This study evaluated the prognostic performance of the Oxygenation-Modified Shock Index (O-MSI) compared with conventional SI for predicting in-hospital mortality in hospitalized PE patients. We conducted a retrospective observational study including 358 adults hospitalized with confirmed PE between January 1, 2024, and January 1, 2026. SI (heart rate/systolic blood pressure) and O-MSI (SI divided by oxygen saturation) were calculated. Of 358 patients, 58 (16.2

BACKGROUND:This study aims to evaluate the predictive value of the fibrosis-4 (FIB-4) index, a noninvasive measure of liver fibrosis, for in-hospital and 5-year outcomes in patients undergoing carotid artery stenting (CAS). METHODS:A retrospective cohort study of 598 patients undergoing CAS were categorized into three groups based on their FIB-4 indices: low (<1.3, n = 233), intermediate (1.3-2.67, n = 303), and high (>2.67, n = 62). In-hospital and long-term outcomes were compared between the groups. Assessment of prognostic performance was conducted using multivariable Cox models and receiver operating characteristic (ROC) analysis. RESULTS:In-hospital rates of ipsilateral and major strokes, myocardial infarction, death, and major adverse cardiovascular events (MACE) were significantly increased in patients with high index compared to those with intermediate and low indices (3.9% vs. 5.6% vs. 14.5%, P = 0.006; 2.1% vs. 14.9% vs. 24.2%, P < 0.001; 0% vs. 3% vs. 4.8%; P = 0.013; 1.3% vs. 5.6% vs. 16.1%, P < 0.001; 4.3% vs. 13.9% vs. 29%, P < 0.001, respectively). At 5 years of follow-up, rates of ipsilateral and major strokes, transient ischemic attack, death, and MACE were significantly different between the groups (6.7% vs. 11.4% vs. 20%, P = 0.008; 8.8% vs. 9.4% vs. 16.7%, P = 0.025; 3.6% vs. 4.7% vs. 11.7%; P = 0.035, 4.9% vs. 16.7% vs. 26.7%, P < 0.001; 10.7% vs. 21.7% vs. 28.3%, P < 0.001, respectively). FIB-4 indices >1.8 and >1.57 predicted in-hospital major stroke and mortality with areas under the ROC curves of 0.751 and 0.739, respectively (P < 0.001 for all) CONCLUSION: Higher FIB-4 index may serve as a surrogate marker of carotid artery stenosis, extending its prognostic relevance beyond hepatic fibrosis and may also predict increased risk of in-hospital and 5-year stroke and mortality in patients undergoing CAS.

AIMS:This study evaluates the association between the Intermountain Risk Score (IMRS) and coronary artery ectasia (CAE) to determine its predictive value. MATERIALS & METHODS:A retrospective study was conducted at a tertiary hospital from January 2019 to January 2024. A total of 446 patients (226 with CAE, 220 controls) were included. Clinical, laboratory, and angiographic data were analyzed. IMRS was calculated based on routine demographic and laboratory parameters. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve analysis. RESULTS:Patients with CAE had significantly higher IMRS scores (p = 0.011) and were more likely to fall into high-risk IMRS categories (p = 0.002). Smoking (HR: 3.744, p = 0.045), mean corpuscular volume (HR: 1.105, p = 0.019), and IMRS color category (HR: 5.255, p = 0.016) were independent predictors. ROC analysis showed an AUC of 0.617 for IMRS score and 0.627 for IMRS color category. CONCLUSIONS:IMRS is a significant predictor of CAE and may serve as a practical risk stratification tool. Higher-risk patients could benefit from closer monitoring and targeted interventions. Further validation in prospective studies is needed.

