Background/Objectives: Hematopoietic stem cell transplantation (HSCT) exposes patients to cardiovascular stress through inflammation, metabolic disturbances, and prior cardiotoxic therapies. Although overt dysfunction is uncommon early after transplantation, subclinical cardiac adaptation remains poorly defined. Methods: We evaluated early electrical and mechanical cardiac responses after HSCT using integrated electrocardiographic (ECG) and echocardiographic assessment. In this prospective cohort study, patients underwent paired pre-transplant and early post-transplant (3-6 months) ECG and comprehensive echocardiography, including tissue Doppler and speckle-tracking analyses of atrial, ventricular, and right heart function. Results: Patients were stratified into multiple myeloma (MM) and non-MM subgroups. ECG voltage increased after HSCT, particularly in MM patients, without changes in left ventricular (LV) mass, geometry, or global systolic indices, suggesting electrical-structural dissociation. Left atrial (LA) reservoir strain decreased despite stable atrial volumes. Diastolic indices showed selective modulation, including a group-time interaction in the lateral e '/a ' ratio without elevated filling pressures. Subgroup analyses suggested divergent myocardial responses, with numerical global longitudinal strain (GLS) improvement in MM patients and reduced LV deformation and right ventricular (RV) fractional area change in non-MM patients. Conclusions: Early cardiac responses after HSCT were heterogeneous and compartment-specific, supporting multiparametric imaging for detection of subclinical cardiac adaptation.

Introduction and Objectives Portopulmonary hypertension (PoPH) represents a significant pulmonary vascular complication in patients with portal hypertension, substantially increasing perioperative mortality during liver transplantation (LT). While systematic transthoracic echocardiographic (TTE) screening has become standard practice, optimal diagnostic thresholds and prevalence data across diverse populations remain incompletely characterized. This investigation sought to determine the prevalence of PoPH among LT candidates at a tertiary hepatology center, comprehensively characterize the clinical and hemodynamic profiles of affected patients, and evaluate the diagnostic efficacy of TTE screening protocols. Patients or Materials and Methods We conducted a comprehensive retrospective analysis of 422 consecutive LT candidates with portal hypertension evaluated at our tertiary center between 2007–2017. All patients underwent systematic TTE, with right heart catheterization (RHC) performed when right ventricular systolic pressure (RVSP) exceeded 40 mmHg or when indirect pulmonary hypertension indicators were present. PoPH was defined according to currently established hemodynamic criteria: mean pulmonary arterial pressure >20 mmHg, pulmonary vascular resistance >2 Wood units, and pulmonary arterial wedge pressure ≤15 mmHg. Results Among 422 patients (mean age 52.9 ± 12.3 years, 67.5 % male), chronic hepatitis B predominated (35.1 %). Fifty-two patients underwent RHC, with twenty (4.74 % of total cohort) receiving definitive PoPH diagnosis. PoPH patients demonstrated significantly higher pulmonary vascular resistance (3.51 ± 1.90 vs 1.25 ± 1.02 Wood units, p < 0.001), and transpulmonary gradient (18.05 ± 9.28 vs 9.56 ± 8.43 mmHg, p = 0.001), while reduced pulmonary arterial wedge pressure (9.45 ± 1.73 vs 13.53 ± 4.81 mmHg, p < 0.001), cardiac output (5.21 ± 0.95 vs 7.57 ± 1.38 L/min, p < 0.001), and cardiac index (2.97 ± 0.98 vs 4.15 ± 0.85 L/min/m², p = 0.023) compared to non-PoPH patients. Targeted pulmonary vasodilator therapy was initiated in three patients with mean pulmonary arterial pressure ≥35 mmHg, with two severe cases successfully bridged to LT following demonstrable hemodynamic improvement. The 40 mmHg TTE threshold demonstrated robust diagnostic performance characteristics: 95.0 % sensitivity, 93.5 % specificity, 42.2 % positive predictive value, 99.7 % negative predictive value, with positive and negative likelihood ratios of 14.7 and 0.05, respectively. Conclusions PoPH affects 4.74 % of LT candidates with portal hypertension using contemporary diagnostic criteria. Systematic TTE screening employing a 40 mmHg threshold for RVSP effectively identifies patients requiring further hemodynamic assessment, with exceptional negative predictive value enabling confident exclusion of clinically significant disease while minimizing unnecessary procedures. Early recognition coupled with targeted therapy successfully bridges selected patients to LT with excellent long-term outcomes.

