Background and Objectives: There is a well-established correlation between premature ventricular contractions (PVCs) and atrial fibrillation (AF), with a higher burden of PVCs increasing the likelihood of new-onset AF. This study aims to investigate the impact of heart rate variability (HRV) on the onset of AF in patients with moderate to high burdens of PVCs, as observed through 24 h ambulatory electrocardiogram (ECG) analysis. Materials and Methods: Our study was a retrospective analysis involving 187 patients at a single tertiary center. We analyzed PVC counts from 24 h ECG recordings, categorizing the patients into groups based on whether they developed AF or not. Additionally, we developed a nomogram to estimate the risk of AF development in these patients. Results: A new-onset AF was detected in 16% of the cohort. Analysis of 24 h ambulatory ECG data revealed statistically significant increases in the SDNN index, RMSSD, PNN50, total power (TP), and low-frequency (LF) values in AF patients. To estimate the risk of AF, a risk prediction nomogram was created using high-frequency (HF), LF, SDNN index, and PNN50. Among these variables, PNN50 was identified as the strongest predictor in the multivariable model. Additionally, a decision curve analysis demonstrated that the nomogram offers a net clinical benefit for detecting AF in patients when the baseline threshold risk exceeds 15%. Conclusions: Our study found that among patients with AF who had a moderate to high burden of PVCs using 24 h ambulatory ECGs, several HRV parameters were elevated. This increased autonomic instability may play a role in the development and persistence of AF episodes.

PURPOSE:Chronic obstructive pulmonary disease (COPD) frequently leads to right heart structural and functional alterations. This study evaluates the right atrial coupling index (RACI), calculated as the right atrial volume index (RAVI) divided by the tricuspid annular late diastolic velocity (a'), as a novel echocardiographic marker for discriminating patients with prior COPD-related hospitalizations and for assessing functional decline, measured via the six-minute walking distance (6MWD). METHODS:This cross-sectional study enrolled 76 stable COPD patients in sinus rhythm. Participants underwent transthoracic echocardiography to measure right heart parameters and performed a six-minute walk test. Hospitalization history was retrieved from electronic health records. RACI was analyzed using receiver operating characteristic (ROC) curves and correlation tests. RESULTS:Of the 76 participants (83% male, mean age 67.6 ± 9.2 years), those with prior hospitalizations exhibited significantly higher RACI (2.51 ± 0.84 vs. 1.73 ± 0.63 cm3/m2/m/s, p < 0.001). In discriminating patients with prior hospitalizations, RACI achieved an AUC of 0.763 (95% CI: 0.652-0.853). For identifying functional decline (6MWD < 357 m), RACI showed an AUC of 0.844 (95% CI: 0.743-0.917) at a threshold of 1.99 cm3/m2/m/s. RACI consistently outperformed its individual components, RAVI and tricuspid a'. CONCLUSIONS:RACI is significantly associated with a history of COPD-related hospitalizations and with reduced exercise capacity. As a cross-sectional discriminative marker, RACI outperformed its individual components and may serve as a useful echocardiographic index for characterizing right heart burden in stable COPD patients. Prospective longitudinal studies are warranted to establish its predictive validity for future exacerbation events.

OBJECTIVE:Transthoracic echocardiography (TTE) is widely used for cardiac evaluation in acute ischemic stroke (AIS), but it may miss intracardiac thrombi that can be detected by transesophageal echocardiography (TEE). The stress hyperglycemia ratio (SHR), which adjusts admission glucose for baseline glycemia, has emerged as a novel biomarker in cardiovascular disease. However, its association with intracardiac thrombus undetected by TTE in AIS remains unclear. METHOD:This retrospective study included 486 AIS patients who underwent TEE despite negative baseline TTE findings. Demographic, laboratory, and echocardiographic data were evaluated. Logistic regression and receiver operating characteristic (ROC) analysis were used to assess independent associations with intracardiac thrombus. RESULTS:TEE detected thrombus in 64 patients (13.2%). Patients with thrombus had higher SHR (0.99 +- 0.42 vs. 0.84 +- 0.27, P < 0.001), glucose, C-reactive protein (CRP), and creatinine levels, and lower ejection fraction. In univariable analysis, SHR showed a strong association with intracardiac thrombus (odds ratio [OR] = 3.68, P < 0.001) and remained independently associated after multivariable adjustment (OR = 2.39, 95% confidence interval: 1.11-5.17, P = 0.027), along with CRP, paroxysmal atrial fibrillation, and male sex, while ejection fraction was inversely associated with thrombus presence. The model demonstrated good discriminative performance (area under the curve: 0.796). CONCLUSION:SHR is associated with intracardiac thrombus missed by TTE but detected by TEE in AIS. SHR may enhance risk stratification and help guide selective use of TEE.

