Background and Aim: Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. Prognostic models such as the Get With the Guidelines-HF (GWTG-HF) score are validated for predicting in-hospital mortality, but data from critically ill populations in South India are limited. To validate the predictive accuracy of the GWTG-HF score for hospital mortality in acute decompensated HF (ADHF) cases managed in a tertiary intensive care unit (ICU). Materials and Methods: In this prospective observational study, 67 adults admitted with HF over three months were enrolled. Patients with chronic kidney disease, thyroid disorders, valvular heart disease, pulmonary arterial hypertension, or pregnancy were excluded. Clinical, laboratory, and hemodynamic data were collected, and GWTG-HF scores were calculated at admission. Patients were stratified into low (0-33), moderate (34-50), and high (>50) risk groups. Outcomes included in-hospital mortality and ICU stay. Statistical tests included analysis of variance, Kruskal-Wallis, chi-square/Fisher’s exact, and receiver operating characteristic (ROC) curve analysis. Results: Of 67 patients, 61 (91%) survived and 6 (9%) died. Mortality increased across risk groups: 0% in low, 9.3% in moderate, and 28.6% in high (P = 0.012). Non-survivors had higher mean GWTG-HF scores (47.7±7 vs. 38.4±8.1; P = 0.013) and lower sodium levels (128±4 vs. 134.6±6.3 mmol/L; P = 0.007). ROC analysis showed good discrimination (area under the curve: 0.754). At a cut-off ≤47, sensitivity was 66.7%, specificity 85.2%, and negative predictive value 96.3%. ICU stay was longer in higher-risk groups (P = 0.041). Conclusion: The GWTG-HF score demonstrated good predictive performance for in-hospital mortality in ICU patients with ADHF. Its strong negative predictive value supports its use for identifying low-risk patients, while incorporating biomarkers such as N-terminal pro-brain natriuretic peptide may enhance prognostic accuracy.
Background and Aim: Type 2 diabetes mellitus (T2DM) is a significant risk factor for cardiovascular diseases, leading to subclinical left ventricular systolic dysfunction (LVSD). Early detection is crucial to prevent progression. To assess the utility of mitral annular plane systolic excursion (MAPSE) in detecting subclinical LVSD in asymptomatic T2DM patients and its correlation with 2D speckle-tracking echocardiography and tissue Doppler imaging (TDI) parameters. Materials and Methods: A cross-sectional comparative study involving 200 participants (100 with T2DM and 100 controls) was conducted. Echocardiographic parameters, including MAPSE, global longitudinal strain (GLS), and TDI, were analysed. Statistical tests included t-tests and Pearson correlation analyses. Results: T2DM patients showed significantly reduced MAPSE (1.2±0.3 cm vs. 1.4±0.2 cm, P < 0.001), GLS (-17.2±3.1% vs. -22.6±2.7%, P < 0.001), and TDI (0.08±0.02 m/s vs. 0.10±0.01 m/s, P < 0.001) compared with controls. MAPSE correlated positively with GLS (r=0.699, P = 0.001) and TDI [r=0.04, P = 0.03; 95% confidence interval (CI): 0.01-0.07] and negatively with HbA1c (r=-0.018, P = 0.02; 95% CI: -0.04-0.00) and diabetes duration (r=-0.117). Conclusion: MAPSE <1.2 cm, a value supported by previous echocardiographic studies, identifies subtle impairment of longitudinal systolic function in asymptomatic T2DM patients. MAPSE demonstrates strong agreement with GLS and TDI and provides a simple, reproducible, and accessible marker for detecting subclinical LVSD, particularly in resource-limited settings.