BACKGROUND:We aimed to investigate the prognostic value of serum albumin-to-creatinine ratio (sACR) in carotid artery stenting (CAS) patients regarding in-hospital and 5-year outcomes.METHODS:This is a retrospective study. Baseline characteristics were compared between patients by admission albumin to creatinine ratio and categorized accordingly: T1, T2 and T3. 609 patients were included in the study. Serum albumin and creatinine levels at hospital admission were used to calculate the sACR. The primary endpoint was all-cause mortality. MACE consisted of stroke, transient ischemic attack (TIA), myocardial infarction (MI) and death. All follow-up data were obtained from electronic medical records or by interview. The study was terminated after 60 months of follow-up.RESULTS:Serum albumin levels were found to be significantly lower in T1, while creatinine was found to be significantly higher in T1. T1 has the lowest sACR while T3 has the highest. In hospital, ipsilateral stroke, major stroke, MI and death were significantly higher in T1. In long-term outcomes, ipsilateral stroke, major stroke, and death were significantly higher in T1.CONCLUSIONS:Low sACR values at hospital admission was independently associated with in-hospital and long-term mortality and major stroke in patients underwent CAS.

ÖzObjective: Coronary artery ectasia (CAE) is a cardiovascular disease characterized by dilatation of the coronary arteries and microvascular coronary ischemia.P-wave peak time duration (PWPT), T wave peak to end (Tp-Te) interval and Tp-Te/QS ratio are electrocardiographic (ECG) repolarization parameters associated with an increased risk of arrhythmia.Although awareness of CAE has increased in recent years, there is a paucity of available data on its arrhythmogenic effects.This study aims to evaluate the relationship between CAE and repolarization parameters as PWPT, Tp-Te interval and Tp-Te/QS ratio. Material and Methods:Retrospective data analysis of 45 patients with CAE and 51 control patients with normal coronary anatomy was performed.Clinical data, electrocardiogram results and coronary angiography results were analyzed.Among ECG parameters, PWPT, Tp-Te interval and Tp-Te/QTc ratios were particularly emphasized. Results:In the comparison between the CAE group and the control group, Tp-Te and Tp-Te/QTc ratios were significantly higher in CAE patients (p=0.013 and p=0.008, respectively).However, no significant difference was found in the PWPT range (p=0.289).Amaç: Koroner arter ektazisi (KAE), koroner arterlerin genişlemesi ve mikrovasküler koroner iskemi ile karakterize bir kardiyovasküler hastalıktır.P dalgası pik süresi (PWPT), T dalgası pik-son arası (Tp-Te) aralığı ve Tp-Te/QS oranı aritmi gelişme riskinde artış ile ilişkili elektrokardiyografik repolarizasyon parametrelerdir.Son yıllarda KAE farkındalığı artmasına rağmen, aritmojenik etkisi hakkında mevcut veriler yetersizdir.Bu çalışma, KAE ile elektrokardiyografik miyokardiyal repolarizasyon parametreleri olan PWPT, Tp-Te aralığı ve Tp-Te/QS oranı arasıdaki ilişkiyi değerlendirmeyi amaçlamaktadır

Background and Objectives: Studies have shown that inflammation markers can be used as prognostic tools in predicting acute ischemic stroke. In this study, we conducted a comparison of several inflammation scores in predicting left atrial thrombosis (LAT) in patients with ischemic stroke without AF. Materials and Methods: In this single-center, retrospective study, we included 303 consecutive patients with ischemic stroke. Each patient underwent a transesophageal echocardiography (TEE) examination within 10 days of admission to detect the presence of LAT. To identify independent predictors of LAT, we conducted a multivariate logistic regression analysis. Results: In total, 303 patients who had ischemic stroke were included in the analysis. LAT was detached in 34 patients at the time of the TEE examination. The patients were categorized into two groups based on their LAT status. The Prognostic Nutritional Index (PNI), HALP score, and C-reactive Protein–Albumin Ratio (CAR) were identified as statistically significant predictors of LAT. Based on the results of the multivariate regression analysis, the CAR emerged as the only independent predictor of LAT. Conclusions: Among several inflammation scores, the PNI, HALP, and CAR were statistically significant predictors of LAT in ischemic stroke patients without AF. CAR was identified as the optimal score for the prediction of LAT in patients with stroke and without AF.

