Background and Objectives: Long-term prognosis after acute coronary syndrome (ACS) may reflect multidomain baseline characteristics. We evaluated outcome-independent mixed-data phenotypes and post hoc additive frameworks for all-cause mortality. Materials and Methods: Of 3801 consecutive patients hospitalized with ACS during 2017–2024, 3561 formed the survival cohort after 240 patients lacking mortality status or valid follow-up were excluded. Gower–PAM phenomapping included 3491 patients after 70 patients with incomplete clustering variables were excluded. Cluster number was selected among k = 2–4 using prespecified outcome-independent silhouette, minimum-size, and bootstrap-stability criteria. AAR-3, CARE-4, and ACEF were compared in a common complete-case cohort of 3492 patients using an age-inclusive clinical reference model. Results: During a median follow-up of 3.35 years, 407 deaths occurred in the survival cohort. Three Gower–PAM phenotypes were selected (average silhouette width, 0.417), with crude mortality proportions of 12.1%, 4.2%, and 19.2% in phenotypes A, B, and C, respectively (global log-rank p < 0.001). The phenotype factor improved the primary age-inclusive model (joint p < 0.001), although only phenotype B differed from phenotype A after adjustment. The joint phenotype effect was attenuated after expanded clinical adjustment (p = 0.673), and agreement with k-means sensitivity analyses was low. In the common cohort, the first-year adjusted HRs were 1.78 per 1-point increase in AAR-3 (95% CI, 1.46–2.19), 2.08 per 1-point increase in CARE-4 (95% CI, 1.76–2.46), and 2.66 per 1-unit increase in ACEF (95% CI, 2.14–3.30). The corresponding >365-day landmark HRs were 1.56 (95% CI, 1.32–1.85), 1.66 (95% CI, 1.44–1.91), and 2.39 (95% CI, 1.95–2.92), respectively. Full-follow-up C-indices were 0.793 (95% CI, 0.772–0.814) with AAR-3, 0.815 (95% CI, 0.795–0.834) with CARE-4, and 0.812 (95% CI, 0.792–0.833) with ACEF, compared with 0.770 (95% CI, 0.747–0.792) for the age-inclusive reference model. None materially improved the model that already contained age, hemoglobin, eGFR, and LVEF continuously. Conclusions: Outcome-independent phenomapping identified exploratory, method-dependent patterns rather than ordered biological risk classes. The post hoc additive frameworks were internally associated with mortality but should not be regarded as validated prediction or treatment-directing tools. Prospective multicenter external validation is required before clinical application.

Background: Noninvasive echocardiographic markers are widely used to estimate left ventricular filling pressure, but their relationship with directly measured left ventricular end-diastolic pressure (LVEDP) is often modest and context-dependent. Whether routinely available noninvasive findings reflect elevated LVEDP through an intermediate invasive pulmonary hemodynamic phenotype remains insufficiently characterized. Objective: To evaluate the relationship of noninvasive echocardiographic and laboratory markers with directly measured LVEDP and to determine whether invasive pulmonary artery diastolic pressure (dPAP) functions as a hemodynamic bridge linking upstream noninvasive findings to elevated left ventricular filling pressure in a routine catheterization cohort. Methods: This retrospective single-center observational study included patients undergoing routine cardiac catheterization with available direct LVEDP measurement and invasive pulmonary artery pressure data. Elevated LVEDP was defined as LVEDP ≥ 15 mmHg, and elevated dPAP as dPAP ≥ 24 mmHg. Noninvasive, bridge, and invasive validation models were evaluated using logistic regression, receiver operating characteristic analysis, calibration assessment, and bootstrap internal validation. Results: A total of 75 patients had direct LVEDP data, 94 had invasive dPAP data, 83 had echocardiographic systolic pulmonary artery pressure (echo-sPAP), and 37 had pulmonary capillary wedge pressure (PCWP) measurements. Patients with elevated LVEDP had significantly higher creatinine (p = 0.026), dPAP (p = 0.043), and PCWP (p = 0.004). Echo-sPAP showed good discrimination for elevated dPAP, with an AUC of 0.791 (95% CI 0.695-0.888), supporting its role as an upstream noninvasive marker of invasive pulmonary hemodynamic burden. A noninvasive model combining echo-sPAP and creatinine showed modest discrimination for elevated LVEDP (AUC 0.664, 95% CI 0.522-0.806; Brier score 0.198), whereas an invasive validation model combining dPAP and creatinine showed better performance (AUC 0.734, 95% CI 0.617-0.850; Brier score 0.176). In bootstrap validation, the optimism-corrected AUCs were approximately 0.624 and 0.711, respectively. Although the invasive model performed numerically better, DeLong comparison did not show a statistically significant difference between the two models (p = 0.459). Conclusions: Routinely available noninvasive echocardiographic and laboratory findings appear to relate to directly measured left ventricular filling pressure through an intermediate invasive pulmonary hemodynamic pattern. Echo-sPAP showed its strongest signal at the level of elevated dPAP, whereas dPAP combined with creatinine provided the most informative model for elevated directly measured LVEDP. These findings support a hypothesis-generating hemodynamic framework linking noninvasive assessment to directly measured filling pressure and may help inform noninvasive hemodynamic triage and physiological risk enrichment in selected clinical settings.

