Background:Left main coronary artery (LMCA) aneurysms are exceedingly rare, found in ∼0.1% of coronary angiograms, and acute coronary syndromes are an uncommon first presentation. When the aneurysm involves the distal LMCA and its bifurcation, percutaneous covered-stent treatment is generally not feasible, leaving surgical and medical therapy as the only realistic options, with no controlled data to favour either. Case summary:We report two male patients presenting with non-ST-elevation myocardial infarction and thrombosed distal LMCA aneurysms. Both patients were evaluated by a multidisciplinary heart team but received divergent therapeutic strategies. Case 1 (44-year-old male) underwent surgical revascularization with coronary artery bypass grafting and aneurysm ligation following unsuccessful percutaneous recanalization of the left circumflex artery. Case 2 (65-year-old male) declined surgery and was managed medically with intensive antiplatelet and anticoagulation therapy. Both remained asymptomatic during three months of follow-up. Discussion:This case series underscores the diagnostic and therapeutic complexity of thrombosed distal LMCA aneurysms. Although surgical exclusion of the aneurysmal sac may, on anatomical grounds, be hypothesized to reduce the risk of recurrent thromboembolism, medical management remains a legitimate option in selected patients who decline or are unsuitable for surgery. The risk of recurrent thrombosis in medically managed patients remains incompletely characterized, and the short follow-up in our cases limits long-term conclusions. In the absence of randomized controlled trials, management decisions must be individualized through multidisciplinary heart team discussion, incorporating aneurysm size, morphology, thrombus burden, clinical presentation, and patient preferences.

Diagnosis of symptoms and elucidating their association with quality of life in patients with heart failure may contribute to more effective symptom management and enhancement of quality of life. This study aimed to examine symptoms of the patients with heart failure and the relationship between the symptoms and quality of life. This cross-sectional and correlational study was conducted with a convenience sample of 242 patients in a training and research hospital. Data were collected using the Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF) and the Minnesota Living With Heart Failure Questionnaire (MLHFQ). Descriptive statistics and hierarchical linear multiple regression analysis were used for data analysis. The mean prevalence of the symptoms experienced by the patients was 15.14±6.52. The physical symptoms with the highest prevalence and burden were fatigue, difficulty breathing when lying flat, and shortness of breath, while the psychological symptoms with the highest prevalence and burden were nervousness, uneasiness, and anxiety. The physical and psychological symptoms were found to have a significant relationship with the total (p < 0.001; p=0.026, respectively) and physical (p < 0.001; p=0.004, respectively) quality of life. However, the physical symptoms were not found to be significantly related to the emotional quality of life (p=0.156). The prevalence and burden of symptoms are high among patients with heart failure, and both physical and psychological symptoms have a significant relationship with total quality of life. Applying self-care and other intervention strategies can contribute to easing symptoms and improving quality of life and other patient outcomes.

Percutaneous closure of secundum atrial septal defects (ASDs) is a standard procedure. However, it is not without risk, and complications can be severe even in apparently straightforward cases. A 19-year-old male (80 kg, 170 cm), with a history of infantile strabismus, underwent percutaneous closure of a small (11 × 12 mm) secundum ASD with adequate rims using an 18 mm Occlutech septal occluder.The procedure was performed under general anesthesia and transesophageal echocardiography (TEE) guidance, and the device initially appeared well positioned. The following day, routine transthoracic echocardiography (TTE) failed to visualize the device, and a diagnostic error led to the device’s location being misinterpreted as a pulmonary artery on fluoroscopy. Emergency surgery was performed to remove the device and close the defect, but the device was not found. Post-operatively, real-time 3D Computed Tomography (CT) located the device in the aortic arch. It was subsequently retrieved percutaneously. During extubation, the patient developed agitation and confusion, and a cranial CT revealed a right posterior cerebral artery infarction, resulting in left homonymous hemianopsia. Follow-up neurological assessment and MRI confirmed the ischemic sequelae. Interestingly, the patient’s pre-existing strabismus completely resolved. The potential etiology of the cerebral ischemic event includes thromboembolism from the device or catheter manipulation. This case highlights that severe complications, including device embolization to unexpected systemic locations and subsequent cerebrovascular events, can occur even in low-risk ASD closures. It underscores the critical importance of meticulous, multi-view intra procedural and post-procedural imaging to prevent diagnostic errors. The unexpected resolution of strabismus following a posterior cerebral artery infarct suggests a complex neuro-ophthalmological phenomenon requiring further investigation.