OBJECTIVE: The aim of this study was to evaluate the choroidal thickness and choroidal vascular index in normotensive individuals with dipping and nondipping patterns. METHODS: Patients who applied to the cardiology clinic for routine checkups and underwent 24-h blood pressure monitoring were included in our study. They were divided into two groups based on their dipper status. The patients in whom systolic blood pressure decreased during the nocturnal time by 10% or more of the daily blood pressure were defined as dippers. On the contrary, patients whose nocturnal systolic blood pressure decreased by less than 10% were defined as nondippers. Choroidal thickness and choroidal vascular index were measured by spectraldomain optical coherence tomography. Central macular thickness, retinal nerve fiber layer, and ganglion cell layer (GCL) analyses were also recorded. RESULTS: In total, 35 patients with dipper pattern and 34 patients with nondipper pattern were recruited. The mean subfoveal choroidal thickness was 349.72 +/- 90 mu m in the dipper group and 358.54 +/- 132.5 mu m in the nondipper group. The groups had no significant difference in choroidal thickness, central macular thickness, retinal nerve fiber layer, and ganglion cell layer analyses. However, the choroidal vascular index was statistically significantly lower in the nondipper group when compared to the dipper group (0.61 +/- 0.02 vs. 0.64 +/- 0.02; p<0.001). Also, the choroidal vascular index was negatively correlated with subfoveal choroidal thickness in the nondipper group (Spearman; r=-0.419; p=0.033). CONCLUSION: Our study showed that the choroidal vascular index was significantly lower in nondippers than in dippers. Nondipper individuals may be affected by vascular dysregulation, leading to alterations in the choroidal circulation.

BACKGROUND:There are various changes in cardiac physiology in athletes compared to the normal population. These physiological changes may differ according to the exercise content. The aim of this study was to compare the effects of different exercise methods on the heart. METHODS:A total of 122 male athletes from various sports were evaluated. Depending on the sorts of sports, these participants were split into aerobic, mixed, and resistance groups. Each athlete had to meet the inclusion criteria of having participated in the present sport for at least a year and having trained for at least 600 minutes per week over the previous three months. Transthoracic echocardiography was used to investigate the effects of different exercise types. RESULTS:The aerobic group's heart rate and ejection fraction were found to be lower than those of the resistance and mixed groups (F(2.105)=23.487, P=0.001). The end-diastolic thicknesses of the interventricular septum (8.7 SD 0.8 vs. 10.0 SD 0.7), interventricular septum (11.3 SD 0.9 vs. 13.0 SD 0.9), left ventricular posterior wall (8.6 SD 0.7 vs. 9.9 SD 0.8), and interventricular septum (11.1 SD 0.9 vs. 13.3 SD 0.9) were all found to be lower in the aerobic group than in the resistance group (P=0.0001). The effect of resistance exercise on heart rate was not observed as clearly as other groups. CONCLUSIONS:Resistance exercise has a more dominant effect on ventricular thickness than aerobic exercise. In mixed exercise groups, this increase in thickness is similar to resistance exercise. The content of the training should be considered in the evaluation of the athlete's heart. Identifying the subgroups of the athlete's heart will be useful in the differentiation of pathologies and also in the follow-up of the athletes.