Large language models (LLMs) are increasingly evaluated using medical examination datasets, yet most studies emphasize overall accuracy rather than the psychometric structure of test items. We evaluated five LLMs on 199 text-only cardiology residency in-service examination items previously characterized using resident-derived psychometric metrics. Three frontier models were compared with two open-source comparators using a standardized zero-shot, repeated-query protocol and strict-majority scoring. Frontier models achieved substantially higher accuracy than open-source comparators, with Claude Opus 4.6, Gemini 3.1 Flash-Lite, and GPT-5.4 reaching 86.4%, 82.9%, and 81.9%, respectively, compared with 53.3% for MedQwen and 18.6% for Qwen-3.5-35B. Across frontier models, performance increased progressively from hard to easy resident-derived item strata. In multivariable analyses, item difficulty was the only classical psychometric factor consistently associated with AI correctness. IRT-based re-analysis confirmed that higher latent item difficulty was independently associated with lower frontier-model accuracy. Human-AI item-level correlations were modest but exceeded permutation-based null expectations, and frontier-model errors were concentrated among highly ranked human distractors. These findings show that item-level psychometric analysis helps explain variation in frontier LLM performance beyond overall accuracy alone. However, expert-rated rationale assessment and none-of-the-above perturbation testing revealed that strong examination accuracy did not guarantee high-quality explanatory support or reliable recognition of answer absence, indicating that examination performance and answer-selection robustness represent related but distinct dimensions of model behavior.

Background: The optimal anesthesia strategy for transfemoral transcatheter aortic valve implantation (TAVI) remains uncertain. We evaluated the impact of local anesthesia, conscious sedation, and general anesthesia on early and long-term outcomes after TAVI. Methods: This single-center cohort included 401 patients undergoing transfemoral TAVI with local anesthesia (LA, n = 77), conscious sedation (CS, n = 147), or general anesthesia (GA, n = 177). Outcomes were assessed using hierarchical win-ratio analysis prioritizing mortality over major adverse cardiovascular and cerebrovascular events (MACCE), supported by Kaplan-Meier and restricted mean survival time analyses. Sensitivity analyses using inverse probability of treatment weighting (IPTW) were performed to account for baseline differences between groups. Results: Baseline comorbidities were broadly comparable, although GA patients had higher-risk anatomical and procedural features. In unadjusted win-ratio analyses, LA showed a significant advantage over GA at 0-6 months (win ratio [WR] 1.79; 95% CI 1.10-2.93; p = 0.020). After multivariable adjustment, LA remained superior to GA at 6-12 and 12-24 months (adjusted WR 1.67 and 1.56, both p < 0.05). One-year mortality differed significantly among groups (p = 0.012). RMST analysis demonstrated a cumulative survival advantage for LA versus GA, reaching 6.6 months at 60 months. MACCE-free survival was largely comparable across strategies. However, in IPTW-weighted analyses, anesthesia type was not independently associated with mortality or MACCE. Conclusions: Minimally invasive anesthesia strategies were associated with more favorable early survival patterns after transfemoral TAVI in primary analyses. However, after adjustment for baseline differences using IPTW, anesthesia type was not independently associated with mortality or MACCE. These findings suggest that apparent outcome differences may partly reflect underlying patient risk profiles rather than a purely causal effect of anesthesia strategy.