BACKGROUND AND AIM: Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by pulmonary artery obstruction due to persistent organized thrombus and remodeling of pulmonary vascular structures. The treatment of CTEPH is considered a multimodal approach, including pulmonary endarterectomy (PEA) surgery, balloon pulmonary angioplasty, and medical therapy. We aimed to report our 12-year experience with CTEPH patients and identify risk factors for mortality in a real-life setting. METHODS: Patients older than 18 years, evaluated by a multidisciplinary expert team between July 1, 2011 and July 1, 2023, and diagnosed with CTEPH, were included in the study. RESULTS: The study population comprised 32 CTEPH patients with a mean age of 61.0 +/- 13.8 years and a median follow-up duration of 28 months. At the end of the follow-up period, 13 (40.6%) patients had died. A high neutrophil-to-lymphocyte ratio (NLR) and elevated B-type natriuretic peptide (BNP) levels at the time of diagnosis, along with low BNP levels and pulmonary artery pressure (PAP) changes within the first year, were observed in patients with mortality. Survival analysis, including NLR, BNP, pulmonary endarterectomy, and hematocrit (Hct) demonstrated that a high NLR and the absence of surgical treatment were independently associated with mortality. CONCLUSIONS: Our study underscores the critical role of PEA surgery in treatment of CTEPH, in addition to the importance of BNP trajectories and the neutrophil-to-lymphocyte ratio as prognostic biomarkers. Further research is needed to evaluate the reliability of easily obtained measurements, such as NLR, in categorizing high-risk patients.

Metastatic involvement of the heart, although less frequent than pri-mary cardiac tumours, poses a significant complication of malignancy. Secondary tumours often lead to pericardial effusion rather than direct myocardial infiltration. Common cancers with cardiac metastasis in-clude melanoma and primary mediastinal tumours, which can cause ob-structive lesions and arrhythmias.1The occurrence of complete heart block due to metastatic disease is particularly rare.This report describes a 64-year-old male with a history of lung adenocarcinoma presented with fatigue and worsening dyspnoea. Initial evaluation revealed a third-degree atrioventricular (AV) block, significant septal hypertrophy (28 mm), and subaortic obstruction with a maximum gradient of 25 mmHg. Advanced imaging with cardiac magnetic resonance imaging (MRI) and positron emission tomography- computed tomography (PET-CT) identified a mass encircling both ventricular outflow tracts and increased metabolic activity in the inter-ventricular septum, consistent with metastasis (Figure 1).We discuss the pathophysiological mechanisms through which car-diac metastasis can cause both AV block and left ventricular outflow tract (LVOT) obstruction. Direct myocardial invasion by metastatic tis-sue disrupts the normal conduction pathways, leading to AV block, while mass effect within the septum can lead to LVOT obstruction by physic-ally impinging on the outflow tract and altering hemodynamics.2This case is notable for the rare occurrence of cardiac metastasis re-sulting in both complete AV block and LVOT obstruction-previously reported only once in the literature, and that diagnosis was established post-mortem.2The ability to diagnose such conditions pre-mortem through multimodality imaging underscores the essential role of ad-vanced imaging in identifying atypical manifestations of metastatic cancer