Aims Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality globally. While it impacts both sexes, women are frequently underdiagnosed and undertreated, particularly in lipid management. This study aimed to evaluate sex differences, and the gender-related factors potentially underlying them, in lipid control, the utilization of lipid-lowering therapy (LLT), and related perceptions within a large real-world cohort. Methods We analyzed 1,482 patients with established ASCVD from the nationwide, multicenter EPHESUS registry, conducted in 40 cardiology outpatient clinics across Turkey. Differences between women and men in risk profiles, LLT use, low density lipoprotein-cholesterol (LDL-C) goal attainment, and perceptions from both patients and physicians were assessed. Women and men were compared before and after 1:1 propensity score matching for age and education; covariate balance was quantified with standardized mean differences (SMD). Results Women showed a greater burden of cardiometabolic conditions such as hypertension, diabetes, and obesity, yet were less often prescribed statins. Total cholesterol, HDL-C, non-HDL-C and on-treatment LDL-C were higher in women than in men, whereas triglycerides were similar between the sexes; on-treatment LDL-C was significantly higher in women (115 mg/dL vs. 100 mg/dL, p < 0.001). Women also met LDL-C targets less frequently according to the 2016 ESC/EAS guidelines (14.9% vs. 19.6%, p = 0.017), while the difference for the 2019 target was not significant (6.3% vs. 8.3%, p = 0.186). After matching, 924 patients (462 women and 462 men) remained; age and education were well balanced (SMD < 0.05), whereas cardiometabolic covariates remained imbalanced by design. Differences in lipid levels were no longer apparent, and among patients receiving high-intensity statins women more frequently achieved the 2016 LDL-C target (26.0% vs. 13.6%, p = 0.017), whereas the corresponding difference for the 2019 target did not reach statistical significance (10.7% vs. 4.5%, p = 0.072). Media influence was the most common physician-reported reason for LLT cessation; side effects and physician-advised discontinuation were reported more often for women, although these differences were not statistically significant. Conclusion Age and education accounted for a substantial part of the observed differences between women and men in ASCVD care, whereas lower statin prescription in women persisted after matching. Studies addressing sex differences should incorporate gender-related demographic factors into their design and analysis.

Background The relationship between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) is well-established. Recently, non-high-density lipoprotein cholesterol (non-HDL-C) has been validated as a superior predictor of ASCVD, especially in individuals with mild to moderate hypertriglyceridemia. The EPHESUS study evaluated real-life hypercholesterolemia management and awareness of non-HDL-C in cardiology outpatient practices. Methods Data from 1868 patients with ASCVD or high-risk primary prevention were analyzed to assess cholesterol goal attainment, statin adherence, and physician perceptions. This analysis focused on awareness of non-HDL-C as an ASCVD predictor, adherence to lipid-lowering therapy, and clinicians’ perceptions. Associations between patient demographics, clinical characteristics, and statin adherence were examined. Results Among patients, 20.2% achieved non-HDL-C and 16.5% achieved LDL-C goals. In primary prevention, 18.1% reached non-HDL-C and 10.6% reached LDL-C goals, while in secondary prevention, 20.8% and 18.0% met these goals. High-intensity statin therapy was observed in 21.2% of patients, with 30.3% and 24.3% achieving non-HDL-C and LDL-C targets, respectively. Statin use was lower in women than men (54.0% vs 66.9%, P < 0.001). Women less frequently achieved non-HDL-C and LDL-C goals in both prevention groups. Conclusions Non-HDL-C goal attainment remains suboptimal in both primary and secondary prevention of hypercholesterolemia, particularly in women who had lower statin use and goal achievement. These findings highlight the need for improved awareness, education, and treatment strategies to reduce residual cardiovascular risk and improve outcomes.