Background: The non-high-density lipoprotein cholesterol (non-HDL-C) / high-density lipoprotein cholesterol (HDL-C) ratio has emerged as a marker of residual vascular risk; however, its role in patent foramen ovale (PFO)-associated cryptogenic stroke (CS) remains unclear. We investigated the association between the non-HDL-C/HDL-C ratio and CS in patients with PFO and evaluated its incremental predictive value beyond the Risk of Paradoxical Embolism (ROPE) score. Methods: This retrospective study included 316 patients with confirmed PFO, including 56 patients with CS. Multivariable logistic regression, restricted cubic spline analysis, ROC analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), decision curve analysis, and bootstrap internal validation were performed. Results: Patients with CS had significantly higher non-HDL-C/HDL-C ratio levels than those without CS (p < 0.001). In multivariable analysis, the non-HDL-C/HDL-C ratio remained independently associated with CS (OR: 1.881, 95% CI: 1.310-2.700, p < 0.001). Restricted cubic spline analysis demonstrated a significant nonlinear association between the non-HDL-C/HDL-C ratio and CS risk (overall p = 0.001; nonlinear p = 0.015). Addition of the non-HDL-C/HDL-C ratio to the ROPE score improved discrimination, increasing the AUC from 0.781 to 0.819 (DeLong p = 0.010), and significantly improved risk reclassification (continuous NRI: 0.555, p = 0.002; IDI: 0.057, p = 0.002). Internal validation demonstrated stable model performance with minimal optimism. Conclusions: The non-HDL-C/HDL-C ratio was independently associated with CS and demonstrated potential incremental predictive value beyond the ROPE score in patients with PFO. These findings suggest that metabolic lipid burden may contribute to thromboembolic susceptibility and may improve individualized risk stratification in PFO-related stroke.

OBJECTIVE:To examine whether a simple electrophysiological descriptor derived from routinely measured antegrade atrioventricular nodal conduction parameters is associated with non-inducible atrioventricular nodal reentrant tachycardia (AVNRT). METHODS:This retrospective cohort included 387 consecutive patients undergoing electrophysiological study for clinically suspected AVNRT. The Total Antegrade Nodal Delay (TAND) index was defined as the sum of the atrio-His (AH) interval and antegrade Wenckebach cycle length (WBCL). Logistic regression, receiver operating characteristic analysis, and quadrant-based continuum analysis were performed. Because WBCL values were missing predominantly in inducible patients, complete-case and sensitivity analyses were conducted. RESULTS:Non-inducible AVNRT occurred in 106 patients (27.4%). In the complete-case TAND cohort (n = 329), higher TAND values were associated with non-inducibility (odds ratio [OR] per 50-ms increase: 1.26, 95% CI: 1.02-1.56, P = .032), remaining significant after adjustment for age and sex (adjusted OR: 1.31, 95% CI: 1.05-1.63, P = .016). Discrimination was modest (area under the curve: 0.592, 95% CI: 0.525-0.659). After multiple imputation, the association remained directionally consistent but was attenuated (adjusted OR: 1.21, 95% CI: 0.99-1.46, P = .056). Quadrant analysis demonstrated a graded increase in non-inducibility from the low-AH/low-WBCL to the high-AH/high-WBCL quadrant (25.0% vs. 42.3%; trend OR: 1.32, 95% CI: 1.07-1.61, P = .008). CONCLUSION:Total Antegrade Nodal Delay was modestly associated with non-inducible AVNRT and may describe a group-level electrophysiological pattern characterized by slower antegrade nodal conduction and higher functional conduction thresholds. However, TAND should not be interpreted as a mechanistic requirement for AVNRT inducibility or as an individual-level prediction tool.

