Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir最新文献

{"title":"A Bleeding-Risk Score is Not a Bleeding Endpoint: DAPT De-Escalation in mGPS-High NSTEMI.","authors":"Hasan Burak İşleyen, Sercan Bulut, Emirhan Hancıoğlu","doi":"10.5543/tkda.2026.50345","DOIUrl":"https://doi.org/10.5543/tkda.2026.50345","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":"149187420","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":"Automated Two-component Pre-CTPA ECG Risk Phenotype and 365-day Mortality among ECG-evaluated Patients with Computed Tomography-confirmed Pulmonary Embolism.","authors":"Hasan Burak İşleyen, Sevil Tuğrul Yavuz, Sercan Bulut, Oğuzhan Abanoz, Esra Danışman, Necla Zeynep Eren, Nuray Kahraman Ay, Nusret Açıkgöz, Ramazan Özdemir, Ali Arda Sözen, Mahmut Uluganyan","doi":"10.5543/tkda.2026.05898","DOIUrl":"https://doi.org/10.5543/tkda.2026.05898","url":null,"abstract":"<p><strong>Objective: </strong>Electrocardiographic abnormalities are common in acute pulmonary embolism, but their prognostic value in public waveform-linked cohorts remains incompletely characterized. We evaluated whether an interpretable automated two-component pre-CTPA ECG risk phenotype was associated with 365-day mortality among ECG-evaluated patients with CTPA-confirmed pulmonary embolism.</p><p><strong>Method: </strong>This secondary analysis used a retrospective cohort derived from MIMIC-IV-Ext-PE linked to MIMIC-IV-ECG. The source population included 1,534 unique PE-positive patients after patient-level indexing. A total of 650 patients had an ECG within 6 hours before CTPA, 571 were admission-linked, and 567 passed waveform signal-quality screening. The exposure assigned 1 point for tachycardia >100 beats/min and 1 point for V3 T-wave inversion. The primary Cox model was adjusted for age, sex, Charlson comorbidity index, PE subtype, ICU admission initiated at or before CTPA, and early physiologic derangement after excluding heart rate from the derangement definition.</p><p><strong>Results: </strong>The primary cohort included 567 patients and 126 deaths within 365 days. Crude 365-day mortality increased across score levels: 15.0% for score 0, 26.8% for score 1, and 41.7% for score 2. In the primary model, each 1-point increase in the score was associated with higher 365-day mortality (HR 1.70 [1.36-2.13], P<0.001). The exposure-level proportional hazards diagnostic did not show clear evidence of violation (P=0.060). A stabilized inverse-probability-of-selection weighted Cox model yielded a similar estimate (HR 1.59, 95% CI 1.28-1.99; P<0.001), although measured selection imbalance was reduced but not eliminated.</p><p><strong>Conclusion: </strong>Among ECG-evaluated patients with CTPA-confirmed pulmonary embolism, an automated two-component pre-CTPA ECG risk phenotype was associated with higher 365-day mortality. The phenotype should be interpreted as an early prognostic marker requiring further validation rather than as a validated clinical decision tool.</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":"149187423","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":"A Giant Inferior Vena Cava: The Extreme Limits of Caval Dilation in Chronic Right-Sided Pressure Overload.","authors":"Yalçın Velibey, Erkan Kahraman, Muhsin Melik, Salih Bektaş, Bilal Çakır, Osman Bolca","doi":"10.5543/tkda.2026.56828","DOIUrl":"https://doi.org/10.5543/tkda.2026.56828","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":"149187454","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":"Evaluation of Pediatric Cardiologists' Knowledge Levels Regarding Pulmonary Hypertension: Commonly Misunderstood Concepts.","authors":"Serdar Kula, Gizem Karkın Tozlu, Meliz Yurdaer","doi":"10.5543/tkda.2026.13808","DOIUrl":"https://doi.org/10.5543/tkda.2026.13808","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify common misconceptions regarding pulmonary hypertension (PH) among pediatric cardiologists.</p><p><strong>Method: </strong>Before an online educational session on common misconceptions in PH, a 10-question test was administered to pediatric cardiologists across Türkiye via the Jotform platform. The questionnaire was developed following a pilot study in which an initial 20-question survey was administered to five experienced pediatric cardiologists. Based on their feedback, the 10 questions that best captured clinically relevant misconceptions were retained for the final instrument. The questions were prepared by an expert pediatric cardiologist and reviewed by two additional specialists. The test comprised multiple-choice, fill-in-the-blank, and true/false items covering the diagnostic criteria, treatment approaches, and pharmacological management of PH. Correct answer rates were calculated as percentages.</p><p><strong>Results: </strong>Sixty-six pediatric cardiologists participated, with an overall correct response rate of 43.6%. The most common misconceptions involved bosentan storage after reconstitution and the use of a three-stratum risk assessment model in pediatric PH. Nearly half of the participants incorrectly identified first-line therapy in vasoreactivity-positive IPAH/HPAH patients.</p><p><strong>Conclusion: </strong>This study demonstrates that important concepts in pediatric PH management are not consistently understood among pediatric cardiologists. The identified knowledge gaps, particularly in pharmacology and risk assessment, highlight the need for targeted educational initiatives and regular updates on current guideline recommendations to promote more consistent clinical practice.</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":"149187404","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":"Bee Sting-Associated Kounis Syndrome Presenting as Myocardial Infarction: A Case Report and Systematic Review with Age-Based Analysis.","authors":"Ahmet Yetkin, Ömer Faruk Yılmaz, Mehmet Semih Belpınar, Anastasia Balta, Yusuf Ziya Şener","doi":"10.5543/tkda.2026.83835","DOIUrl":"https://doi.org/10.5543/tkda.2026.83835","url":null,"abstract":"<p><p>Kounis syndrome (KS) is an uncommon acute coronary syndrome triggered by allergic or hypersensitivity reactions. Bee stings are a recognized precipitant, although the available evidence is largely limited to case reports and small case series. We present a 44-year-old man with probable bee sting-associated KS and systematically review published cases, including an exploratory age-based comparison using ≤45 years as the cutoff for myocardial infarction in younger individuals. PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) and Scopus were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. A total of 47 patients were included, comprising 46 previously reported cases and our index case. The mean age was 55.7+-13.0 years, and 39/47 patients (83.0%) were male. Symptoms developed within 30 minutes in 29/47 patients (61.7%), and chest pain occurred in 41/47 (87.2%). Type II KS predominated (29/43, 67.4%), while ST-segment elevation myocardial infarction (STEMI) occurred in 37/47 patients (78.7%), and revascularization was performed in 27/47 (57.4%). Cardiogenic shock, cardiac arrest, and rhythm or conduction disturbances occurred in 11/46 (23.9%), 5/46 (10.9%), and 7/46 patients (15.2%), respectively. Recovery at the last reported assessment was documented in 45/46 patients (97.8%), with no reported deaths. No follow-up data were available after the index patient left the hospital against medical advice approximately five hours after presentation. Thirteen patients (27.7%) were aged ≤45 years; age-stratified descriptive analyses did not reveal clear differences in most clinical characteristics; however, interpretation was limited by the small number of younger patients. Bee sting-associated KS may cause severe acute coronary presentations, including in younger individuals. Given the case-based and heterogeneous nature of the evidence, these findings should be interpreted cautiously and confirmed in systematically collected cohorts.</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":"149187434","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":"Anterior ST-Segment Elevation Myocardial Infarction Followed by Acute Popliteal Artery Occlusion in a 25-Year-Old Tobacco Smoker with Cannabis Use.","authors":"Yalçın Dalgıç, Denizhan Karaçimen, Ahmet Berk Duman, Emine Büşra Kıtlık, Samet Solmaz, Yunus Koç, Şükriye Ebru Önder","doi":"10.5543/tkda.2026.47908","DOIUrl":"https://doi.org/10.5543/tkda.2026.47908","url":null,"abstract":"<p><p>Myocardial infarction before 30 years of age warrants evaluation beyond conventional atherosclerosis, particularly when a second arterial event occurs in another vascular bed. A 25-year-old man with a nine-pack-year history of tobacco smoking and occasional cannabis use presented with anterior ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention of the left anterior descending artery. Left ventricular ejection fraction was 30%, with severe apical wall-motion abnormality. Twelve days after discharge, he developed acute left popliteal artery occlusion (Rutherford IIb), which improved to IIa and subsequently to I during therapeutic anticoagulation and was managed without revascularization. Fasting homocysteine measured on day 21 was 18.4 µmol/L, with a vitamin B12 level of 121 pg/mL and a folate level of 1.9 ng/mL. Vitamin B12 replacement and folic acid 5 mg/day were prescribed; fasting homocysteine remained mildly elevated at approximately 6 and 18 months (21.6 and 20.7 µmol/L, respectively), with follow-up folate levels of 5.2 and 4.7 ng/mL. Renal and thyroid function were not reassessed at these later measurements. Genotyping showed compound heterozygosity for MTHFR C677T (Methylenetetrahydrofolate reductase) and A1298C, which was considered an accompanying finding rather than a causal thrombophilia. A missed or transient left ventricular apical thrombus represents a plausible, and possibly the most likely, explanation for the limb event. The patient remained free of recurrent thrombotic or bleeding events for 18 months while receiving an individualized warfarin regimen.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187457","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":"No-Reflow in the Young: Does the Inflammatory Prognostic Index Add Anything?","authors":"Özcan Başaran, Barış Güngör","doi":"10.5543/tkda.2026.49700","DOIUrl":"https://doi.org/10.5543/tkda.2026.49700","url":null,"abstract":"","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129747","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":"Anterior ST-Segment Elevation Myocardial Infarction With Coronary Thrombosis in a Young Man with Newly Diagnosed HIV Infection and Pneumocystis jirovecii Pneumonia.","authors":"Yasin Aktaş","doi":"10.5543/tkda.2026.57598","DOIUrl":"https://doi.org/10.5543/tkda.2026.57598","url":null,"abstract":"<p><p>Human immunodeficiency virus (HIV) infection is associated with an increased cardiovascular risk through chronic inflammation, immune dysregulation, endothelial dysfunction, and prothrombotic mechanisms. However, the mechanisms underlying acute coronary events in young patients with newly diagnosed advanced HIV infection remain incompletely understood. We report the case of a 36-year-old man with newly diagnosed HIV infection and severe immunosuppression who was initially evaluated for suspected systemic vasculitis and subsequently diagnosed with Pneumocystis jirovecii pneumonia. His initial CD4 cell count was 13.56 cells/mm³, and his HIV RNA level was 14,095,323 copies/mL. Twenty-five days after the initiation of antiretroviral therapy, he developed an acute anterior ST-segment elevation myocardial infarction. Peak high-sensitivity cardiac troponin T was 1051 ng/L. Coronary angiography demonstrated a 90-99% thrombotic lesion at the ostium of the left anterior descending artery with preserved TIMI 3 flow. Given his clinical stability, preserved coronary flow, and potential procedural risks, percutaneous coronary intervention was deferred, and treatment with abciximab, unfractionated heparin, aspirin, and ticagrelor was continued. Repeat angiography after 72 hours demonstrated marked regression of the thrombotic lesion without significant residual stenosis, and no coronary intervention was required. Antiphospholipid antibody testing was negative; however, a comprehensive evaluation for inherited and acquired thrombophilia was not performed. The coexistence of profound immunosuppression, active opportunistic infection, systemic inflammation, and acute coronary thrombosis raises the possibility of a multifactorial prothrombotic state. However, causality cannot be established based on a single case. This case highlights the importance of considering acute coronary thrombosis in young patients with severe HIV-related immunosuppression and active opportunistic infection while recognizing alternative thrombotic mechanisms.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129741","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":"Prognostic Value of the Non-HDL-C/HDL-C Ratio for Predicting One-Year Major Adverse Cardiac and Cerebrovascular Events in Young Patients with Myocardial Infarction.","authors":"Mustafa Ferhat Keten, Kadir Bıyıklı","doi":"10.5543/tkda.2026.30998","DOIUrl":"https://doi.org/10.5543/tkda.2026.30998","url":null,"abstract":"<p><strong>Objective: </strong>Young patients with myocardial infarction (MI) remain at risk for recurrent cardiovascular events despite favorable short-term outcomes. The prognostic significance of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (non-HDL-C/HDL-C) ratio in this population remains insufficiently studied. We aimed to evaluate its association with 1-year major adverse cardiac and cerebrovascular events (MACCE).</p><p><strong>Method: </strong>This retrospective, single-center study included 856 consecutive patients aged ≤50 years who were hospitalized with acute MI between January 2022 and January 2025, including 302 (35.3%) with STEMI and 554 (64.7%) with NSTEMI. The primary outcome was 1-year MACCE, defined as a composite of all-cause mortality, ischemic stroke, recurrent MI, and unplanned repeat coronary revascularization. Patients were categorized into low- and high-ratio groups using a receiver operating characteristic (ROC)-derived cutoff based on the Youden index. Associations were assessed using multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>During follow-up, 129 patients (15.0%) experienced MACCE. The optimal non-HDL-C/HDL-C cutoff was 4.43. The ratio was independently associated with 1-year MACCE (HR=1.568, 95% CI=1.463-1.681; P < 0.001), with consistent effects across the STEMI and NSTEMI subgroups (p for interaction=0.545). The non-HDL-C/HDL-C ratio showed the highest discriminatory performance among the lipid parameters (AUC=0.864), outperforming LDL-C, non-HDL-C, and the atherogenic index of plasma (DeLong P < 0.001).</p><p><strong>Conclusion: </strong>In this retrospective observational cohort, a higher non-HDL-C/HDL-C ratio was independently associated with an increased risk of 1-year MACCE in young patients with MI. Prospective multicenter studies are warranted to confirm these findings.</p>","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129803","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":"Beyond the Culprit Lesion and Traditional Risk Factors: New Data on Residual Coronary Risk After Premature Myocardial Infarction.","authors":"Domenico Mario Giamundo, Elad Asher, Pierre Sabouret","doi":"10.5543/tkda.2026.84937","DOIUrl":"https://doi.org/10.5543/tkda.2026.84937","url":null,"abstract":"","PeriodicalId":94261,"journal":{"name":"Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129758","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}