Background and Aim: Octogenarians (≥80 years) with acute coronary syndrome (ACS) represent a high-risk group due to comorbidities, frailty, and atypical clinical presentations, which pose significant management challenges. There is limited evidence to guide optimal management, especially regarding the choice between conservative and invasive strategies. This study examines the clinical characteristics, treatment approaches, and short-term outcomes in this population. Materials and Methods: In this multi-center observational study, 197 octogenarian ACS patients were enrolled between January 2022 and August 2024. Patients were categorized into conservative (57.4%) and invasive (42.6%) management groups. Demographics, comorbidities, clinical presentation, and geriatric assessments (Fried Frailty Scale, Confusion Assessment Method, Geriatric Depression Scale) were collected. Outcomes assessed included in-hospital and 30-day mortality, reinfarction, bleeding (Bleeding Academic Research Consortium ≥3), and target vessel revascularization (TVR). Results: The cohort was predominantly non-ST-elevation ACS (88.3%) with high frailty (53.8%). Selection bias was notable: the conservative group had more peripheral vascular disease (38.9% vs. 19.0%, P = 0.003) and delirium (42.5% vs. 26.2%, P = 0.02), while the invasive group had higher Global Registry of Acute Coronary Events scores (P = 0.039) and body mass index (P = 0.028). In-hospital (5.9% vs. 7.9%) and 30-day mortality (9.6% vs. 15.9%) were lower in the invasive group, though these differences were not statistically significant. The invasive group had a higher TVR rate (13.1% vs. 0.0%, P < 0.001) and a trend toward lower reinfarction (3.5% vs. 10.6%, P = 0.12). Major bleeding rates were similar (13.1% vs. 9.7%, P = 0.61). Conclusion: Geriatric syndromes have a substantial impact on ACS management in octogenarians. Frailty and delirium are associated with a preference for conservative care. In appropriately selected patients, invasive treatment appears safe and associated with numerical reduction of recurrent ischemic events without increasing short-term risk. Comprehensive geriatric assessment is essential for individualized treatment planning.
Background and Aim: Electrocardiography (ECG) remains the cornerstone for diagnosing cardiac arrhythmias. The purpose of this study was to assess the diagnostic performance of a smartphone-based ECG device (Spandan Ultra 12-lead) compared with a standard 12-lead ECG device for detecting common cardiac arrhythmias (bradycardias, tachycardias, and ectopic arrhythmias), with a cardiologist as the reference standard. Materials and Methods: The study was a prospective, cross-sectional, single-blind, observational, comparative diagnostic accuracy study conducted in 321 patients aged ≥20 years who exhibited signs of arrhythmias. For analysis of diagnostic performance, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, F-score, positive and negative likelihood ratios [(positive likelihood ratio (PLR) and negative likelihood ratio (NLR)], Matthews correlation coefficient (MCC), and the Farrington-Manning score were used to provide a comprehensive evaluation. Results: The mean age was 51.95±14.51 years; 50.47% were male. The smartphone-based ECG demonstrated higher sensitivity (86.54% vs. 77.80%), specificity (93.68% vs. 91.38%), PPV (72.58% vs. 64.61%), NPV (97.29% vs. 95.31%), accuracy (92.52% vs. 89.09%), F1 score (0.79 vs. 0.70), PLR (13.7 vs. 9.05), MCC (0.75 vs. 0.64), area under the curve (0.851 vs. 0.846), and lower NLR (0.14 vs. 0.24) compared with the standard 12-lead ECG. The Farrington-Manning non-inferiority test demonstrates that the smartphone-based ECG was non-inferior to the standard 12-lead ECG on all validation parameters. Conclusion: The Spandan Ultra 12-lead smartphone-based ECG is a reliable diagnostic tool for detecting common bradycardias, tachycardias, and ectopic arrhythmias. Its simultaneous multichannel recording enables rapid and accurate rhythm assessment, demonstrating comparable diagnostic performance to that of the standard 12-lead ECG and serving as a complementary diagnostic tool for detecting common arrhythmias.
