with reduced cardiogenic shock (2.2% vs. 2.3%; HR: 0.995, 95% CI: 0.963-1.028; p=0.771) and ventricular tachycardia (5.1% vs. 4.8%; HR: 0.977, 95% CI: 0.956-1.000; p=0.048). Conclusion: Among patients with diabetes mellitus and AF, poor glycemic control is associated with significantly increased mortality and higher rates of cardiovascular and renal complications. These findings emphasize the importance of optimal glycemic control in diabetic patients with AF to improve clinical outcomes and reduce adverse events.
Objectives: Acute iliofemoral deep vein thrombosis (DVT) is distinguished by a pronounced symptomatology and an increased risk of post-thrombotic syndrome. Various techniques of prompt thrombus removal are intended to improve venous patency and outcomes; however, controversy still surrounds the appropriate modality of endovascular treatment and the necessity of routine stenting. In this study, we aimed to evaluate the procedural safety, efficacy, and intermediate-term outcomes of a standard stent-free pharmacomechanical thrombectomy with catheter-directed thrombolysis (PMT-CDT) in acute iliofemoral DVT. Materials and Methods: This was a retrospective single-center study of 50 consecutive patients undergoing treatment for acute iliofemoral DVT between January 2020 and December 2023. All patients underwent a standardized endovascular treatment protocol using PMT and low-dose CDT without the routine use of venous stenting. Technical success, periprocedural complications, and re-thrombosis were evaluated. Estimation of re-thrombosis-free survival was performed using Kaplan-Meier survival analysis at 3, 6, and 12 months. Results: Technical success was obtained in 46 patients (92%). There were no deaths, pulmonary embolism, and major hemorrhage. Minor complications occurred in five patients (10%) and were managed conservatively. During the period of follow-up, five patients (10%) were lost to follow-up. Kaplan-Meier estimates showed that the probability of freedom from re-thrombosis at 3 months, 6 months, and 12 months was 97.5%, 92.5%, and 87.5%, respectively. Venous stent insertion was not necessary in any patient after thrombus clearance based on venographic assessment. Conclusion: In this study, a standard stent-free PMT-CDT approach was shown to be a feasible and safe option for selected patients with acute iliofemoral DVT, with good mid-term patency results. However, these results should be interpreted with caution, as this study was descriptive in nature, without any standard evaluation of outcome, such as post-thrombotic syndrome scoring. Further prospective studies are needed to clarify the role of stent-free techniques in managing acute iliofemoral DVT.
The differential diagnosis of a mitral valve mass includes infectious vegetation, papillary fibroelastoma, and, rarely, cardiac myxoma. Distinguishing these masses from other valvular lesions is crucial, as the management strategies can differ significantly. We present a case of a 69-year-old man admitted to the cardiac emergency unit with chest pain. Further investigations revealed ST-elevation myocardial infarction affecting both the anteroseptal and inferior walls, along with pulmonary edema. Transthoracic echocardiography revealed severe mitral regurgitation associated with an oscillating mass originating from the anterior mitral leaflet, measuring 13 mm x 10 mm. Despite negative blood cultures, the mitral valve mass was initially managed as infective endocarditis. However, the patient failed to demonstrate any significant clinical improvement. Subsequent coronary angiography identified two-vessel coronary artery disease with a SYNTAX II score of 22. Given these findings, the decision was made to proceed with coronary artery bypass grafting in conjunction with resection of the mitral valve mass and mitral valve replacement. Histopathological analysis of the excised tissue ultimately revealed the characteristics of a cardiac myxoma.
Parkinson’s disease (PD) is a common neurodegenerative disorder that is becoming increasingly prevalent in the United States. Current research suggests a possible bidirectional relationship between cardiovascular disease (CVD) and PD. This review aims to synthesize relevant evidence to analyze the interplay between CVD and PD. Researchers utilized academic databases to find current and relevant studies that met the defined inclusion and exclusion criteria. After reviewing various articles, a majority of evidence suggests a correlation between CVD and worsening prognosis for PD patients regarding mortality, cardiac dysfunction, and blood pressure. Conflicting and inconclusive studies are acknowledged within this review, showing the complexity of this subject and the need for continuing research to determine causality. Future research should adopt a prospective study design with stricter diagnostic methods and detailed sample demographics to identify confounding variables. The underlying biological and physiological background within these diseases should also be studied to help better understand the interplay between CVD and PD.