BACKGROUND:The recent 2019 European Society of Cardiology/European Atherosclerosis Society practice guidelines introduced a new risk categorization for patients with diabetes. We aimed to compare the implications of the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines with regard to the lipid-lowering treatment use, low-density lipoprotein cholesterol goal attainment rates, and the estimated proportion of patients who would be at goal in an ideal setting.METHODS:Patients with diabetes were classified into 4 risk categories according to 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidemia guidelines from the database of EPHESUS (cross-sectional, observational, countrywide registry of cardiology outpatient clinics) study. The use of lipid-lowering treatment and low-density lipoprotein cholesterol goal attainment rates were then compared according to previous and new guidelines.RESULTS:This analysis included a total of 873 diabetic adults. Half of the study population (53.8%) were on lipid-lowering treatment and almost one-fifth (19.1%) were on high-intensity statins. While low-density lipoprotein cholesterol goal was achieved in 19.5% and 7.5% of patients, 87.4% and 69.6% would be on target if their lipid-lowering treatment was intensified according to 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society lipid guidelines, respectively. The new target <55 mg/dL could only be achieved in 2.2% and 8.1% of very high-risk primary prevention and secondary prevention patients, respectively.CONCLUSION:The control of dyslipidemia was extremely poor among patients with diabetes. The use of lipid-lowering treatment was not at the desired level, and high-intensity lipid-lowering treatment use was even lower. Our simulation model showed that the high-dose statin plus ezetimibe therapy would improve goal attainment; however, it would not be possible to get goals with this treatment in more than one-third of the patients.

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a common inherited disease, leading to premature atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Achieving LDL-C goals is extremely important for preventing the complications of this fatal disease. We evaluated the management of FH patients with ASCVD in cardiology practice. METHODS: We analyzed patients with ASCVD from the nationwide EPHESUS registry, which was conducted in 40 cardiology outpatient clinics, and compared those with and without FH. RESULTS: Of the 1482 consecutively enrolled patients with ASCVD, 618 (41.7%) had FH, among which 455 were categorized as 'Possible FH' and 163 as 'Probable or Definite FH'. Proposed LDL-C goals were not attained in more than 90% of the patients with FH. The proportion of those on statin therapy was 77% for possible and 91% for probable or definite FH, whereas 34.2 % and 59.4% were in use of high-intensity statins, respectively. None of the patients were on PCSK-9 inhibitors, and only 2 used ezetimibe. Adverse media coverage was the most common cause of statin discontinuation (32.5% in 'possible FH' and 45.7% in 'probable/definite FH'). The negative impact of media in the decision to stop lipid lowering therapy (LLT) was increasing with education level. CONCLUSIONS: In real life most of the FH patients with ASCVD are undertreated in cardiology practice regarding statin dosing and combined LLT. Drug discontinuation rates are notably high and are mostly media-related, and side effects very rarely cause cessation of LLT. Urgent measures are needed to increase the awareness of FH among healthcare providers and patients and to develop improved treatment strategies aimed at preventing the complications of FH. (c) 2023 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Background: Heart failure with preserved ejection fraction is a complex and heterogeneous clinical syndrome, poses significant diagnostic challenges. The HFA-PEFF [Heart Failure Association of ESC diagnostic algorithm, P (Pretest Assessment), E (Echocardiographic and Natriuretic Peptide score), F1 (Functional testing in Case of Uncertainty), F2 (Final Aetiology)] and H2FPEF [Heavy (BMI>30 kg/m2), Hypertensive (use of ≥2 antihypertensive medications), atrial Fibrillation (paroxysmal or persistent), Pulmonary hypertension (Doppler Echocardiographic estimated Pulmonary Artery Systolic Pressure >35 mm Hg), Elderly (age >60 years), Filling pressure (Doppler Echocardiographic E/e' >9)] scoring systems were developed to aid in diagnosing heart failure with preserved ejection fraction. This study aimed to assess the concordance and clinical accuracy of these scoring systems in the 'A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON' cohort. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON study was conducted as a multicenter, cross-sectional, and observational study; to evaluate a group of Heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction patients who were seen by cardiologists in 13 participating centers across 12 cities in Türkiye. Results: The study enrolled 819 patients with heart failure with preserved ejection fraction, with high probability heart failure with preserved ejection fraction rates of 40% and 26% for HFA-PEFF and H2FPEF scorings, respectively. The concordance between the 2 scoring systems was found to be low (Kendall's taub correlation coefficient of 0.242, P < .001). The diagnostic performance of both scoring systems was evaluated, revealing differences in their approach and ability to accurately identify heart failure with preserved ejection fraction patients. Conclusion: The low concordance between the HFA-PEFF and H2FPEF scoring systems underscores the ongoing challenge of accurately diagnosing and managing patients with heart failure with preserved ejection fraction. Clinicians should be aware of the strengths and limitations of each scoring system and use them in conjunction with other clinical and laboratory findings to arrive at an accurate diagnosis. Future research should focus on identifying additional diagnostic factors, developing more accurate and comprehensive diagnostic algorithms, and investigating alternative methods of diagnosis or stratification of patients based on different clinical characteristics.