Background: Renal and cardiac dysfunction are major determinants of adverse outcomes following transcatheter aortic valve replacement (TAVR). The ratio of blood urea nitrogen to left ventricular ejection fraction (BUN/EF) integrates renal and cardiac status into a single physiological index. This study aimed to evaluate the prognostic value of both baseline and temporal (48-72 h) BUN/EF ratios for predicting mortality after TAVR. Methods: A total of 429 patients (mean age 76 ± 8 years; 51% female) who underwent TAVR for severe aortic stenosis between 2017 and 2025 were retrospectively analyzed. The primary endpoint was long-term all-cause mortality; in-hospital mortality was secondary. Receiver operating characteristic (ROC) curves, Cox regression, and reclassification metrics (NRI, IDI) assessed prognostic performance. Restricted cubic spline (RCS) analysis explored non-linear associations. Results: During a median follow-up of 733 days, overall and in-hospital mortality rates were 37.8% and 7.9%, respectively. Both baseline and 48-72 h BUN/EF ratios were independently associated with mortality (HR = 3.46 and 3.79 per 1 SD increase; both p < 0.001). The temporal ratio showed superior discrimination for in-hospital mortality (AUC = 0.826 vs. 0.743, p = 0.007). Adding baseline BUN/EF to EuroSCORE II significantly improved model performance (AUC 0.712 vs. 0.668, p = 0.031; NRI = 0.33; IDI = 0.067). RCS analysis revealed a linear relationship for baseline and a steep, non-linear association for temporal ratios with mortality risk. Conclusions: The 48-72 h BUN/EF ratio is a robust dynamic biomarker that predicts early mortality after TAVR, while baseline BUN/EF identifies patients at long-term risk. Integrating this simple bedside index into risk algorithms may refine postoperative monitoring and improve outcome prediction in TAVR populations.

Background: Obstructive sleep apnea syndrome (OSAS) is associated with sympathetic overactivity, intermittent hypoxia, and increased vascular resistance, leading to cardiovascular morbidity. Electrical cardiometry (EC) is a novel, non-invasive technology that continuously measures hemodynamic parameters such as systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), cardiac output (CO), and cardiac index (CI). The aim of this study was to compare SVR and SVRI values, measured by EC, between patients with OSAS and age- and sex-matched healthy controls. Methods: In this retrospective case-control study, 70 participants were enrolled, including 33 patients with polysomnography-confirmed OSAS and 37 healthy controls matched for age and sex. All participants underwent standard EC measurement (ICON® Cardiotronics, Osypka Medical, GmbH, Berlin, Germany) under resting, supine conditions. Hemodynamic parameters such as SVR, SVRI, and CI were compared between groups. Results: EC revealed significantly higher SVR (1498.7 ± 335.6 vs. 1260.1 ± 251.5 dyn·s·cm-5, p = 0.013) and SVRI (2969.4 ± 749.1 vs. 2347.4 ± 481.0 dyn·s·cm-5·m2, p < 0.001) in patients with OSAS compared with controls, while CI was significantly lower in the OSAS group (2.6 ± 0.5 vs. 3.2 ± 0.8 L/min/m2, p < 0.001), indicating increased vascular load and reduced cardiac performance. Conclusions: This study is the first to apply EC in OSAS. EC-derived parameters, particularly SVRI and CI, effectively differentiated OSAS patients from healthy subjects, reflecting increased vascular afterload and reduced cardiac performance. These findings suggest that EC is a feasible, non-invasive tool for assessing hemodynamic alterations in OSAS and may have potential for bedside monitoring and future risk stratification studies.