The Naples prognostic score (NPS) predicts patient survival in gastroesophageal cancer using parameters related to nutritional and inflammatory status. These parameters include risk factors for coronary endothelial dysfunction except for low total cholesterol. Therefore, we modified the score (mNPS) to include high cholesterol, a risk factor for coronary endothelial dysfunction. We aimed to evaluate the relationship between mNPS and the angiographic epicardial coronary slow flow phenomenon (CSFP). This retrospective study included 301 patients with coronary slow flow who underwent coronary angiography between 2018 and 2022. The mNPS parameters were calculated and the population was divided into three groups based on the calculated parameters. Angiographic findings were classified in the left anterior descending (LAD), circumflex (Cx), right coronary (RCA) arteries, and three coronary arteries together. Statistical analyses were performed to identify mNPS as predictors of a slow flow phenomenon. Participants were divided into mNPS Group 1 (n=63), mNPS Group 2 (n=201), and mNPS Group 3 (n=37). No significant differences were observed in age, gender, or medications among the mNPS groups. The RCA had a statistically significant association with mNPS groups for slow flow phenomenon (p=0.006). Considering all three coronary arteries, the association with mNPS groups was also significant (p=0.005). White blood cell and lymphocyte counts showed significant differences. Compared with group 1, group 3 had 4.11 times more coronary artery slow flow. Our study suggests that the mNPS, integrating nutritional and inflammatory parameters along with high cholesterol, holds promise as a potential predictor for the coronary slow flow phenomenon. This could impact risk stratification and clinical management in this patient group.

Introduction Pregnancy is a process that causes several physiological changes including all systems as well as cardiovascular system. Ventricular hypertrophy and dilation of cardiac chambers are seen as a result of these changes. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we have evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. Methods This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers’ measurements were compared between the groups. Results In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. There were also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. Conclusion Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.

Background Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings. Objective To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases. Methods The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11–24) months. Results In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058–1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010–1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters. Conclusions Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

SUMMARY OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1–4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1–4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036–1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

Objective This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI). Methods A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) were enrolled in the study. In-hospital and 3-year outcomes were compared between the four groups (Q1–4). The SII was calculated using the following formula: neutrophil*platelet/lymphocyte. Results The frequency of in-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had an independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. Receiver operating characteristic analysis showed that the best cutoff value of SII to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity. Kaplan–Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6, 96.9, 91.6 and 81.0%, respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had an independent risk for mortality compared to Q1. Conclusion SII, a novel inflammatory index, was found to be a better predictor for in-hospital and long-term outcomes than traditional risk factors in patients with STEMI undergoing pPCI.

Background: According to clinical practice guidelines, thrombolysis can be administered during the 14 days after the beginning of symptoms in PE. However, the role of the early thrombolysis in PE has not been comprehensively investigated. In this study we evaluated the effect of short symptom-to-thrombolysis time (STT) in these patients who received the thrombolytic therapy within the 48-h.Method: A total of 456 patients with pulmonary embolism who underwent thrombolytic therapy in a tertiary center were included in the current study. The patients were stratified into three groups according to STT as: <12 h (Group 1), 12 to 24 h (Group 2) and > 24 to 48 h (Group 3). In-hospital events and long-term mortality were compared between the groups.Results: Group 3 had higher in-hospital mortality, acute kidney injury, cardiogenic shock, asystole, and the use mechanical ventilation and 3-year mortality compared to the other two groups. The 3-year overall survival for Group 1, 2 and 3 were 82.1%, 77.7% and 25.9% respectively. According to regression analysis, a STT > 24 h was independently associated with in-hospital and long-term mortality. Group 1 and 2 had similar in-hospital outcomes and long-term mortality.Conclusion: A short STT has a great importance in patients with PE who treated with thrombolytic therapy. The efficacy of systemic thrombolysis significantly drops after 24 h. Because of this situation, the period between the symptom onset and thrombolytic therapy should be kept short as much as possible.