Objective: The association between the nutritional status and outcomes in pulmonary embolism is unclear. This study was aimed at examining the value of the Controlling Nutritional Status (CONUT) score in assessing malnutrition among acute pulmonary embolism patients. Subject and Methods: We retrospectively reviewed the records of adult patients with acute pulmonary embolism hospitalized through our ED. Demographic, clinical, and laboratory data on admission were recorded. Nutritional status was assessed with the CONUT score, which is calculated by the albumin, total cholesterol, and lymphocyte counts. The primary endpoint of the study was in-hospital mortality. Results: A total of 308 consecutive patients (mean age 68.2 ± 12.9 years, 53.9% female) were included, and 35 of the patients (11.4%) died during their in-hospital course. Multivariate analysis showed that a pulmonary embolism severity index >148 (OR 3.12, 95% CI: 1.65–8.81, p < 0.001), the presence of heart failure (1.25, 95% CI: 1.08–1.78, p = 0.03), and a CONUT score >4 (OR 1.39, 95% CI: 1.146–3.424, p = 0.015) were independent predictors of in-hospital mortality. Conclusion: The present study indicates that the presence of malnutrition defined by the CONUT score predicts in-hospital mortality following acute pulmonary embolism.

Objective: Indications and appropriateness of aspirin use have not been well investigated in Turkey. Therefore, the aim of this study is to investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting. Methods: The ASSOS study is a cross-sectional, multicenter registry involving consecutive cardiology patients who were using aspirin. Patients were divided into two groups according to the use of aspirin; primary prevention and secondary prevention group. The indication of aspirin use was evaluated according to 2016 the European Society of Cardiology (ESC) and 2016 the United States Preventative Services Task Force (USPTF) guidelines in the primary prevention group. Results: A total of 5007 patients (mean age 62.15± 11.05, 39% female) were enrolled. The primary prevention group included 1132 (22.6%) patients and the secondary prevention group included 3875 (77.4%) patients. Of the 1132 patients, inappropriate use of aspirin was determined in 100% of the patients according to the ESC guidelines, and 71 % of the patients according to the USPTF guidelines. Conclusion: Although there are considerable differences between the USPTF and the ESC guidelines with respect to recommendations for aspirin use in primary prevention, inappropriate use of aspirin in Turkey is frequent in real-world practice for both guidelines.

Objective: The aim of this study was to describe the current status of aspirin use and the demographic characteristics of patients on aspirin for primary and secondary prevention of cardiovascular diseases. Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) trial was a multicenter, cross-sectional, and observational study conducted in Turkey. The study was planned to include 5000 patients from 14 cities in Turkey. The data were collected at one visit, and the current clinical practice regarding aspirin use was evaluated (ClinicalTrials.gov number NCT03387384). Results: The study enrolled all consecutive patients who were admitted to the outpatient cardiology clinics from March 2018 until June 2018. Patients should be at least 18 years old, have signed written informed consent, and on aspirin (80-325 mg) therapy within the last 30 days. Cardiologists from the hospital participates in the study. Patients were divided into 2 categories according to presence or absence of atherosclerotic cardiovascular disease, namely secondary prevention group and primary prevention group, respectively. The appropriate use of aspirin in the primary and secondary prevention groups was assessed according to the European Society of Cardiology guidelines and US Preventive Services Task Force. The patients' gastrointestinal bleeding risk factors and colorectal cancer risk were evaluated. Conclusion: The ASSOS registry will be the most comprehensive and largest study in Turkey evaluating the appropriateness of aspirin use. The results of this study help understand the potential misuse of aspirin in a real-world setting.