Background: Despite advances in reperfusion strategies, long-term major adverse cardiac and cerebrovascular events (MACCE) remain frequent after ST-elevation myocardial infarction (STEMI). Practical risk stratification tools applicable at presentation are therefore needed. We investigated the prognostic value of a simple composite index integrating age, blood urea nitrogen, and left ventricular ejection fraction (Age×BUN/LVEF) for predicting long-term MACCE in STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods: This retrospective, single-center cohort study included 313 consecutive STEMI patients undergoing primary PCI between 2020 and 2024. The Age×BUN/LVEF (AGEBUNeFR) index was calculated using age and admission blood urea nitrogen values and left ventricular ejection fraction assessed during index hospitalization. The primary outcome was long-term MACCE, defined as a composite of all-cause mortality, recurrent myocardial infarction, repeat revascularization, stroke, and heart failure hospitalization. The median follow-up was 2.24 years (interquartile range 1.40–3.06). Results: During follow-up, 93 patients (29.7%) experienced MACCE. The AGEBUNeFR index was independently associated with MACCE after multivariable adjustment (adjusted HR 1.028 per unit increase, 95% CI 1.016–1.040; p < 0.001). Time-varying analyses demonstrated a dynamic prognostic effect, with significant associations in the early post-PCI period (p = 0.002) and a pronounced re-emergence of risk during late follow-up (>36 months; p < 0.001). Conclusions: The AGEBUNeFR index is a simple, readily available, and powerful predictor of long-term MACCE in STEMI patients undergoing primary PCI. By integrating age, renal/hemodynamic stress, and cardiac function, this composite index provides dynamic and incremental prognostic information beyond conventional clinical models, supporting its potential role as a practical tool for long-term risk stratification after STEMI.

The C-reactive protein–albumin–lymphocyte (CALLY) index is an emerging composite biomarker that integrates inflammatory, nutritional, and immune parameters. Although its prognostic utility has been established in oncological and certain cardiovascular contexts, its role in predicting outcomes following transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate the prognostic value of the CALLY index in patients with severe aortic stenosis undergoing TAVI, with a focus on its association with all-cause mortality. A single-center, retrospective cohort study was conducted including 330 patients who underwent TAVI for severe aortic stenosis between December 2016 and January 2025. The CALLY index was calculated using preprocedural C-reactive protein, serum albumin, and lymphocyte count. Primary outcome was the incidence of all-cause mortality. The CALLY index was lower in deceased patients than in survivors (1.0 [0.4-2.0] vs. 3.0 [1.0-10.6], p < 0.001). In multivariable analysis, a lower CALLY index was independently associated with higher all-cause mortality (HR: 0.965, 95

Background and Objectives: The Naples Prognostic Score (NPS), a composite index indicative of nutritional and inflammatory status, has been suggested as an important prognostic marker. Uric acid, an indicator of oxidative stress and endothelial impairment, is also associated with cardiovascular risk. This study sought to examine the synergistic value of NPS and uric acid levels in forecasting long-term major adverse cardiovascular and cerebrovascular events (MACCE) in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI), using time-varying hazard ratio and time-dependent Receiver Operating Characteristic (ROC) analyses. Materials and Methods: A retrospective analysis was conducted on 288 patients diagnosed with CCS from January 2020 to November 2023. The NPS was determined utilizing serum albumin, total cholesterol, the neutrophil-to-lymphocyte ratio (NLR), and the lymphocyte-to-monocyte ratio (LMR). Cox regression, time-varying hazard ratio models, and time-dependent ROC curve analyses were performed to assess both temporal risk patterns and predictive performance. The principal endpoint was the incidence of MACCE. Results: Major adverse cardiovascular and cerebrovascular events (MACCE) occurred in 69 individuals, representing 23.4% of the total cohort. Both high NPS and elevated uric acid were independently associated with an increased risk of MACCE. The integration of the NPS with uric acid showed superior discriminative and reclassification capabilities compared to the use of each marker independently (p < 0.05 for all). Time-varying hazard ratio analyses demonstrated that the prognostic impact of the NPS was more pronounced in the early follow-up, while the effect of uric acid became stronger in the late phase. Time-dependent ROC analyses confirmed that the combined use of the NPS and uric acid provided superior predictive accuracy compared with either parameter alone across the follow-up period. Conclusions: NPS and uric acid offer complementary prognostic information in CCS. Their combined assessment improves long-term risk stratification, while time-varying and time-dependent analyses reveal that their predictive effects evolve dynamically throughout follow-up. This integrated evaluation may improve clinical decision-making and risk stratification in routine practice.

