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Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are breakthrough agents for the treatment of type 2 diabetes mellitus (T2DM) and heart failure (HF). However, among patients with HF and T2DM, some uncertainty remains about individual comparisons, including dosing., Objectives: We aimed to make a real-life individual comparison of SGLT2is among patients with HF and T2DM., Methods: This was a subgroup analysis of the Turkish Ministry of Health's National Electronic Database for adult patients with HF (TRends-HF). All-cause mortality (ACM) data up to 7 years were evaluated. Patients with HF and T2DM who were prescribed an SGLT2i were identified, and individual doses of empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg were compared. For individual comparisons, propensity score-matching analysis was generated as 1:1:1, and disease-modifying therapies (DMTs) for HF were considered., Results: In the triple-matched cohort, 1-, 5-, and 7-year survival rates were 95%, 81%, and 76% versus 94%, 78%, and 72% versus 94%, 80%, and 75% for empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg, respectively. Among patients who were on triple DMT for HF, 1-, 5-, and 7-year survival rates were 95%, 78%, and 70% for empagliflozin 25 mg, 95%, 74%, and 66% for empagliflozin 10 mg, and 94%, 77%, and 69% for dapagliflozin, respectively. Annual emergency department visits were slightly lower with empagliflozin 10 mg and dapagliflozin 10 mg than with empagliflozin 25 mg. A greater proportion of patients on dapagliflozin 10 mg did not experience hospitalization during the 7-year follow-up compared with both doses of empagliflozin, albeit with a small effect size., Conclusion: Among patients with HF and T2DM, SGLT2is are instrumental, and empagliflozin 10 mg remains significantly inferior to dapagliflozin 10 mg and empagliflozin 25 mg in terms of 5- and 7-year ACM., Competing Interests: Declarations. Funding: No external funding was used in the preparation of this manuscript. Conflict of Interest: Mehmet Birhan Yılmaz, Ahmet Çelik, Tuğçe Çöllüoğlu, Anıl Şahin, Dilek Ural, Arzu Kanık, Naim Ata, Mustafa Mahir Ulgu, and Şuayip Birinci have no potential conflict of interest that might be relevant to the contents of this manuscript. Authors’ Contributions: Mehmet Birhan Yılmaz: study design, writing. Ahmet Çelik and Dilek Ural: data interpretation, writing. Tugce Çöllüoğlu: data collection, writing. Anıl Şahin: data analysis, data collection. Arzu Kanık: data analysis. Naim Ata, Mustafa Mahir Ulgu, and Şuayip Birinci: study design, resources. Data Availability Statement: All data generated or analyzed during this study are included in this published article and its supplementary information files. Ethics Approval: We received approval from the Ministry of Health of Türkiye (approval number: 95741342-020). Code Availability: Not applicable. Consent to Participate: Not applicable. Consent for Publication: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF)., Objectives: This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes., Methods: In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%., Results: The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups., Conclusion: HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients.

Background: Frontal plane QRS-T angle (fQRS-T) and platelet-to-lymphocyte ratio (PLR) are highly important parameters that well-predict unfavorable outcomes in patients with ST-elevated myocardial infarction (STEMI).There are limited data on the predictive significance of ischemic cardiomyopathy (I-CMP) from the combination of fQRS-T and PLR in STEMI, compared to using fQRS-T and PLR alone., Aim: We aimed to evaluate the ability of the combination of fQRS-T and PLR routinely obtained on admission to identify STEMI patients at risk of I-CMP., Method: Six hundred and thirty-eight consecutive patients with STEMI who underwent primary percutaneous coronary intervention between 2018 and 2021 were included. The assessment of I-CMP was conducted through two-dimentional (2D)-echocardiography 6 weeks post-STEMI and I-CMP was defined as a left ventricular ejection fraction (LVEF) of 50% or less. Multivariate logistic regression analysis and receiver operating curve (ROC) analysis were performed to predict the development of I-CMP., Results: In ROC analysis, the cut-off values of fQRS-T and PLR for best predicting I-CMP were 66.72° and 101.23, respectively. The model using the combination of two markers was the most powerful predictor of I-CMP risk (OR: 3.183, 95% CI: 1.971-5.139, p = .001) when included in a single variable such as high fQRS-T or high PLR (OR: 1.422, 95% CI: 0.870-0.232, p = .160). Additionally, the concomitant presence of high fQRS-T and high PLR exhibited the highest specificity (77%) for I-CMP relative to the individual presence of high fQRS-T (66%) or PLR (49%)., Conclusion: The combination of fQRS-T and PLR, which is a simple and cost-effective risk assessment, may serve as a more reliable prognosticator for I-CMP as opposed to the use of fQRS-T and PLR alone for STEMI., (© 2024 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)