Background and Aim: Adequate comprehension of drug information leaflets is essential for safe medication use, particularly in cardiology where elderly patients and polypharmacy are common. This study evaluated the readability of patient information leaflets for commonly used cardiovascular drugs in Türkiye. Materials and Methods: Instructions for use (IFU) and short product information (SPI) sections of 28 cardiovascular drugs (10 NOACs, 9 antiarrhythmics, and 9 antiplatelets) were analyzed using two validated Turkish readability formulas: Ateşman, Bezirci and Yılmaz. Structural text parameters were also quantified. Results: SPI sections contained significantly higher word, sentence, and character counts than IFU sections (P < 0.001). Despite these differences, overall Ateşman readability scores did not differ significantly between IFU and SPI. However, SPI sections of antiarrhythmic drugs demonstrated significantly lower readability and required higher estimated educational levels compared with their IFU counterparts (P < 0.05). Conclusion: The readability of cardiovascular drug leaflets, particularly SPI sections of antiarrhythmic medications, may exceed the educational level of a substantial proportion of elderly patients. Simplification of written drug information may improve patient understanding and medication safety.
Coronary artery perforation (CAP) is an uncommon yet clinically significant complication that may occur during percutaneous coronary intervention. Ongoing advances in interventional devices and techniques have enabled treatment of increasingly complex lesions, including heavily calcified or tortuous vessels and chronic total occlusions, thereby contributing to a higher incidence of CAP. Early recognition and implementation of appropriate treatment strategies are crucial for reducing mortality and complications associated with CAP. In this case series, we report nine cases of CAP that were successfully managed with timely recognition and appropriate intervention, achieving favorable in-hospital outcomes without in-hospital mortality or need for urgent surgical intervention.
The global prevalence of methamphetamine and other amphetamine-type stimulants (ATS) continues to rise, contributing substantially to cardiovascular morbidity and mortality. ATS-associated cardiomyopathy (ATSAC) is an increasingly recognized but underdiagnosed cause of heart failure in young adults. This case report aims to describe the clinical presentation, management, and outcome of ATSAC and to highlight its potential reversibility with stimulant cessation and guideline-directed medical therapy (GDMT). A 24-year-old male with a long-standing history of polysubstance ATS abuse presented with progressive dyspnea and symptoms of acute decompensated heart failure. Comprehensive clinical evaluation, laboratory testing, echocardiography, and cardiac magnetic resonance imaging excluded alternative etiologies of cardiomyopathy. On admission, the patient demonstrated severe left ventricular systolic dysfunction with a left ventricular ejection fraction of 14%. GDMT for heart failure was initiated, alongside sustained cessation of stimulant use and multidisciplinary follow-up. Serial echocardiographic assessments over 12 months documented marked clinical and functional improvement. This case illustrates that ATSAC should be considered in young patients presenting with otherwise unexplained cardiomyopathy. Importantly, it demonstrates that significant—and potentially complete—recovery of cardiac function is achievable with early recognition, abstinence from stimulant use, and appropriate medical management. Further research is warranted to identify predictors of reversibility, clarify underlying mechanisms of myocardial injury, and develop standardized diagnostic and therapeutic strategies for ATSAC.
Background and Aim: Coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide, underscoring the need for early detection of CAD before myocardial infarction (MI) develops. Materials and Methods: This cross-sectional study included 471 Iraqi participants (126 controls, 126 confirmed CAD with MI and 149 suspected CAD without MI) assessed at cardiology departments in Baghdad. Biochemical parameters, including asymmetric dimethylarginine (ADMA), lipid profile, C-reactive protein, and cardiac troponin I, were measured. One-way analysis of variance showed significant differences in all parameters among confirmed CAD patients. Results: Four machine learning models—logistic regression, support vector machine, random forest, and XGBoost—were applied to evaluate the detection capacity of ADMA under two clinical classes: C1) all groups (A, B, and C); and C2) A and C only. In C1, random forest achieved the highest overall area under the curve (AUC): (0.803), while logistic regression and support vector machine showed overfitting driven by MI. In C2, random forest (AUC: 0.822) and XGBoost (AUC: 0.781) maintained clinically relevant discriminatory power. Shapley Additive exPlanations analysis confirmed ADMA as the primary marker in early CAD. This study demonstrates that ADMA, combined with machine learning, enhances the detection of subclinical CAD and provides a more reliable risk-stratification tool prior to progression to acute coronary events. Conclusion: DMA showed significant differences across groups. Random forest retained its diagnostic ability in suspected cases, supporting early detection. ADMA indicated potential for early detection of CAD in the suspected group. Random forest and XGBoost demonstrate the strongest diagnostic performance for clinical decision-making.