Background/Objectives: Pleural effusions may be seen in patients with severe AS complicated by hemodynamically significant heart failure. However, there are no data on the association between pleural effusion and long-term mortality in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess the impact of pre-procedural pleural effusion on long-term mortality in these patients. Methods: A retrospective, single-center analysis was conducted on 401 patients who underwent TAVI between January 2010 and December 2023. The patients were categorized into two groups based on the presence of pleural effusion, which was assessed via pre-procedural imaging using thoracic computed tomography (CT). Results: Pleural effusion was present in 158 patients (39.4%). The patients with pleural effusion had significantly higher long-term mortality rates compared to those without pleural effusion (46.2% vs. 24.3%, p < 0.001). Multivariate analysis identified pleural effusion as an independent predictor of long-term mortality (HR: 1.568, 95% CI: 1.065–2.308, p = 0.023). Also, the patients with pleural effusions had a higher long-term mortality rate compared with those without pleural effusions (log-rank p < 0.001). Conclusions: Pre-procedural pleural effusion is independently associated with increased long-term mortality in TAVI patients. Early recognition and management of pleural effusion are critical for optimizing outcomes in this high-risk population.

Background/Objectives: Heart failure is a very common disease, and its incidence is increasing. Echocardiography is a non-invasive tool frequently used in the diagnosis and risk stratification of heart failure. In our study, we aimed to evaluate the risk of all-cause mortality, hospitalization due to decompensated heart failure, and appropriate shocks in reduced ejection fraction patients (HFrEF) with an implantable cardioverter–defibrillator (ICD) according to a novel tissue Doppler echocardiographic parameter that reflects pulmonary capillary wedge pressure. Methods: A total of 320 HFrEF patients with ICD were included in the study between 1 February 2021 and 30 June 2023, from the cardiology outpatient clinic and cardiology ward. Using tissue Doppler, the peak systolic velocity (ST) at the free wall side of the tricuspid annulus and the peak systolic velocity (SM) at the lateral side of the mitral annulus were measured, and the ratio of ST to SM (ST/SM) was calculated. The inferior vena cava diameter (IVCDi) was measured during inspiration. These two values were multiplied to form the formula IVCDi × (ST/SM). Based on the IVCDi × (ST/SM) value, patients were divided into two groups: those with high values (>17, n = 144) and those with low values (≤17, n = 176). The primary endpoint of our study was all-cause mortality, and the secondary endpoint was major adverse cardiovascular events (MACE), including appropriate shocks, hospital admission due to acute heart failure decompensation, and mortality. Results: Long-term mortality was higher in the high IVCDi × (ST/SM) group compared to the low-value group (44% vs. 15%, p < 0.001). The MACE frequency was also higher in patients with high IVCDi × (ST/SM) values (71% vs. 30%, p < 0.001). In multivariable analysis, IVCDi × (ST/SM) was an independent predictor of both mortality (HR: 1.027, 95%CI: 1.009–1.046, p = 0.003), and MACE (HR: 1.018, 95%CI: 1.004–1.032, p = 0.013). Conclusions: We demonstrated that the IVCDi × ST/SM value, a novel tissue Doppler echocardiographic parameter, is an independent predictor of both long-term mortality and major adverse cardiac events (MACE) in HFrEF patients with ICD. This parameter may be valuable in identifying high-risk patients and optimizing their treatment management.

BACKGROUND:Infective endocarditis (IE) remains a life-threatening condition despite treatment advances. Early identification of high-risk patients is essential. The neutrophil percentage-to-albumin ratio (NPAR) is a novel inflammatory marker linked to poor outcomes in various diseases, but its prognostic value in IE remains unclear. This study aimed to investigate the association between NPAR and in-hospital mortality in patients with IE. METHODS:We retrospectively analyzed 263 patients diagnosed with IE between January 2009 and January 2024 at a tertiary care center. Clinical, laboratory, and echocardiographic data were collected. NPAR was calculated as (Neutrophil %/Albumin [g/dL]). Predictors of mortality were identified using LASSO-based logistic regression, and a nomogram was constructed to illustrate predictive performance. RESULTS:In-hospital mortality occurred in 59 patients (22.4%). NPAR was significantly higher among non-survivors (median: 0.335 vs. 0.228, p < 0.001). High NPAR ( >0.274) was independently associated with in-hospital mortality (OR: 6.70, 95% CI: 3.07-15.61, p < 0.001), along with large vegetation and diabetes mellitus. High NPAR showed good discriminative power (AUC = 0.72, 95% CI: 0.66-0.79, p < 0.001). CONCLUSION:High NPAR was an independent predictor of in-hospital mortality in IE and may serve as a simple, cost-effective biomarker for early risk stratification.