Background: The clinical applicability of large language models (LLMs) in high-stakes cardiac emergencies remains unexplored. This study evaluated how well advanced LLMs perform in managing complex catheterization laboratory (Cath lab) scenarios and compared their performance with that of interventional cardiologists. Methods and Results: A cross-sectional study was conducted from 20 June to 2 December 2024. Twelve challenging inferior myocardial infarction scenarios were presented to seven LLMs (ChatGPT, Gemini, LLAMA, Qwen, Bing, Claude, DeepSeek) and five early-career interventional cardiologists. Responses were standardized, anonymized, and evaluated by thirty experienced interventional cardiologists. Performance comparisons were analyzed using a linear mixed-effects model with correlation and reliability statistics. Physicians had an average reference score of 80.68 (95% CI 76.3-85.0). Among LLMs, ChatGPT ranked highest (87.4, 95% CI 82.5-92.3), followed by Claude (80.8, 95% CI 75.7-85.9) and DeepSeek (78.7, 95% CI 72.9-84.6). LLAMA (73.7), Qwen (66.2), and Bing (64.3) ranked lower, while Gemini scored the lowest (59.0). ChatGPT scored higher than the early-career physician comparator group (difference 6.69, 95% CI 0.00-13.37; p < 0.05), whereas Gemini, LLAMA, Qwen, and Bing performed significantly worse; Claude and DeepSeek showed no significant difference. Conclusions: This expanded assessment reveals significant variability in LLM performance. In this simulated setting, ChatGPT demonstrated performance comparable to that of early-career interventional cardiologists. These results suggest that LLMs could serve as supplementary decision-support tools in interventional cardiology under simulated conditions.

Objective: The Intermountain Risk Score (IMRS), derived from routine laboratory parameters, predicts cardiovascular outcomes. Its association with saphenous vein graft degeneration (SVGD) post-coronary artery bypass grafting (CABG) remains underexplored. Methods: This retrospective cohort study analyzed data from 261 CABG patients who underwent coronary angiography. SVGD was defined as ≥50% graft stenosis. IMRS was calculated using laboratory data, age, and sex. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were used to assess IMRS’s predictive value for SVGD. Results: Of the 261 patients, 138 (52.9%) had SVGD. The SVGD group had higher median IMRS scores (12.5 vs. 10, p<0.001). After adjusting for confounders, IMRS was an independent predictor of SVGD (OR 1.640, 95% CI 1.310-2.054, p<0.001), as were chronic kidney disease and smoking. ROC analysis showed an area under the curve of 0.676, with a cutoff of IMRS >12 yielding a specificity of 83% and a sensitivity of 50%. Conclusions: Elevated IMRS independently predicts SVGD in post-CABG patients. As a cost-effective tool, IMRS may guide preoperative risk stratification and postoperative prevention strategies.

OBJECTIVE:The aim of this study was to assess autonomic dysfunction via heart rate variability (HRV) in residents with on-call shifts. METHOD:A cross-sectional study of 140 residents (104 on-call, 36 non-on-call) was conducted. HRV parameters, stress indices, and physical activity (International Physical Activity Questionnaire, IPAQ) were compared using parametric and non-parametric tests. RESULTS:On-call residents showed elevated heart rates (84 vs. 79 bpm, P = 0.006), higher stress indices (12.1 vs. 9.96, P = 0.003), and reduced parasympathetic markers (root mean square of successive differences [RMSSD], standard deviation of normal-to-normal intervals [SDNN], parasympathetic nervous system index [PNS index]; all P ≤ 0.006). Physical activity did not differ between groups. CONCLUSION:An association between on-call shifts and altered autonomic balance was observed, suggesting a potential increase in cardiovascular risk independent of lifestyle factors. These findings may be considered by policymakers when planning resident physician workloads.