Background: Combined pulmonary fibrosis and emphysema (CPFE) has been recognised as a phe-notype of pulmonary fibrosis. We aimed to compare serum surfactant protein-A (SP-A), surfactant protein-D (SP-D) and Krebs von den Lungen-6 (KL-6) levels, functional parameters, in CPFE and IPF (idiopathic pul-monary fibrosis) patients. Methods: Patients diagnosed with ???CPFE??? and ???IPF??? were consecutively included in 6 months as two groups. The patients with connective tissue diseases are excluded. Results: In this study, 47 patients (41 males, 6 females) with CPFE (n = 21) and IPF (n = 26) with a mean age of 70.12 ?? 8.75 were evaluated. CPFE patients were older, had more intense smoking history, had lower DLCO/VA, lower FVC, and worse six-minute walking distance than the IPF group (p=0.005, p=0.027, p=0.02, p<0.001, p=0.001, respec-tively). Serum KL-6 levels were higher in CPFE group compared to IPF group [264.70 U/ml (228.90-786) vs 233.60 (101.8-425.4), p<0.001]. Serum KL-6 levels of 245.4 U/ml and higher have 81% sensitivity and 73% specificity for the discrimination of CPFE from IPF. Conclusions: Our study has shown that serum KL-6 level is a promising biomarker to differentiate CPFE from IPF. In CPFE cases respiratory and functional parameters are worse than those of pure fibrosis cases.

Background Combined pulmonary fibrosis and emphysema (CPFE) has been recognised as a phenotype of pulmonary fibrosis. We aimed to compare serum surfactant protein-A (SP-A), surfactant protein-D (SP-D) and Krebs von den Lungen-6 (KL-6) levels, functional parameters, in CPFE and IPF (idiopathic pulmonary fibrosis) patients. Methods Patients diagnosed with 'CPFE' and 'IPF' were consecutively included in 6 months as two groups. The patients with connective tissue diseases are excluded. Results In this study, 47 patients (41 males, 6 females) with CPFE (n = 21) and IPF (n = 26) with a mean age of 70.12 ± 8.75 were evaluated. CPFE patients were older, had more intense smoking history, had lower DLCO/VA, lower FVC, and worse six-minute walking distance than the IPF group (p=0.005, p=0.027, p=0.02, p<0.001, p=0.001, respectively). Serum KL-6 levels were higher in CPFE group compared to IPF group [264.70 U/ml (228.90-786) vs 233.60 (101.8-425.4), p<0.001]. Serum KL-6 levels of 245.4 U/ml and higher have 81% sensitivity and 73% specificity for the discrimination of CPFE from IPF. Conclusions Our study has shown that serum KL-6 level is a promising biomarker to differentiate CPFE from IPF. In CPFE cases respiratory and functional parameters are worse than those of pure fibrosis cases.

Objectives:The aim of this study is to examine the prevalence and predictors of microalbuminuria and to investigate the association between microalbuminuria and pulse pressure among patients with isolated systolic and diastolic hypertension (DH). Materials and Methods:In this cross-sectional study, patients with DH and isolated systolic hypertension (ISH) were included.Data including patient age, sex, duration of hypertension (HT), comorbidities, and drugs were recorded.Blood analysis of serum total cholesterol, high D-density lipoprotein (HDL) cholesterol, triglyceride, urea, creatinine, and fasting blood glucose, urinalysis, electrocardiography (ECG), transthoracic echocardiography, exercise stress test (EST), and coronary angiography (if the patient had a positive EST result) were performed.Results: Overall, we included 183 patients (58.5% female) with HT.The patients with ISH had significantly higher pulse pressure, left ventricular (LV) mass, and LV mass index, but had a shorter duration of HT and lower diastolic blood pressure than those with DH.All patients were in sinus rhythm, and there were no ischemic ECG changes.Fifty-