Background: Acute kidney injury (AKI) is a frequent complication following transcatheter aortic valve implantation (TAVI) and has been linked to increased mortality. However, the temporal pattern of this association remains uncertain. This study aimed to evaluate the time-dependent impact of AKI on mortality after TAVI using advanced survival analyses. Methods: We retrospectively analyzed 381 consecutive patients who underwent transfemoral TAVI between December 2016 and October 2024 at two tertiary cardiovascular centers. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. The primary outcome was all-cause mortality. Patients were categorized into AKI and non-AKI groups. Clinical outcomes, including 30-day, 1-year, and overall mortality, were evaluated. Results: Among 381 patients who underwent TAVI, 59 (15.5%) developed AKI according to the AKIN criteria. During a 33.9 months (18.0–59.2) median follow-up of overall mortality was significantly higher in the AKI group compared with those without AKI. In the multivariate Cox regression analysis, AKI was significantly associated with long-term mortality (HR: 2.07, 95% CI 1.32–3.25; p = 0.002). The time-varying hazard ratio curve demonstrated that the excess mortality risk associated with AKI was most pronounced in the early period and gradually declined thereafter. In time-interval–specific analyses, AKI was strongly associated with mortality within the first month (HR 6.30, 95% CI 3.03–13.08, p < 0.001) and remained significant up to 12 months (HR 2.18, 95% CI 1.32–3.59, p = 0.002). Beyond the first year, this association attenuated and lost statistical significance at 12–36 months (HR 0.90, p = 0.79), 36–60 months (HR 0.57, p = 0.24), and >60 months (HR 0.43, p = 0.13). Conclusions: AKI is an important predictor of early and mid-term mortality following TAVI, but its long-term prognostic impact is less pronounced. Preventive strategies and early management of AKI may improve outcomes in this high-risk population.

Background and Aim: The annual risk of major bleeding due to anticoagulant use ranges from 2% to 5%, with 0.5% to 1% of these bleedings being fatal. The global usage of oral anticoagulants is 0.65%, with warfarin being the most commonly used oral anticoagulant agent. In our study, we aimed to determine the long-term bleeding risks of patients using warfarin in our clinic and to make treatment and risk factor adjustments according to this risk situation. We investigated the effectiveness of the most commonly used bleeding risk scores and their superiority over one another in this study. Materials and Methods: This study included patients taking warfarin from January 2010 to January 1, 2022. Demographic data, laboratory parameters, known, and potential bleeding risk factors were recorded for all patients. Pre-treatment CHA2DS2-VASc, ATRIA, HAS-BLED, and ORBIT scores were calculated for all patients included in the study, along with their time in therapeutic range (TTR) values during follow-up. Patients were retrospectively monitored for bleeding events. Results: In our study, we observed that anemia, chronic kidney failure, cancer, and mechanical valves were associated with an increased risk of bleeding compared with other risk factors. We found that among the risk scores assessed in patients, the HAS-BLED risk score more strongly predicted the risk of bleeding than the other risk scores. Additionally, we found that low TTR values were directly associated with bleeding. Conclusion: Modifying identified risk factors in patients during the warfarin treatment process (such as anemia, chronic kidney failure, etc.) may reduce the risk of bleeding. Similarly, close monitoring of TTR, particularly in patients with high HAS-BLED and ORBIT risk scores assessed before treatment initiation, is considered a safe treatment approach to reduce the risk of bleeding.