Objective: The aim of this study was determine the rate of achievement of lifestyle, risk factors and drug therapy targets recommended for the secondary prevention in coronary artery patients and of the effects such as age, gender and event type on the achievement of risk factor targets Methods: This cross-sectional study enrolled 136 patients with coronary artery disease who had an acute myocardial infarction, coronary artery bypass graft, and percutaneous coronary intervention. The data related to the risk factors, lifestyle, and drug therapies were determined using questionnaires, anthropometric and laboratory measurements. Data analysis was conducted using descriptive statistics and the Pearson's Chi-square test. Results: Of the patients, 19.9% were smokers, 44.8% were inactive, 41.2% were obese, and 36.8% did not maintain a healthy diet. Furthermore, 44.1% had elevated total cholesterol, 78.7% had low-density lipoprotein cholesterol >= 70 mg/dL, 35.3% had blood pressure >= 140/90 mm/Hg, and 52.1% of patients previously diagnosed with diabetes had a glycated hemoglobin A1c >= 6.5%. Elderly patients had high low-density lipoprotein cholesterol and were physically inactive whereas younger patients had high smoking rates. Only 39.7 % used lipid-lowering medication. Conclusion: Results of this study showed that the achievement rate of treatment targets recommended for secondary prevention in coronary artery patients was low. Age was a factor affecting control rate of smoking, physical activity and low-density lipoprotein cholesterol.

The possibilities of selective screening to reduce the costs of screening programmes for breast cancer were considered. Discriminant function analysis was used in an effort to describe a high-risk group of breast cancer, which will be subjected to screening. The high-risk group consisted of females with a combination of reproductive and hormone use characteristics. One-fifth of the breast cancer cases remained in the low-risk group, when the high-risk group was small enough (two-thirds of the population) to yield a meaningful reduction in costs. Selective screening for breast cancer seems to have only limited applicability and is not effective enough for application in public health work.

Objective: The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF. Methods: This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared. Results: In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p<0.001) and more symptomatic, with a higher rate of classification as New York Heart Association functional class III IV, paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, pulmonary crepitations, and peripheral edema. The hospitalization rate for heart failure was higher (28.4% vs 12.6%; p<0.001) in patients with AF, and participants with AF had higher level of N-terminal pro-B-type natriuretic peptide (887 pg/mL vs 394.8 pg/mL; p<0.001) and higher left atrial volume index level. Patients without AF had a higher burden of diabetes mellitus, obstructive sleep apnea, and coronary artery disease. The prescription rate of nondihydropyridine calcium blockers, digoxin, loop diuretics, and anticoagulant drugs was higher in the AF group. Conclusion: The results of this study revealed that in a large Turkish cohort with HFpEF, significant clinical differences were present between those with and without AF and. Further prospective studies are needed to clarify the prognostic implications of AF in this growing heart failure population in our country.

Background: To determine and compare the demographic characteristics, clinical profile and management of patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) in a Turkish cohort. Methods: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is an observational and multicenter study conducted in Turkey. Consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had HFmrEF or HFpEF were included (NCT326114). Results: The study population included 1065 (mean age of 67.1 +/- 10.6 years, 54% women) patients from 12 sites in Turkey. Among participants, 246 (23.1%) had HFmrEF and 819 (76.9%) had HFpEF. Compared to patients with HFpEF, those with HFmrEF were more likely to be male (57.7 vs 42.2%; p < 0.001), had higher N-terminal pro-B-type natriuretic peptide levels (853 vs 528 pg/ml, p < 0.001), were more likely to have ECG abnormalities (72.4 vs 53.5%, p < 0.001) and hospitalization history for heart failure (28 vs 18.6%; p = 0.002). HFmrEF patients were more likely to use beta-blockers (69.9 vs 55.2%, p < 0.001), aldosterone receptor antagonists (24 vs 14.7%, p = 0.001), statins (37 vs 23%, p < .001), and loop diuretics (39.8 vs 30.5%, p = 0.006) compared to patients with HFpEF. Conclusions: The results of APOLLON study support that the basic characteristics and etiology of HFmrEF are significantly different from HFpEF. This registry also showed that the patients with HFmrEF and HFpEF were younger but undertreated in Turkey compared to patients in western countries.