Hyperkalemia is a common electrolyte abnormality in heart failure (HF) that can cause potentially life-threatening cardiac arrhythmias and sudden cardiac death. HF patients with diabetes, chronic kidney disease and older age are at higher risk of hyperkalemia. Moreover, hyperkalemia is also often associated with the use of renin-angiotensin-aldosterone system inhibitors (RAASi) including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and sacubitril-valsartan. In clinical practice, the occurrence of hyperkalemia is a major concern among the clinicians and often limits RAASi use and/or lead to dose reduction or discontinuation, thereby reducing their potential benefits for HF. Furthermore, recurrent hyperkalemia is frequent in the long-term and is associated with an increase in hyperkalemia-related hospitalizations. Therefore, management of hyperkalemia has a special importance in HF patients. However, treatment options in chronic management are currently limited. Dietary restriction of potassium is usually ineffective with variable adherence. Sodium polystyrene sulfonate is commonly used, but its effectiveness is uncertain and reported to be associated with intestinal toxicity. New therapeutic options such as potassium binders have been suggested as potentially beneficial agents in the management of hyperkalemia. This document discusses prevalence, predictors and management of hyperkalemia in HF, emphasizing the importance of careful patient selection for medical treatment, uptitration of the doses of RAASi, regular surveillance of potassium and treatment options of hyperkalemia.

Introduction: Peripartum cardiomyopathy is a rare disease that is difficult to diagnose and treat. Clinical findings are similar with heart failure. New treatments are needed in addition to the treatment of heart failure. Case Report: A 32-year-old woman presented with symptoms of heart failure 4 days after first delivery. Chest X-ray showed cardiomegaly. Serum BNP level was high. Transthoracic echocardiography (TTE) indicated dilated left atrium and left ventricle, severe mitral regurgitation and ventricular dysfunction. The global longitudinal strain was – 9.1%. Cardiac magnetic resonance imaging (MRI) revealed mid-myocardial staining detected in late phase images. Concomitant bromocriptine (2,5 mg po twice a day for 15 days and then 2,5 mg po once a day for 15 days) was used with standard heart failure therapy. At 6 months, TTE and cardiac MRI revealed normal biventricular function and size. Global longitudinal strain was –14%. Conclusion: Patients with peripartum cardiomyopathy may benefit from bromocriptine.

Bu çalışmada Bursa Uludağ Üniversitesi Tıp Fakültesi’nde değerlendirilen ve karaciğer nakli yapılan hastalardaki latent tüberküloz sıklığını ve tedavi durumlarını incelemeyi amaçladık. Son 2 yıl içerisinde karaciğer nakli amacıyla başvuran 16’sı kadın 60 hasta çalışmaya alındı. Yaş ortalaması 53,8 idi. Olguların değerlendirmesinde 39 olguda tüberkülin cilt testi (TCT) 5 mm ve üzerinde pozitif olarak değerlendirildi. Olguların 25’inde karaciğer nakli gerçekleşmişti. Bütün olgular Göğüs Hastalıkları Anabilim Dalı tarafından değerlendirilerek TCT pozitif olan olgulara izoniyazid profilaksisi önerildi. Tedavi önerilen olguların sadece 3 tanesinin ilacını kullandığı saptandı. Latent tüberküloz tedavisi başlanılması önerilen olguların sadece %8’inin tedavi aldığını saptadık. Latent tüberküloz tedavisi karaciğer nakli olan hastalarda TCT pozitifliği saptanması durumunda rehberler tarafından kuvvetle önerilmektedir. Olgularımızda bu çalışmayı yaparak uyum oranının çok düşük olduğunu saptadık. Düzenli takiplere gelen bu hastaların profilaksi tedavisini kullanmaları yönünde değerlendirilmesi gerekmektedir.

Background: This study examined whether the serum PON1 activity is different in patients with ischaemic dilated cardiomyopathy (IDCM) and nonischaemic dilated cardiomyopathy (NDCM) and the relation between the serum PON1 activity and serum pro-BNP levels. Methods and results: In this study, we enrolled 60 patients with left ventricular systolic failure (New York Heart Association [NYHA] class III-IV) and a left ventricular ejection fraction (EF) < 40% as determined by echocardiography and 30 healthy subjects. The patients with systolic heart failure were divided into two groups: patients with IDCM and patients with NDCM. Blood samples were obtained to measure the serum PON1 activity and the serum pro-BNP levels. The median serum PON1 activities were lower among the patients with IDCM or with NDCM compared with the control subjects (p <.001, p = .043, respectively). Compared with the control subjects, the patients with IDCM or with NDCM had higher serum pro-BNP levels (p < .001, p < .001, respectively). The serum PON1 activity was negatively correlated with the serum pro-BNP levels in patients with IDCM (r = -0.548, p < .001). The area under the ROC curve of the serum PON1 activity was 0.798. Using a serum PON1 activity of 201.3 U/L as a cut-off value, the sensitivity was 86.84% and specificity was 66.67% for the diagnosis of IDCM. Conclusions: In this study, the serum PON1 activity was significantly reduced in the patients with IDCM or with NDCM compared with the control subjects. The serum PON1 activity of the patients with IDCM was negatively correlated with the serum pro-BNP levels.