Infective endocarditis (IE) is a heterogeneous disease with diverse clinical presentations, microbiological profiles, and outcomes. Conventional classification systems may not fully capture this complexity. We aimed to identify data-driven clinical phenotypes in IE using an unsupervised machine learning (ML) approach. In this multicenter retrospective study, 335 patients with definite IE from three hospitals were included. A total of 55 clinical, microbiological, and echocardiographic variables were analyzed. Missing data were imputed using the MissForest algorithm. Clustering was performed using spectral clustering based on a Gower dissimilarity matrix and supported by a Bayesian non-parametric approach. Associations between cluster assignment and clinical outcomes were assessed using regression analyses. Two distinct clusters were identified, reflecting different clinical profiles. Cluster 1 was characterized by native valve endocarditis, a higher burden of comorbidities, inflammatory activation, and larger vegetations. Cluster 2 was characterized by prosthetic valve and device-related IE, higher rates of atrial fibrillation, and larger cardiac dimensions. Cluster assignment was not significantly associated with in-hospital mortality in either unadjusted or adjusted analyses. Increasing age emerged as an independent predictor of in-hospital mortality. In the adjusted model, Cluster 2 was independently associated with longer hospital stay, whereas no significant difference was observed in ICU stay. Unsupervised ML identified two clinically distinct phenotypes in IE, reflecting disease heterogeneity. Although these phenotypes were not associated with major clinical outcomes, they provide a data-driven framework for understanding disease heterogeneity and may contribute to future personalized approaches in the management of IE. Larger prospective studies are needed to determine their clinical applicability.

Background:Preoperative cardiac evaluation aims to reduce cardiovascular risks in elective non-cardiac surgery, however its routine use is a subject of ongoing debate due to low event rates. This study examines patient characteristics, risk factors, diagnostic findings, recommendations, and outcomes to assess the value of these consultations and refine referral criteria. Methods:This retrospective cohort study included 482 patients who underwent elective non-cardiac surgery with preoperative cardiology consultations at a tertiary hospital (March-September 2021). Data on demographics, cardiovascular risks, echocardiographic/electrocardiographic findings, recommendations, and outcomes (in-hospital complications, mortality, one-year survival, hospital stay) were analyzed. Results:The median age of the patients was 69 years (interquartile range [IQR] 60-76), and 66.2% were male. Common surgeries included endoscopy/colonoscopy (31.7%) and genitourinary procedures (19.3%). Coronary artery disease (48.8%), hypertension (48.9%), and diabetes (37.8%) were prevalent. Most cases (96.5%) were asymptomatic, with ejection fractions > 50% (88.1%). Common recommendations included antiplatelet/anticoagulant modification (41.1%), although 54.8% of patients required no new recommendations. New diagnoses were rare (3.7%). In-hospital complications occurred in 2.9%, mortality in 0.6%, and one-year mortality in 1.7% of the patients, with a median hospital stay of 1 day (IQR 0-3). Conclusions:Despite the high burden of comorbidities in the study cohort, low adverse event rates suggest many consultations may be unnecessary, particularly in asymptomatic patients with preserved function, supporting more selective referral criteria to enhance efficiency.