Background The systemic immune-inflammation index (SII), based on white blood cell, neutrophil, and platelet counts, is a proposed marker of systemic inflammation and immune activation. This study aimed to explore the relationship between SII and complete atrioventricular block (CAVB) development in STEMI patients undergoing primary PCI. Methods We retrospectively analyzed data from 883 patients who underwent primary PCI for STEMI between January 2009 and December 2017. Patients were categorized into two groups based on CAVB development. SII levels were calculated from blood samples taken on admission. Results Of the included patients, 48 (5.03%) developed CAVB. SII was higher in patients with CAVB compared to those without CAVB (1370 [1050–1779]x109/L vs. 771 [427–1462] x109/L, p < 0.001). Multivariate analysis showed a significant positive correlation between SII and the risk of CAVB development (OR:1.0003, 95%CI:1.0001–1.0005, P = 0.044). The cut-off value for the SII in the estimation of CAVB was 1117.7 × 10 9 /L (area under the ROC curve [AUC]: 0.714, 95% CI = 0.657–0.770 with a sensitivity of 70.8% and specificity of 65.6%, p < 0.001). Conclusion This study showed a significant link between high SII levels and CAVB development in STEMI patients undergoing PCI. Our findings suggest that SII may be a valuable, routinely available, and inexpensive marker for identifying patients at increased risk of CAVB.

Background and Aim: Over the years, transvenous lead extraction (TLE) procedures (TLEP) have been increasing because of factors such as infection, loss of device function, and lead-related complications. This study aimed to evaluate the factors affecting major complications during TLEP. Materials and Methods: Between January 2011 and May 2023, patients who underwent TLE of cardiac implantable electronic devices were included in the study. The demographic and procedural features of all patients were evaluated according to major complications. Results: A total of 121 consecutive patients (192 leads) underwent TLEP. The mean age was 63 ± 17.3 years, and 76% were male. Most leads were active fixation leads (67%) and 74 procedures (61%) required an extraction device. The mean lead dwell time was 5.6 ± 5.2 years. Major complications were observed in 16 procedures (13.2%) and 5 of them (4.1%) resulted in exitus. When we compared the groups according to the major complication, the rates of chronic obstructive pulmonary disease (4 vs. 3; P = 0.020), existence of passive fixation leads (PFL) (24 vs. 9; P = 0.013), and device indication (P = 0.012) were higher in the complication group. Multivariate analysis revealed that only the presence of PFL was associated with major complications. (odds ratio 4.486, 95% confidence interval 1.365-14.748; P = 0.013) Conclusion: The present study showed that the presence of a PFL is a predictive factor for major complications.

Contrast-induced nephropathy (CIN) defined as an acute kidney injury following the administration of iodinated contrast medium (CM). Hysterosalpingography (HSG) is a radiologic procedure used to investigate the shape and structure of the uterine cavity and the patency of the fallopian tubes in the evaluation of infertility. To date, there have been no reports evaluating the development of CIN after HSG procedure. Therefore, we investigated whether CIN development occurs in infertile women who underwent HSG and its relationship with clinical and laboratory changes in women who underwent HSG. This study was undertaken in 65 women who had infertility evaluation, uterine anomalies and/or tubal blockages. CIN was defined as a 25

Background and Aim: Atherosclerotic burden is a key determinant of long-term cardiovascular outcomes. The objective of this study was to investigate the association between atherosclerotic burden and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing simultaneous diagnostic angiography of multiple vascular territories. Materials and Methods: This retrospective study included 153 consecutive patients who underwent concurrent angiography of the coronary, peripheral, carotid, subclavian, and renal arteries at a tertiary care hospital between January 2010 and March 2020. The patients were divided into two groups based on their atherosclerotic burden: the low group (<4 points, n=95) and the high group (≥4 points, n=58). The primary outcome was all-cause long-term mortality over a median follow-up period of 5.97 years. The secondary endpoint was the occurrence of MACCE at long-term follow-up. Results: A primary outcome event occurred in 34 of 58 patients (58.6%) in the high group and in 37 of 95 patients (38.9%) of 95 patients in the low group (P = 0.018). MACCE occurred in 40 of 58 patients (69.0%) in the high group and in 42 of 95 patients (44.2%) in the low group (P = 0.003). Propensity score matching demonstrated that the high group exhibited significantly higher primary outcome (59% vs. 33%, P = 0.007) and MACCE incidence (69% vs. 39%, P = 0.001) compared to the low group. Conclusion: Among patients who underwent simultaneous diagnostic angiography of multiple vascular territories, those with a high atherosclerotic burden had a higher risk of MACCE and mortality than those with a low atherosclerotic burden over a median follow-up of 5.97 years.