This study compares the effectiveness of fluoroscopy versus non-fluoroscopy procedures during percutaneous closure of atrial septal defects (ASD) in children. The clinical concern surrounding radiation exposure in children and medical staff is well recognized. A systematic review and meta-analysis were conducted using PubMed, ScienceDirect, and Cochrane databases, including studies up to February 2024. Prospective studies were assessed for risk of bias and effect sizes were calculated using standard mean differences (MD) and log risk ratios. Out of 18 studies, five were included in qualitative analysis and four in the meta-analysis. Findings indicated significantly higher success rates in the non-fluoroscopy group compared to the fluoroscopy group [odds ratio (OR) =3.40, P < 0.001], shorter procedure times (MD =12.59), and a lower risk of postoperative complications (OR =3.22). Non-fluoroscopy-guided ASD closure appears to be a more effective and safer approach in pediatric patients.
Background and Aim: Coronary artery disease (CAD) is a major contributor to mortality in those with diabetes. Chronic hyperglycaemia exacerbates endothelial dysfunction, vascular inflammation, and atherosclerosis, hence worsening the severity of CAD. The SYNTAX score II (SSII) is a common tool for assessing the complexity of CAD and guiding treatment decisions. This study seeks to evaluate the severity of CAD in diabetic patients using the SSII and examining the association between glycated hemoglobin (HbA1c) and additional risk factors. Materials and Methods: An observational study was conducted at SRM Medical College Hospital and Research Centre, enrolling 121 diabetic patients with angiographically confirmed CAD. SSII was applied to classify patients into low (<22), intermediate (23-32), and high (≥33) risk categories. Logistic regression and chi-square tests were employed to assess the associations between HbA1c levels, duration of diabetes, and severity of CAD. Results: The average HbA1c was 8.53%±1.68, and the diabetes duration was 7.17±4.64 years. Higher HbA1c levels were significantly associated with severe CAD (P = 0.040), with each 1% increase in HbA1c raising the odds of high-risk SSII by 62.9% [odds ratio (OR) =1.62, P = 0.014]. Prolonged diabetes duration (OR =1.13, P = 0.049) and reduced left ventricular ejection fraction (OR =0.0004, P = 0.019) were also independent predictors. Conclusion: Elevated HbA1c levels and prolonged diabetes duration are strongly associated with CAD severity in diabetic patients. SSII functions as a valuable instrument for risk stratification and the formulation of treatment plans.
Lev’s disease is an age-related degenerative conduction disorder characterized by progressive fibrosis and calcification of the His-Purkinje system and adjacent structures. It typically manifests in elderly patients as advanced atrioventricular (AV) block and is often associated with calcific valvular disease. This case report describes a 74-year-old man with a history of stable, non-obstructive coronary atherosclerosis who presented with dizziness and was found to have complete AV block with a ventricular escape rhythm of 36 beats per minute. Transthoracic echocardiography demonstrated severe aortic stenosis with an aortic valve area of 0.96 cm². Contrast-enhanced computed tomography revealed extensive aortic valve calcification extending into the interventricular septum, raising strong clinical-radiological suspicion of Lev’s disease due to the anatomical proximity of the His bundle. Surgical risk stratification using Society of Thoracic Surgeons and European System for cardiac operative risk evaluation II indicated an elevated operative risk. Given the patient’s advanced age, severe symptomatic aortic stenosis, and persistent conduction abnormality, the multidisciplinary Heart Team recommended transcatheter aortic valve implantation (TAVI) rather than surgical replacement. The patient underwent successful TAVI followed by dual-chamber pacemaker implantation for persistent AV block and remained pacemaker-dependent with a stable rhythm and resolution of symptoms during follow-up. This case underscores that degenerative conduction disease may remain clinically silent until irreversible AV block occurs. Unlike most reports describing new-onset conduction disturbances after TAVI, our patient already presented with complete AV block and imaging demonstrated extension of septal calcification involving the conduction system. Although histopathological confirmation and prior serial electrocardiogram were unavailable, this case highlights the potential role of advanced imaging in identifying patients at increased risk for permanent pacemaker dependence, thereby enabling more accurate risk stratification and guiding closer follow-up.