Anti-anginal agents that modulate myocardial substrate metabolism, such as ranolazine and trimetazidine, are pharmacologically capable of altering exercise performance independently of their licensed indication in ischemic heart disease. Trimetazidine has been included on the World Anti-Doping Agency (WADA) Prohibited List since 2014 on the basis of comparable evidence. Whether ranolazine, a mechanistically distinct late sodium current inhibitor, produces analogous performance-modifying effects in the absence of myocardial ischemia has not been systematically examined. This exploratory, hypothesis-generating study characterized the functional exercise and structural echocardiographic correlates of chronic ranolazine and trimetazidine administration in healthy rats. Twenty-four male Sprague–Dawley rats were randomized in a blinded, parallel-group design to ranolazine (50 mg/kg/day), trimetazidine (10 mg/kg/day), or saline control (n = 8 per group) for 30 days. Two control-group rats died under ketamine-xylazine anesthesia during baseline (day 0) echocardiography, before any study data were collected, and were excluded from all subsequent analyses, yielding a final analytic sample of 22 rats (control, n = 6; trimetazidine, n = 8; ranolazine, n = 8). Forced swimming, rotarod testing, and transthoracic echocardiography were performed at baseline, day 15, and day 30. Because Shapiro–Wilk testing indicated non-normal distributions, non-parametric statistics (Kruskal–Wallis, Friedman, Wilcoxon signed-rank with Bonferroni-adjusted post-hoc thresholds) were applied a priori, and exact p-values are reported throughout. Total swimming time differed significantly between groups (ranolazine 39,668 s [33,794–43,838]; trimetazidine 35,694 s [30,776–39,516]; control 32,426 s [29,389–34,453]; p = 0.006), with ranolazine exceeding trimetazidine in sessions 16–18 (p < 0.001). Rotarod performance was unchanged across groups and time (p > 0.05 for all comparisons). Echocardiography showed small but statistically significant increases in interventricular septal thickness and calculated left ventricular mass in all three groups, including controls, with ejection fraction and fractional shortening preserved throughout. Chronic ranolazine administration was associated with exercise-performance changes that paralleled, and in later sessions exceeded, those produced by trimetazidine, together with modest echocardiographic changes that are compatible with, but not proof of, physiological cardiac remodeling. Because the present design did not include biochemical, histological, electrocardiographic, or direct oxygen-consumption confirmation, and because the structural changes occurred in controls as well as treated animals, these observations should be regarded as hypothesis-generating rather than mechanistically conclusive. They identify ranolazine as a candidate worthy of further, more deeply mechanistic investigation rather than establishing, on their own, a basis for anti-doping action.

Chronic alcohol consumption is a recognized contributor to non-ischemic dilated cardiomyopathy, particularly in individuals with an underlying genetic predisposition, through myocardial inflammation, oxidative stress, and apoptosis. Colchicine, an NLRP3 inflammasome inhibitor, has cardioprotective potential, but its role in alcohol-induced injury is unknown. This study aimed to evaluate the dose-dependent effects of colchicine (0.1 mg/kg and 0.3 mg/kg) on alcohol-induced cardiac damage in rats. Overall, 40 Sprague–Dawley rats were randomized into five groups: control, alcohol (20

In the original publication [...].

Femoral artery pseudoaneurysms are a recognized complication of coronary angiography performed via femoral access, with incidence rates ranging from 0.2

Objective: The objective of this study was to compare changes in choroidal thickness (ChT) and choroidal vascular index (CVI) between patients with coronary artery ectasia (CAE) and healthy individuals. Methods: This study included 34 patients with CAE and 40 age-matched healthy subjects with normal coronary arteries. Measurements of ChT and CVI were taken using spectral-domain optical coherence tomography, employing the binarization method for CVI calculation. Additional parameters, including central macula thickness (CMT), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCC) thickness, were also documented. Results: The results indicated no significant differences in either subfoveal ChT or in ChT at 1500 µm both nasal and temporal to the fovea. However, significant differences were noted in ChT at the 500 µm nasal and temporal areas. The CVI was found to be significantly lower in the CAE group compared to the healthy controls. Furthermore, this study noted a significant difference in GCC thickness between the two groups, while no significant differences were observed in CMT and RNFL measurements. Conclusions: The findings suggest that patients with CAE exhibit decreased ChT and CVI in comparison to healthy controls. This highlights the potential role of ChT and CVI as important markers of disease in coronary artery ectasia, offering valuable insights into systemic cardiovascular health.

Contrast-induced nephropathy (CIN) is a serious complication in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Early identification of high-risk patients is essential to improve outcomes and reduce mortality. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was originally designed to predict mortality in heart failure patients, but its role in predicting CIN has not been fully explored. In the present retrospective study, 1403 STEMI patients treated with pPCI were analyzed. Those who developed CIN had higher mortality, longer hospital stays, and more comorbidities. The MAGGIC score and 21 clinical parameters were incorporated into deep learning (DL) models, including multilayer perceptrons, TabNet, TabTransformer, and Kolmogorov-Arnold Networks (KAN) and one machine learning algorithm such as logistic regression. The best-performing model, KAN, significantly improved CIN prediction with an area under curve (AUC) of 0.92. SHapley Additive exPlanations (SHAP) analysis revealed key predictors such as pain-to-balloon time, contrast volume, baseline creatinine, and MAGGIC score. Our findings demonstrate that combining MAGGIC risk scoring with DL substantially enhances CIN prediction in STEMI patients. This approach enables identification of at-risk individuals and supports implementation of nephroprotective strategies at an early stage. The web-based calculator may assist clinical decision making.