Objectives: Postoperative atrial fibrillation (POAF) is common after coronary artery bypass grafting (CABG). Gamma-glutamyl transferase (GGT), an index of oxidative injury, could provide predictive information regarding POAF. Materials and Methods: Patients who underwent on-pump or off-pump CABG between January 2019 And December 2023 were included in this retrospective cohort study. Both pre- and post-CABG GGT concentrations were documented. POAF events were continuously monitored by means of telemetry. Tables provide information on demographics, biochemical measures, and POAF outcomes. Results: A total of 183 patients were included in the analysis. POAF occurred more frequently in on-pump patients (35%) Than in off-pump patients (20%). Postoperative GGT levels were significantly higher in the POAF group. estimated p-values are included in all the tables below. Conclusion: High levels of postoperative GGT are correlated with POAF after CABG.
Objectives: Atrial fibrillation (AF), a common cardiac arrhythmia with significant stroke risk, is expected to increase in prevalence with an ageing population. Cardiac computed tomography angiography (CCTA) is a non-invasive imaging modality that provides detailed cardiac and extracardiac anatomical information, particularly relevant for preprocedural assessment of AF catheter ablation. This study aimed to determine the prevalence of extracardiac findings (ECFs) during CCTA performed prior to AF catheter ablation. Materials and Methods: This retrospective single-center study reviewed data from 163 patients with AF who underwent catheter ablation between January 2021 and January 2022. Among the 163 patients, 140 (85.88%) underwent preprocedural CCTA. ECFs were defined as newly detected findings necessitating follow-up, diagnostic workup, or therapeutic measures, excluding known abnormalities and clinically nonsignificant findings. Results: Out of the 140 patients who underwent CCTA, 50 patients (35.7%) had 52 incidental ECF. Pulmonary findings were the most common, including pulmonary nodules (>6 mm) in 20 patients (14.2%), pulmonary infiltrates in 8 patients (5.71%), and a pulmonary mass in 1 patient (0.71%). Other significant findings included aortic aneurysms in 3 patients (2.13%), enlarged mediastinal lymph nodes in 8 patients (5.71%), abdominal mass in 1 patient (0.71%), and unclear liver lesions in 5 patients (3.55%). Two incidental findings led to the postponement of the AF catheter ablation procedure. Conclusion: Pre-procedural CCTA serves as a valuable opportunistic screening tool, identifying significant ECF in over one-third of patients. These findings underscore the importance of multidisciplinary collaboration between cardiology and radiology to optimize comprehensive patient management in these workflows.
Objectives: Myocardial ischemia-reperfusion injury remains a major source of morbidity in cardiac surgery, and novel strategies for cardioprotection are needed. Preoperative dietary modulation has been proposed as a feasible approach to enhance myocardial resilience. This study investigated the effects of preoperative plant-based versus animal-based diets (ABD) on myocardial protection in a rat model of cardioplegic arrest, with emphasis on apoptosis, oxidative stress, and stress response markers. Materials and Methods: Sixteen male Wistar albino rats were initially randomized to receive either a plant-based diet (PBD) (soy protein, palm oil) or an ABD (casein, milk fat) for 12 weeks. Due to peri-experimental losses, final analyses were performed on 6 rats in the PBD group and on 7 rats in the ABD group. At the end of the feeding period, rats underwent a standardized cardioplegic arrest induced by St. Thomas II crystalloid solution, resulting in 10 minutes of ischemia; blood cardioplegia was then administered prior to tissue harvesting. Left ventricular tissues were harvested for biochemical analysis. Bcl-2 and Bax, glutathione (GSH), protein carbonyls and malondialdehyde (MDA), and heat shock protein 70 (Hsp-70) were measured as markers of apoptosis, redox defense, oxidative damage, and stress response, respectively. Results: Bcl-2 levels were significantly higher in the PBD group compared to the ABD group (11.28±1.22 vs. 9.50±1.25, p=0.025), indicating enhanced antiapoptotic signaling. Among other markers, Bax, MDA, protein carbonyls, and GSH showed trends favoring the PBD group that were not statistically significant, whereas Hsp-70 levels were numerically higher in the ABD group but not statistically significant. Conclusion: In this experimental rat model of cardioplegic arrest, preoperative plant-based nutrition enhanced antiapoptotic signaling through significant upregulation of Bcl-2, while other oxidative and apoptotic markers showed favorable but not statistically significant trends. These findings suggest that diet composition can influence myocardial resilience to surgical stress, supporting the potential role of plant-based preoperative regimens as an adjunct to established cardioprotective strategies. Further validation in larger studies is warranted.