OBJECTIVE:Inflammation plays an important role in the initiation of postoperative atrial fibrillation (PoAF) in individuals undergoing cardiac surgery, Thus, this study aimed to investigate the predictive value of the systemic immune inflammation index (SII) to develop PoAF in such patients. METHODS:In total, 391 consecutive patients undergoing an isolated coronary artery bypass grafting (CABG) were retrospectively analyzed. PoAF was defined according to the current guideline. The SII is determined using the following equation: neutrophil (N) × platelet (P) ÷ lymphocyte (L). RESULTS:The incidence of PoAF in the present study was 24% (n=97 cases). Multivariate logistic regression analysis revealed that the SII was an independent predictor of PoAF (Odds ratio: 1.002 95% confidence interval: (1.001-1.002), p<0.01). The optimal value of the SII in detecting PoAF was established by a receiver operating characteristic curve assessment, and it was >807.8 with 60.8% sensitivity and 80.9% specificity [area under the curve (AUC): 0.7107]. The AUC value of SII in detecting PoAF was much greater than the AUC values of both the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) (AUC: 0.6740 and AUC: 0.6426, respectively). CONCLUSIONS:This study revealed that SII was an independent predictor of PoAF in patients who were operated on for isolated CABG. Additionally, SII had a better discriminative ability for PoAF compared to either NLR or PLR among these cases.

Background: Inflammatory mechanisms play an important role in both atherosclerosis and stroke. There are several inflammatory peripheral blood count markers associated with carotid artery stenosis degree, symptomatic carotid artery lesions and carotid artery stent restenosis that reported in previous studies. However, the prognostic role of the blood cell counts and their ratios in predicting in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS) has not been comprehensively investigated. Systemic immune-inflammation index (SII) proved its' efficiency in patients with solid tumors and its' role was rarely examined in cardiovascular disorders and stroke. The current study evaluated the effect of this novel risk index on in-hospital and long-term outcomes in a large patient population who underwent CAS. Method: A total of 732 patients with carotid artery stenosis who underwent CAS were enrolled to the study. SII was calculated using the following formula: neutrophil-to-lymphocyte ratio pound total platelet count in the peripheral blood (per mm3) and the patients were stratified accordingly: T1, T2 and T3. In-hospital and 5-year outcomes were compared between the tertiles of SII. Results: During the hospitalization, major stroke, ipsilateral stoke, myocardial infarction, death and major adverse cardiovascular events (MACE) rates were significantly higher in high SII level (T3) compared to SII levels (T1 and 2). In longterm outcomes, ipsilateral stroke, major stroke, transient ischemic attack, death, and MACE were significantly higher in the patients with higher SII level (T3). The 5-year Kaplan-Meier overall survival for T1, T2, and T3 were 97.5%, 96.7% and 86.0% respectively. In-hospital and 5-year regression analyses demonstrated that high SII was independently associated with MACE and mortality. Conclusion: SII was independently associated with in-hospital and long-term clinical outcomes in patients undergoing CAS. Immune and inflammation status, as assessed easily and quickly using SII, has a good discriminative value in these patients.

Whole blood viscosity (WBV) is considered as a reasonable proxy measure of blood flow, and it has been investigated in different cohort settings, including in patients with deep venous thrombosis, arterial thrombosis, acute stent thrombosis, and left ventricular apical thrombus formation following acute coronary syndrome. To determine the association between WBV and the presence of thrombus in the left atrium (LA) or left atrial appendage (LAA) in individuals who had transoesophageal echocardiography (TEE). The clinical data from 262 consecutive patients who had TEE at our facility were included in this retrospective cohort study. WBV was determined at both a high shear rate (HSR) and low shear rate (LSR) using hematocrit and total protein levels. In 22 cases (8.3%), the thrombus was detected. According to multivariable analyses, WBV at HSR and LSR were independently linked with thrombus detection in TEE. In a receiver operating characteristic (ROC) analysis, the area under curve (AUC) values of WBV at HSR and LSR were 0.77 and 0.76, respectively. To predict the presence of thrombus in TEE; the ideal value of WBV at HSR was > 16.6 with 81% sensitivity and 69% specificity and the ideal value of WBV at LSR was > 51.4 with 81% sensitivity and 70% specificity. This was the first study to indicate that significantly higher levels of WBV at both the HSR and LSR were linked to the presence of thrombus in the LA and LAA in cases who underwent TEE.