Background and Aim: Originally developed to predict the progression of paroxysmal atrial fibrillation, the hypertension (1 point), age >75 years (1 point), transient ischemic attack or stroke (2 points), chronic obstructive pulmonary disease (1 point), heart failure (2 points) (HATCH) score has recently been explored as a broader prognostic tool in cardiovascular medicine. This study investigates the relationship between the HATCH score and the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, a well-established measure of coronary artery disease (CAD) complexity, among patients with chronic coronary syndrome (CCS). Materials and Methods: We retrospectively analyzed data from 235 patients who underwent coronary angiography for suspected CAD between January 2023 and May 2024. Patients were categorized into two groups based on their SYNTAX scores: low (≤22) and intermediate-high (>22). Demographic, clinical, and laboratory parameters—including the HATCH score—were compared between groups. Univariate analyses and Firth’s penalized logistic regression were performed to identify independent predictors of higher SYNTAX scores. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminative performance of the HATCH score. Results: Patients with intermediate-high SYNTAX scores were significantly older, were more likely to have hypertension, heart failure, prior percutaneous coronary intervention, and renal dysfunction, and had lower left ventricular ejection fraction than those with low SYNTAX scores. Among all evaluated variables, the HATCH score emerged as the strongest independent predictor of intermediate-high coronary complexity [odds ratio: 3.815; 95% confidence interval (CI): 2.656-4.233; P < 0.001]. ROC analysis demonstrated good discriminative capacity, with an area under the curve of 0.805 (95% CI: 0.740-0.870; P < 0.001). A HATCH score cut-off of ≥2 yielded a specificity of 87% and a sensitivity of 72%. Conclusion: The HATCH score, based on accessible clinical parameters, is independently associated with CAD complexity in CCS patients. Its simplicity and high specificity make it a useful tool for early risk stratification in clinical practice. Prospective multicenter studies are needed to validate its prognostic value and clinical utility.
Background and Aim: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with high morbidity and mortality. The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification provides a structured approach to risk stratification. This study examines the predictors of in-hospital and 30-day mortality among AMI-CS patients using the SCAI staging classification. Materials and Methods: A prospective cohort study was conducted on 150 patients admitted with AMI-CS at Department of Cardiology, Ain Shams University Hospitals from November 2023 to August 2024. Patients were categorized into SCAI stages (A to E) at presentation and reassessed 24 hours later. Demographic, clinical, biochemical, and hemodynamic parameters were collected. Results: At presentation, 35.3% of patients were in stage A, 4% in stage B, 54.7% in stage C, 4.7% in stage D, and 1.3% in stage E. Overall in-hospital and 30-day mortalities were 28.7% and 37.3%, respectively. Higher SCAI stages correlated with increased mortality (P < 0.001). Independent predictors of mortality included a Sequential Organ Failure Assessment score greater than 5 [odds ratio (OR) =8.17, P < 0.001], an APACHE score greater than 7 (OR =3.71, P = 0.008), and a serum creatinine level greater than 1.53 mg/dL (OR =5.37, P = 0.005). The SCAI score at 24 hours demonstrated superior predictive accuracy for in-hospital mortality (area under the curve =0.889). Conclusions: SCAI staging is a valuable prognostic tool for MI patients with CS. Reassessment at 24 hours enhances mortality prediction, emphasizing the importance of dynamic risk stratification.