Objectives: Early risk stratification in acute coronary syndrome (ACS) is crucial for guiding management and improving outcomes. Although established scores such as thrombolysis in myocardial infarction and Global Registry of Acute Coronary Events are widely used, their complexity and reliance on multiple parameters may limit practicality in emergency settings. We aimed to investigate whether a simple combination of three routinely available parameters, shock index (SI), neutrophil-to-lymphocyte ratio (NLR), and serum creatinine, could predict 30-day major adverse cardiovascular events (MACE) in ACS patients. Materials and Methods: This single-center retrospective cohort study included 500 consecutive ACS patients [ST-elevation myocardial infarction (STEMI), non-STEMI, unstable angina] admitted between January 2021 and December 2022. SI was calculated as heart rate divided by systolic blood pressure; NLR was obtained from a routine blood count; and serum creatinine was measured on admission. We evaluated the association of these parameters, individually and in combination, with 30-day MACE, defined as all-cause mortality, recurrent myocardial infarction, urgent target-vessel revascularization, or stroke. Logistic regression, ROC analysis, calibration plots, and decision curve analysis were performed. Results: Thirty-day MACE occurred in 56 patients (11.2%). SI ≥0.8 [odds ratio (OR): 2.10; 95% confidence interval (CI): 1.28-3.44], NLR ≥3 (OR: 1.85; 95% CI: 1.14-3.01), and creatinine >1.2 mg/dL (OR: 2.28; 95% CI: 1.39-3.75) were independent predictors. The model combining all three parameters demonstrated strong discriminative ability (area under the curve: 0.80; 95% CI: 0.74-0.85) and performed better than the individual parameters. Conclusion: The three-parameter model (SI, NLR, creatinine) provides a rapid, low-cost, and practical method for bedside risk stratification in ACS patients. This simple model demonstrates strong predictive accuracy for 30-day MACE and may serve as a complementary tool to established risk scores. Further multicenter studies are required to validate its utility.
Objectives: This study aims to compare the outcomes of peripheral cannulation (PC) and central cannulation (CC) techniques in redo cardiac surgeries. Materials and Methods: A retrospective analysis was conducted on 104 patients who underwent redo cardiac surgery between January 2010 and January 2023. Patients were divided into two groups based on the cannulation technique used: PC (n=56) and CC (n=48). Preoperative, intraoperative, and postoperative parameters were collected and analyzed. Results: Significant differences were observed in cardiopulmonary bypass time (127.1±13.6 minutes for PC vs. 120.1±15.4 minutes for CC, p=0.021) and total operation time (295.7±40.4 minutes for PC vs. 249.9±39.5 minutes for CC, p<0.001). The incidence of procedure-related injuries was significantly lower in the PC group (5.4% vs. 31.2%, p=0.036). Overall complications were also significantly lower in the PC group (10.7% vs. 35.4%, p<0.001). Postoperative ventilation duration was shorter in the PC group (5.4±1.1 hours vs. 6.0±1.5 hours, p=0.036). Hemoglobin, C-reactive protein, and ejection fraction levels pre- and postoperatively showed no significant differences between the groups. These findings suggest that PC may offer a safer alternative with fewer complications in redo cardiac surgeries. Conclusion: PC may offer a safer alternative with fewer complications in redo cardiac surgeries compared to CC. These findings suggest the potential benefits of using PC in reducing procedure-related injuries and overall complications.
Pheochromocytoma (PHEO) is a rare catecholamine-secreting neuroendocrine tumor arising from the chromaffin cells of the adrenal medulla. PHEO can occur at any age, but it is most common in people in their 3th and 5th decades. The rule of 10s for PHEO still holds true: 10% are familial, 10% are bilateral, 10% are extra-adrenal, 10% occur in children, and 10% are malignant. The exact number of PHEO patients is unknown because most individuals with PHEO are asymptomatic. With the increase and advancement of imaging methods today, the diagnosis rate has increased, but despite technological advances, only a very small percentage (<1%) of people with high blood pressure are diagnosed with PHEO. Catecholamine-induced cardiomyopathy in PHEO is a comparatively rare but very difficult to manage complication of PHEO. We present a case of cardiomyopathy due to a PHEO attack triggered by herbal slimming tea in a young female patient.