Background Using epicardial adipose tissue thickness (EATt) and neutrophil-to-lymphocyte ratio (NLR) as individual indicators provides beneficial insight into the prognosis of patients suffering from heart failure with preserved ejection fraction (HFpEF). Aim In our study, we aimed to evaluate whether the combined evaluation of NLR and EATt would provide an advantage for identifying high-risk HFpEF patients according to hospitalization for heart failure (HHF) and left ventricular diastolic dysfunction (LVDD). Method A total of 168 outpatients with HFpEF were retrospectively analyzed. The predictive performance of two inflammatory variables was assessed by the receiver operating characteristic curve and a one-way analysis of variance (ANOVA) test. The patients were stratified into three distinct risk categories based on the established cut-off values for EATt and NLR as follows: Group I, high risk; Group II, middle risk; and Group III, low risk. Results Patients in Group I had the highest risk for HHF and the presence of LVDD (p=0.001 for HHF, p=0.011 for LVDD). Patients in Group I also exhibited more symptomatic and a greater number of comorbidities. In Group I, more structural remodeling (enlarged left ventricular end-systolic volume index (LVESVI) and left atrial volume index (LAVI)) and associated signs of increased intracardiac pressure (elevated E/A ratio, medial E/e') were observed. Conclusion The results of our study indicate that the use of both EATt and NLR among patients with HFpEF may provide better accuracy in predicting HHF and LVDD compared to the use of either EATt or NLR alone., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Colluoglu et al.)

Background: Surgical risk in patients after transcatheter aortic valve implantation (TAVI) is determined by conventional scoring systems. However, these risk scores were developed to predict surgical mortality. Due to their insufficient predictive ability in patients after TAVI, novel risk scores are needed to predict long‑term mortality in this population., Aims: The study aimed to investigate the value of conventional risk scores in predicting long‑term mortality. Additionally, the impact of laboratory parameters on long‑term mortality was evaluated., Methods: Our study included 121 patients who underwent transfemoral TAVI., Results: The mean (SD) logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and the Society of Thoracic Surgeons (STS) risk score were 27.4 (9.7), 7.9 (4.6), and 4.6 (2.4), respectively. In‑hospital mortality rate was 1.7%. None of the risk scoring systems predicted in‑hospital mortality correctly. The STS score corresponded with the mortality rate of approximately 2 months, EuroSCORE II, with 6 months, and logistic EuroSCORE, with 30 months. Male gender (odds ratio [OR], 5.668; 95% CI, 1.055–30.446; P = 0.04) and low albumin levels before TAVI (OR, 0.109; 95% CI, 0.018–0.654; P = 0.02) were found to be the independent predictors of long‑term mortality., Conclusions: Although all conventional risk scores overestimated in‑hospital mortality, the STS risk score predicted 2‑month, EuroSCORE II, 6‑month, and logistic EuroSCORE, 30‑month mortality. The independent predictors of long‑term mortality were male gender and low blood albumin levels before the TAVI procedure.

Background: Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required., Aim: The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery., Methods: Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed.Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events.Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray., Results: A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end-systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events.Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery., Conclusions: Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: To our knowledge, no study so far investigated the importance of post-procedural frontal QRS-T angle f(QRS-T) in ST segment elevation myocardial infarction (STEMI). The aim of our study was to investigate the role of baseline and post-procedural f(QRS-T) angles for determining high risk STEMI patients, and the success of reperfusion., Methods: A total of 248 patients with first acute STEMI that underwent primary percutaneous coronary intervention (pPCI) or thrombolytic therapy (TT) between 2013 and 2014 were included in this study. Baseline f(QRS-T) angle was defined as the angle which measured from the first ECG at the time of hospital admission. Post-procedural (QRS-T) angle was defined according to the treatment strategy as follows: the angle which measured from the post-PCI ECG in patients treated with pPCI; the angle which measured from the ECG taken 90 min after onset of therapy in patients treated with TT., Results: The baseline (101.9° ± 48.0 vs. 72.1° ± 49.1, p = 0.014) and post-procedural f(QRS-T) angles (95.7° ± 48.1 vs. 58.1° ± 47.1, p = 0.002) were significantly higher in patients who developed in-hospital mortality than the patients who did not develop in-hospital mortality. Also, f(QRS-T) angle measured at 90 min was significantly lower in patients with successful thrombolysis group compared to failed thrombolysis group (53.2° ± 42.8 vs. 77.3° ± 52.9, p = 0.033), whereas baseline f(QRS-T) angle was similar between two groups (78.6° ± 53.4 vs. 78.9° ± 54.0, p = 0.976). Multivariate analysis showed that post-procedural f(QRS-T) angle ≥89.6° (odds ratio: 3.541, 95% confidence interval: 1.235-10.154, p = 0.019), but not baseline f(QRS-T) angle, was independent predictor of in-hospital mortality., Conclusion: f(QRS-T) angle may be used as a beneficial tool for determining high risk patients in acute STEMI. Unlike previous studies, we showed for the first time that that post-procedural f(QRS-T) can predict in-hospital mortality and TT failure., (© 2018 Wiley Periodicals, Inc.)

Background: No study has investigated the prognostic importance of the combined use of QRS distortion and fragmented QRS (fQRS) for risk stratification in acute ST segment elevation myocardial infarction (STEMI)., Objective: To determine the prognostic value of the combined use of QRS distortion and fQRS in patients with acute STEMI undergoing primary percutaneous coronary intervention (pPCI)., Methods: A total of 454 patients with first STEMI who underwent pPCI were included in this study. Patients were categorized into three groups according to the presence of QRS distortion and fQRS on admission electrocardiography. Group I was defined as fQRS (-) and QRS distortion (-), group 2 was defined as fQRS (+) and QRS distortion (-), or fQRS (-) and QRS distortion (+), and group 3 was defined as both fQRS (+) and QRS distortion (+)., