{"title":"Effects of ChatGPT Use on Self-care Cardiac Rehabilitation Adherence in Patients with Coronary Artery Disease.","authors":"Hac Ift I, Do An Yet T","doi":"10.5543/tkda.2026.31777","DOIUrl":"https://doi.org/10.5543/tkda.2026.31777","url":null,"abstract":"<p><strong>Objective: </strong>To clarify the possible effects of ChatGPT use on self-care cardiac rehabilitation (CR) adherence in patients with coronary artery disease (CAD).</p><p><strong>Method: </strong>Patients in the ChatGPT group participated in a standard cardiac rehabilitation program supplemented with personalized digital support via ChatGPT (n=48). The control group participated in conventional cardiac rehabilitation only, without AI-based support (n=48). Both groups completed a 6-month structured rehabilitation program supervised by a multidisciplinary team. Baseline demographic and clinical data, patient satisfaction assessed using a Likert scale, physical activity levels assessed using the International Physical Activity Questionnaire (IPAQ), and metabolic equivalent of task (MET) values were recorded.</p><p><strong>Results: </strong>The postrehabilitation MET score was 1537 in the ChatGPT group and 1413 in the control group (P = 0.001). Similarly, the change in MET score after rehabilitation was greater in the ChatGPT group than in the control group (1029 vs. 875, P = 0.001). SF-36 parameters, including physical functioning, role-physical, mental health, bodily pain, and general health, were significantly higher in the ChatGPT group than in the control group (P < 0.05 for all). Program compliance was higher in the ChatGPT group than in the control group (91.7% vs. 75.0%, P = 0.028). Patient satisfaction was also higher in the ChatGPT group (4.5 vs. 3.8, P = 0.001).</p><p><strong>Conclusion: </strong>ChatGPT use during CR was associated with higher patient compliance rates. Moreover, ChatGPT-supported CR was associated with higher physical activity levels, greater patient satisfaction, and better selected quality-of-life scores.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sevil Tuğrul Yavuz, Hasan Burak İşleyen, Duygu İnan, Fatmatüz Zehra Özsaray, Kadir Kasım Şahin, Cemal Özanalp, Emel Hamkan, Duygu Genç Albayrak, Emir Hancıoğlu, Alev Kılıçgedik
{"title":"Prevalent Sodium-Glucose Co-Transporter 2 Inhibitor Use, Baseline Laboratory Profile, and Clinical Outcomes in a Real-World Heart Failure Cohort.","authors":"Sevil Tuğrul Yavuz, Hasan Burak İşleyen, Duygu İnan, Fatmatüz Zehra Özsaray, Kadir Kasım Şahin, Cemal Özanalp, Emel Hamkan, Duygu Genç Albayrak, Emir Hancıoğlu, Alev Kılıçgedik","doi":"10.5543/tkda.2026.27385","DOIUrl":"https://doi.org/10.5543/tkda.2026.27385","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prevalence of sodium-glucose co-transporter 2 inhibitor (SGLT2i) use, baseline laboratory profiles, and associated clinical outcomes in a real-world heart failure (HF) cohort.</p><p><strong>Method: </strong>This retrospective, single-center cohort study included consecutive patients with HF who were evaluated between January 2022 and January 2024. Of the 609 patients, 581 with known SGLT2i use status constituted the analytic cohort. The primary outcome was HF hospitalization. A composite outcome comprising all-cause death, HF hospitalization, stroke, or peripheral embolism was assessed as an exploratory endpoint. Propensity score matching and overlap-weighted Cox regression models were used in sensitivity analyses.</p><p><strong>Results: </strong>Among the 581 patients, 349 were SGLT2i users and 232 were non-users. Users had a lower left ventricular ejection fraction, higher B-type natriuretic peptide concentrations, a higher prevalence of diabetes and ischemic etiology, and more intensive background therapy. In the unadjusted analyses, the rates of HF hospitalization and composite events were higher among users; however, these associations were attenuated after adjustment. In the overlap-weighted propensity score analysis, SGLT2i use was not associated with HF hospitalization (HR: 0.91; 95% CI: 0.57-1.47; P=0.700), the study-defined composite endpoint (HR: 0.95; 95% CI: 0.61-1.48; P=0.827), or exploratory all-cause mortality (HR: 1.04; 95% CI: 0.45-2.42; P=0.931).</p><p><strong>Conclusion: </strong>SGLT2i users represented a treated population with more advanced clinical characteristics, and their higher unadjusted event burden did not persist after adjustment. These findings reflect treatment selection rather than therapeutic benefit or harm. Therapies proven to reduce mortality should be systematically implemented in all eligible patients with HF, regardless of their clinical status or estimated mortality risk.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Step-By-Step Left Bundle Branch Area Pacing: A Practical Technical Guide.","authors":"Uğur Canpolat, Serkan Çay","doi":"10.5543/tkda.2026.24973","DOIUrl":"https://doi.org/10.5543/tkda.2026.24973","url":null,"abstract":"<p><p>Left bundle branch area pacing (LBBAP) has emerged as a physiological pacing strategy capable of restoring ventricular synchrony in patients requiring permanent pacing or cardiac resynchronization therapy (CRT). Compared with conventional right ventricular pacing and biventricular pacing, LBBAP provides more physiological ventricular activation by engaging the His-Purkinje conduction system. However, procedural success depends heavily on appropriate patient selection, anatomical targeting, and standardized implantation techniques. This technical review aims to provide a comprehensive, step-by-step guide to LBBAP implantation by integrating electrocardiographic, fluoroscopic, and intracardiac electrophysiological criteria consistent with current European Heart Rhythm Association (EHRA) and Heart Rhythm Society (HRS) recommendations. It summarizes the procedural workflow, patient selection criteria, implantation techniques, electrocardiographic markers, septal penetration strategies, and pacing confirmation parameters based on selected implantation cases supported by annotated electrocardiograms (ECGs), filtered and unfiltered electrograms (EGMs), and fluoroscopic images. Key procedural elements associated with successful LBBAP include systematic evaluation of the interventricular septal anatomy, continuous 12-lead ECG monitoring, precise fluoroscopic targeting, and electrophysiological confirmation of conduction system capture. Important procedural indicators include a W-pattern morphology in lead V1 and aVR-aVL discordance before septal penetration, fixation beats during septal penetration, a terminal r/R wave in lead V1, the V6 R-wave peak time, V6-V1 interpeak interval measurements, and demonstration of selective or nonselective left bundle branch capture or left ventricular septal capture after septal penetration. When performed using standardized implantation criteria and electrophysiological validation, LBBAP represents a reproducible and effective physiological pacing technique for both bradycardia indications and CRT candidates. The adoption of standardized procedural terminology and validation criteria may improve procedural success and clinical outcomes.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ayşe İrem Boladan, Oktay Şeker, Göktuğ Savaş, Semih Eren
{"title":"Very Young ST-Segment Elevation Myocardial Infarction Associated With Chronic Nonmedical Anabolic-Androgenic Steroid Use: A Case Report.","authors":"Ayşe İrem Boladan, Oktay Şeker, Göktuğ Savaş, Semih Eren","doi":"10.5543/tkda.2026.65746","DOIUrl":"https://doi.org/10.5543/tkda.2026.65746","url":null,"abstract":"<p><p>Myocardial infarction (MI) before the age of 40 years is uncommon and warrants a comprehensive evaluation of potential etiologies. Chronic nonmedical anabolic-androgenic steroid (AAS) use has been associated with endothelial dysfunction, accelerated atherosclerosis, and a prothrombotic state, all of which may contribute to premature coronary artery disease. A 29-year-old man with no known medical history and approximately two years of nonmedical testosterone and stanozolol use presented with acute chest pain. Electrocardiography revealed an anterior ST-segment elevation myocardial infarction (STEMI). Emergency coronary angiography demonstrated a thrombotic total occlusion of the mid-left anterior descending coronary artery. Primary percutaneous coronary intervention restored coronary blood flow. The patient presented with Killip class II acute heart failure requiring temporary continuous positive airway pressure (CPAP) and inotropic support. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction (LVEF) of 30-35%, with anterior and apical hypokinesia. Admission laboratory tests revealed marked atherogenic dyslipidemia (total cholesterol, 302 mg/dL; low-density lipoprotein cholesterol, 250 mg/dL; high-density lipoprotein cholesterol, 29 mg/dL; triglycerides, 113 mg/dL; and non-high-density lipoprotein cholesterol, 273 mg/dL). In addition to the culprit lesion, nonobstructive atherosclerotic plaques were identified in other coronary segments. At the one-month follow-up, low-density lipoprotein cholesterol had decreased to 85 mg/dL following statin therapy and the reported discontinuation of AAS use. At three months, the patient remained clinically stable, although LVEF remained at 30%. AAS exposure may have contributed to accelerated atherosclerosis and coronary thrombosis in a susceptible young individual. However, alternative causes of MI at a very young age should be systematically considered.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehmet Zafer Aydın, Mehmet Kamil Teber, Zülfiye Kuzu, Can Baba Arın
{"title":"High Thrombus Burden in Premature Type 1 Myocardial Infarction: Cross-Sectional Associations With STEMI Presentation, Coronary Flow, and Systemic Inflammation.","authors":"Mehmet Zafer Aydın, Mehmet Kamil Teber, Zülfiye Kuzu, Can Baba Arın","doi":"10.5543/tkda.2026.94455","DOIUrl":"https://doi.org/10.5543/tkda.2026.94455","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated whether admission complete blood count-derived inflammatory indices were associated with angiographic high thrombus burden (HTB) in premature myocardial infarction (MI).</p><p><strong>Method: </strong>Consecutive patients aged <45 years with type 1 MI and an identifiable culprit lesion who underwent coronary angiography between 2020 and 2024 were included in this single-center, retrospective, cross-sectional analysis. Thrombus burden was assessed using the Thrombolysis in Myocardial Infarction (TIMI) thrombus grading scale, with occluded vessels reclassified after restoration of coronary flow; HTB was defined as grades 4-5. The neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI) were evaluated using clinically defined multivariable logistic regression models, with and without adjustment for ST-elevation myocardial infarction (STEMI) presentation.</p><p><strong>Results: </strong>Among 137 patients (77 with STEMI and 60 with non-ST-elevation myocardial infarction [NSTEMI]), 81 had an occluded culprit vessel; after restoration of coronary flow, only two lesions remained classified as grade 5. HTB was identified in 79 patients (57.7%) and was associated with STEMI presentation (67.1% vs. 41.4%, P = 0.003) and culprit vessel occlusion (69.6% vs. 44.8%, P = 0.004). Neither NLR (P = 0.54) nor SIRI (P = 0.20) differed significantly between thrombus burden categories, and neither was associated with HTB after adjustment for pre-event characteristics (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.94-1.17 and OR 1.13, 95% CI 0.95-1.35, respectively) or additional adjustment for STEMI presentation (OR 1.03, 95% CI 0.92-1.14 and OR 1.08, 95% CI 0.90-1.30, respectively), whereas STEMI presentation remained significantly associated with HTB (OR 2.75, 95% CI 1.33-5.68, P = 0.006). The findings were consistent across all sensitivity analyses, and discriminatory performance was negligible (areas under the curve of 0.531 and 0.564). No significant differences in in-hospital outcomes were detected; however, these comparisons were underpowered.</p><p><strong>Conclusion: </strong>In young patients with angiographically confirmed type 1 MI, HTB was associated with STEMI presentation and initial coronary occlusion but not with admission inflammatory indices.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ömer Bedir, Ömer Kümet, Remziye Doğan, İsmail Polat
{"title":"Risk Factors, Ischemic Delay, and In-Hospital Outcomes by Sex in Adults Aged 18-50 Years with STEMI Undergoing Primary Percutaneous Coronary Intervention: An Exploratory Single-Center Cohort.","authors":"Ömer Bedir, Ömer Kümet, Remziye Doğan, İsmail Polat","doi":"10.5543/tkda.2026.76537","DOIUrl":"https://doi.org/10.5543/tkda.2026.76537","url":null,"abstract":"<p><strong>Objective: </strong>To describe sex differences in cardiovascular risk factors and reperfusion delays and explore in-hospital outcomes in adults aged 18-50 years with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).</p><p><strong>Method: </strong>This retrospective single-center cohort included 497 consecutive patients (71 [14.3%] women) treated during 2023-2024. Hard major adverse cardiac and cerebrovascular events (MACCE) comprised all-cause death, recurrent myocardial infarction, or stroke. A nonstandard expanded clinical deterioration composite additionally included incident cardiogenic shock and, among patients admitted in Killip class I, incident heart failure. Sex comparisons and Firth penalized logistic models were exploratory.</p><p><strong>Results: </strong>Mean age was 40.7 +- 5.3 years. Current smoking was more frequent in men (69.0% vs 39.4%; P < 0.001), whereas obesity was more frequent in women (54.9% vs 26.8%; P < 0.001). Age-adjusted median symptom-to-first-medical-contact, first-medical-contact-to-device, and total ischemic times were 46, 10, and 48 minutes longer in women, respectively (all P < 0.001). Hard MACCE occurred in 21 patients (4.2%), incident heart failure occurred in 13 of 390 eligible patients (3.3%), and the expanded composite occurred in 46 patients (9.3%). The expanded composite occurred in 12 of 71 women and 34 of 426 men (16.9% vs 8.0%; unadjusted P = 0.025), and incident cardiogenic shock occurred in 7 women and 13 men (9.9% vs 3.1%; unadjusted P = 0.015). In the parsimonious baseline model, the adjusted odds ratio (OR) for female sex was 2.61 (95% confidence interval [CI], 1.21-5.42), attenuating to 1.90 (95% CI, 0.83-4.18) after adding admission Killip class ≥II.</p><p><strong>Conclusion: </strong>Women had a different risk-factor distribution and longer documented ischemic delays. The association between sex and the expanded composite was sensitive to adjustment for baseline clinical severity. Sex-specific outcome estimates are hypothesis-generating given the small female subgroup and event counts. The retrospective single-center design, absence of post-discharge follow-up, and unavailable care- and referral-pathway variables limit causal interpretation.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sevil Tuğrul Yavuz, Hasan Burak İşleyen, Duygu İnan, Ufuk Yıldız, Kadir Kasım Şahin, Muhammet Tekin, Merve Kertmen, Ömer Fakih Türkmen, Gurur Nar Sağır, Alev Kılıçgedik
{"title":"Association of an Exploratory Iron Index Score With Observed NT-proBNP Trajectory in SGLT2-Treated Heart Failure and Clinical Outcomes in a Broader Cohort.","authors":"Sevil Tuğrul Yavuz, Hasan Burak İşleyen, Duygu İnan, Ufuk Yıldız, Kadir Kasım Şahin, Muhammet Tekin, Merve Kertmen, Ömer Fakih Türkmen, Gurur Nar Sağır, Alev Kılıçgedik","doi":"10.5543/tkda.2026.79039","DOIUrl":"https://doi.org/10.5543/tkda.2026.79039","url":null,"abstract":"<p><strong>Objective: </strong>Iron-related risk in heart failure is multidimensional, yet routine assessment still relies primarily on single laboratory-based definitions. This study evaluated whether an exploratory composite Iron Index Score was associated with the observed routine-care NT-proBNP trajectory after SGLT2 inhibitor therapy and with adverse clinical outcomes in a broader score-complete cohort.</p><p><strong>Methods: </strong>This retrospective real-world cohort study used a nested analytic design. The primary biomarker analysis included a final SGLT2-treated cohort with paired baseline and follow-up NT-proBNP measurements and complete score components (n=238). The supportive clinical analysis included a broader score-complete cohort regardless of SGLT2 use (n=472). The cohort predominantly comprised patients with heart failure with reduced ejection fraction. The Iron Index Score assigned 1 point each for transferrin saturation <20%, hemoglobin <12 g/dL, ferritin <100 ng/mL, albumin <3.5 g/dL, and red cell distribution width >14.5%. The primary outcome was the change in log-transformed NT-proBNP from baseline to the lowest recorded on-treatment value. Secondary analyses examined NT-proBNP response, heart failure hospitalization, and exploratory all-cause mortality.</p><p><strong>Results: </strong>In the final SGLT2-treated biomarker cohort, the adjusted ordinal score showed a directionally less favorable delta log NT-proBNP estimate but did not reach conventional statistical significance (beta 0.15, 95% CI -0.00 to 0.30; P=0.054). The high-risk group showed a stronger exploratory adverse signal compared with the low-risk group (beta 1.00, 95% CI 0.40 to 1.59; P<0.001). NT-proBNP responder status was not independently associated with score burden. In the broader score-complete cohort, higher score burden was associated with heart failure hospitalization in the unadjusted analysis, but this association was attenuated after adjustment (hazard ratio 1.04, 95% CI 0.85 to 1.27; P=0.690). All-cause mortality analyses were interpreted as exploratory because only 21 deaths occurred.</p><p><strong>Conclusion: </strong>A higher exploratory Iron Index Score showed a hypothesis-generating signal toward a less favorable observed NT-proBNP trajectory in a predominantly HFrEF SGLT2-treated cohort. Broader cohort analyses showed supportive but less stable clinical outcome signals.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ertan Aydın, Fatih Özçubukcu, Devrim Kurt, Gökhan Gök, Aslı Vural
{"title":"Reply to the Letter to the Editor: \"A Bleeding-Risk Score Is Not a Bleeding Endpoint: DAPT De-Escalation in mGPS-High NSTEMI\".","authors":"Ertan Aydın, Fatih Özçubukcu, Devrim Kurt, Gökhan Gök, Aslı Vural","doi":"10.5543/tkda.2026.45338","DOIUrl":"https://doi.org/10.5543/tkda.2026.45338","url":null,"abstract":"","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}