Background and aims: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of largescale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2). Methods: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH. Results: A-HIT1 evaluated 88 patients (27 +/- 11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 +/- 7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 +/- 13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 +/- 13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 +/- 8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population. Conclusions: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed.

Valvular disease continues to be an important cause of morbidity and mortality across the globe with an increasing number of elderly patients affected by degenerative valvular diseases. Mitral valve disease is the most common of the valvular heart disorders, particularly in ageing populations, with a prevalence of more than 10% in people aged older than 75 years. Mitral regurgitation (MR) is divided into either primary (or organic) or secondary (or functional) MR. It is necessary to distinguish primary from secondary MR because these diseases differ not only by their cause, but also by their prognosis and management. Mitral stenosis is usually due to rheumatic disease, but annular calcification might cause obstruction in mitral valve , particularly in the elderly population. Because of the accompanying risk factors and comorbidities with the increasing age, surgical interventions have been replaced by catheter based alternative treatment options.

This report describes a case of spontaneously developing bilateral perirenal fluid accumulation in a patient under monitoring for tetralogy of Fallot. The causal pathophysiology of perirenal fluid accumulation in patients with tetralogy of Fallot is unidentified. As a result of comprehensive examinations we establish that perirenal fluid develops due to high hematocrit. Perirenal fluid did not relapse after repeated phlebotomy treatment. Our case is the first to describe the combination of tetralogy of Fallot and perirenal fluid accumulation in the literature

Heart failure is an important community health problem. Prevalence and incidence of heart failure have continued to rise over the years. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. Co-morbidities in heart failure have negative impact on clinical course of the disease, further impair prognosis, and add difficulties to treatment of clinical picture. Therefore, successful management of co-morbidities is strongly recommended in addition to conventional therapy for heart failure. One of the most common co-morbidities in heart failure is presence of iron deficiency and anemia. Current evidence suggests that iron deficiency and anemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as those with heart failure and preserved ejection fraction. Moreover, iron deficiency and anemia are referred to as independent predictors for poor prognosis in heart failure. There is strong relationship between iron deficiency or anemia and severity of clinical status of heart failure. Over the last two decades, many clinical investigations have been conducted on clinical effectiveness of treatment of iron deficiency or anemia with oral iron, intravenous iron, and erythropoietin therapies. Studies with oral iron and erythropoietin therapies did not provide any clinical benefit and, in fact, these therapies have been shown to be associated with increase in adverse clinical outcomes. However, clinical trials in patients with iron deficiency in the presence or absence of anemia have demonstrated considerable clinical benefits of intravenous iron therapy, and based on these positive outcomes, iron deficiency has become target of therapy in management of heart failure. The present report assesses current approaches to iron deficiency and anemia in heart failure in light of recent evidence.

The prevalence of heart failure increases with age. Several specific changes in cardiac structure and function are associated with cardiac ageing. Because of age-associated changes leading to diastolic dysfunction, heart failure with preserved ejection fraction is the most common form of heart failure in the elderly. The diagnosis of heart failure may be difficult to diagnose in elderly patients because of a lack of typical symptoms and physical findings. The elderly patients may respond differently to heart failure medications. Age-associated changes in physiology, comorbidities, drug interaction, medication side-effects, and compliance should be considered when choosing a drug to manage heart failure in the elderly.