Objectives: Gender plays a crucial role in shaping experiences and needs in healthcare. Investigating metaphors used by men and women provides valuable insights into gender-based differences, particularly in the context of complex surgeries like open-heart surgery (OHS). However, the use of metaphors to understand patient perspectives in such surgeries remains underexplored. This study aimed to explore the emotions and insights of patients before OHS through metaphorical expressions. Materials and Methods: The study was conducted using the metaphor analysis technique based on the phenomenological method. Metaphor analysis, as a qualitative research approach, provides an in-depth understanding of lived experiences. The COREQ statement, a 32-item checklist for reporting qualitative studies, was followed to ensure transparency and rigor. The sample consisted of 62 patients. Results: More than half of the patients (n=33) were male. Most patients (n=38) were primary school graduates, 28 of them were retired, and almost all of them (n=57) were married. Coronary artery bypass grafting was planned for 45 of the patients. The patients’ ages ranged from 37 to 85 years. Patients produced 38 different metaphors for OHS, frequently including repair, salvation, recreation, goodness, fear, anxiety, and guidance. The metaphors were categorized into four themes: the mechanical perspective, the spiritual perspective, the cognitive-emotional perspective, and the accepting perspective. Male patients more frequently used mechanical and accepting metaphors, whereas female patients predominantly expressed spiritual and cognitive-emotional metaphors. Conclusion: This study highlights the importance of understanding the metaphors patients use to express their experiences before OHS. Recognizing these metaphorical representations can enhance patient care by addressing emotional and spiritual needs. Providing spiritual support, such as prayers and rituals, can reduce anxiety and positively influence recovery. Importantly, considering gender-based differences in metaphorical expressions can help healthcare professionals tailor patient education and support strategies more effectively, offering a more holistic approach to care. Future studies should further investigate how gender-specific metaphorical expressions influence coping strategies and recovery outcomes in patients undergoing OHS.
Objectives: This study aimed to investigate the cardioprotective effects of bosentan, an endothelin receptor antagonist, against myocardial ischemia-reperfusion injury (MIRI) in rats. Materials and Methods: Twenty-four adult Wistar-Albino rats were randomly divided into four groups: control, bosentan only, myocardial ischemia-reperfusion (MIR), and MIR-bosentan (MIR-B). Ischemia was induced by ligation of the left anterior descending coronary artery for 30 minutes, followed by 90 minutes of reperfusion. Bosentan was administered intraperitoneally at 30 mg/kg during ischemia in the MIR-B group. Histopathological evaluation assessed neutrophil infiltration, cardiomyocyte damage, tissue edema, and hemorrhage, while biochemical analyses measured total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and paraoxonase-1 (PON-1) activity in myocardial tissue. Results: The MIR group showed significantly increased histopathological injury scores, including neutrophil infiltration, cardiomyocyte damage, edema, and hemorrhage, compared to control and bosentan-only groups (p<0.001). Bosentan treatment significantly reduced these injury scores in the MIR-B group compared to the MIR group (p<0.05). Biochemically, the MIR group exhibited elevated TOS and OSI levels and reduced TAS and PON-1 activity, indicating oxidative stress. Bosentan administration significantly improved these parameters by lowering TOS and OSI levels, and by increasing TAS and PON-1 activity compared to the MIR group (p<0.05). Conclusion: In conclusion, bosentan demonstrated significant protective effects against MIRI by attenuating histological damage and oxidative stress in rat myocardium. These findings suggest that endothelin receptor antagonism with bosentan may offer a promising therapeutic approach to reduce myocardial injury following ischemia-reperfusion events such as those occurring during coronary artery bypass grafting. Further studies are needed to explore its clinical potential.
Hemodialysis access in small children with genetic syndromes and end-stage renal failure possesses various challenges. Traditional options may quickly support an upper sternal approach over thoracotomy to enhance exposure and facilitate effective catheter placement. Overall, eight attempts were made in two cases involving both techniques. Either thoracotomy or sternotomy has inherited advantages and disadvantages. However, the sternal approach allows wider exposure, more precise catheter placement, and easier future surgeries.