Objective: Coronary artery disease (CAD) is the leading cause of morbidity and mortality globally.The growing interest in natural language processing chatbots (NLPCs) has driven their inevitable widespread adoption in healthcare.The purpose of this study was to evaluate the accuracy and reproducibility of responses provided by NLPCs, such as ChatGPT, Gemini, and Bing, to frequently asked questions about CAD.Methods: Fifty frequently asked questions about CAD were asked twice, with a one-week interval, on ChatGPT, Gemini, and Bing.Two cardiologists independently scored the answers into four categories: comprehensive/correct (1), incomplete/partially correct (2), a mix of accurate and inaccurate/misleading (3), and completely inaccurate/irrelevant (4).The accuracy and reproducibility of each NLPC's responses were assessed.Results: ChatGPT's responses were scored as 14% incomplete/partially correct and 86% comprehensive/correct.In contrast, Gemini provided 68% comprehensive/correct responses, 30% incomplete/partially correct responses, and 2% a mix of accurate and inaccurate/ misleading information.Bing delivered 60% comprehensive/correct responses, 26% incomplete/partially correct responses, and 8% a mix of accurate and inaccurate/misleading information.Reproducibility scores were 88% for ChatGPT, 84% for Gemini, and 70% for Bing. Conclusion:ChatGPT demonstrates significant potential to improve patient education about coronary artery disease by providing more sensitive and accurate answers compared to Bing and Gemini.

OBJECTIVE:The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score has gained interest as a potential predictive biomarker for various clinical outcomes across multiple diseases. This study aimed to evaluate the efficacy of the HALP score in predicting the recurrence of atrial fibrillation (AF) following cryo-balloon ablation (CBA). METHOD:A total of 399 patients who underwent CBA for AF were included in the study. Patients were divided into three equal groups based on their HALP scores, and post-procedural AF recurrence was evaluated retrospectively across these groups. RESULTS:After adjusting for confounding independent variables, patients in Tertile 1 had 2.1-fold higher rate of AF recurrence compared to those in Tertile 3, which served as the reference group. Receiver operating characteristic (ROC) curve analysis showed that the HALP score predicted AF recurrence with an area under the curve (AUC) of 0.69, 65% sensitivity, and 65% specificity (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.63-0.74, P < 0.001). CONCLUSION:This study suggests that the HALP score may serve as an independent predictor of AF recurrence following CBA.

OBJECTIVE:Catheter-based ablation is now widely recognized as a beneficial therapeutic option for managing atrial fibrillation (AF). However, the extended duration and pain associated with the procedure may cause patient movements, potentially leading to disruptions in the electro-anatomical mapping systems. Sedative and analgesic agents are used to prevent body movements and manage pain. This study aimed to conduct a comparison between the safety and effects of ketamine and propofol for deep sedation on outcomes in AF patients undergoing radiofrequency ablation. METHODS:This retrospective and single-center study included 108 patients who underwent radiofrequency AF ablation under deep sedation (without intubation) in our hospital. The patients were categorized into two groups based on the anesthetic agent administered for deep sedation: the propofol group and the ketamine group. Procedure duration, success rates, and recovery times were compared. RESULTS:Of the 108 patients, 54 were in the propofol group and 54 were in the ketamine group. The procedure durations were similar in both groups (propofol group: 135 min (120 - 145) vs. ketamine group: 140 min (120 - 155), p=0.803). The eye-opening time after the procedure was 275 seconds in the propofol group and 266 seconds in the ketamine group (p=0.530). Additionally, no significant variation was detected in the initial measurements of systolic and diastolic blood pressure or heart rate. CONCLUSION:In conclusion, there was no significant difference between the propofol group and the ketamine group in terms of outcomes. To the best of our knowledge, this is the first study to assess the efficacy of ketamine and propofol in the radiofrequency AF ablation patient group.