Objectives: This study aimed to compare the data on mortality of the clinical scoring system that predicts the risk of ischemia-bleeding under dual therapy. Materials and Methods: The records of the patients were retrospectively examined through the hospital information system and archival records. The prepared case data registration form and the Morisky Medication Adherence scale drug compliance scale were filled out. With these data, the patients’ predicting bleeding complications in Patients Undergoing Stent Implantation and Subsequent dual antiplatelet therapy (PRECISE-DAPT) and DAPT scores were calculated. Results: A total of 260 patients were included in the study. The PRECISE-DAPT and DAPT scores were calculated for the patients with acute coronary syndrome. A total of 62 patients (23.8%), exhibited a PRECISE-DAPT score of ≥25. The number of patients with a DAPT score ≥2 was found to be 193 (74.2%). In terms of mortality, patients with PRECISE-DAPT ≥25 and those with PRECISE-DAPT <25 were compared with another group (score should be specified here), and mortality was significantly higher in the high-score group [p=0.001 odds ratio: 6.94 confidence interval: (3.53-13.62)]. Patients were divided into 4 groups based on PRECISE-DAPT and DAPT scores and compared with each other (PRECISE-DAPT <25 and DAPT ≥2, PRECISE-DAPT ≥25 and DAPT ≥2, PRECISE-DAPT <25 and DAPT <2, PRECISE-DAPT ≥25 and DAPT <2). Patients with a high PRECISE-DAPT score had a significantly higher mortality rate compared to those with a lower DAPT score (p<0.001). Conclusion: In our study, we discovered that the bleeding risk score was insufficient for predicting bleeding events, but it could identify high-risk patients in terms of mortality.
Objectives: Aortic arch abnormalities are frequently observed in neonates and may be associated with other congenital cardiac anomalies. Various surgical approaches exist for the repair of these abnormalities. This study aimed to review the outcomes of aortic arch surgery in neonates and infants. Materials and Methods: We retrospectively analyzed patients who underwent aortic arch reconstruction with or without intracardiac anomalies between 2017 and 2022. The subjects were categorized into two groups based on the arch reconstruction technique employed: group 1 underwent patch aortoplasty via sternotomy, whereas group 2 underwent arch reconstruction without a patch via thoracotomy. Demographic information, morbidity rates, and mortality statistics were extracted from the departmental database for the analysis. Results: This study enrolled 37 patients (25 males and 12 females). Twenty-nine patients were assigned to group 1, while eight patients were allocated to group 2. No significant differences were observed in the preoperative variables between the two groups. The overall median age and weight were 11 days (range: 2-270) and 3.1 kg (range: 1.4-5.6), respectively. Nine patients had a weight <2.5 kg. Twenty-eight patients underwent concomitant cardiac procedures. The 30-day mortality rate was 10.8% (n=4), with all deceased patients belonging to STAT Mortality Category 4 (n=31). No mortality was observed in the patients with isolated hypoplastic aortic arch or concomitant ventricular septal defect repair. At a median follow-up of 27 months, three patients in group 2 developed restenosis and underwent surgical correction. In group 1, restenosis was observed in only one patient, who was treated with balloon angioplasty. The incidence of recurrent arch obstruction was significantly higher in group 2 (p=0.02). Conclusion: Aortic arch repair with patch through sternotomy represents a safe and efficacious approach, offering potential for intervention in intracardiac anomalies. The implementation of a patch facilitates tension-free anastomosis and optimal arch geometry, while demonstrating an acceptable rate of restenosis.
Objectives: Lead extraction is a critical procedure for managing complications in patients with cardiovascular implantable electronic devices. The potential predictive value of inflammatory indices, such as the systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and prognostic nutritional index (PNI), in determining procedural outcomes remains unclear. This study aimed to evaluate the relationship between complications following lead extraction and inflammatory indices in patients undergoing the procedure, with a particular focus on those treated for infectious versus non-infectious causes. Materials and Methods: This retrospective, single-center study analyzed patients who underwent lead extraction between 2019 and 2020. Complications, including hematoma, pericardial effusion, and sudden cardiac death, were assessed. Multivariate logistic regression identified predictors of adverse outcomes, and ROC curve analysis evaluated the predictive value of SII, PIV, and PNI. Results: Among the 234 patients included (mean age 62, 81% male), complications occurred in 25.6% (n=60), with mortality recorded in 3.8%. Hematoma and pericardial effusion were observed in 12% and 14.5% of patients, respectively. ROC analysis revealed no significant association between the inflammatory indices (SII, PIV, PNI) and complications. Multivariate logistic regression identified diabetes mellitus (DM) as a significant independent predictor of complications (p<0.05). No differences in outcomes were noted between infectious and non-infectious lead extraction subgroups. Conclusion: While inflammatory indices showed limited predictive utility, DM emerged as a critical risk factor for complications following lead extraction. Comprehensive preprocedural risk stratification, with attention to metabolic conditions such as diabetes, is essential to improving procedural outcomes. Further studies are needed to refine predictive models incorporating both systemic and procedure-specific variables.
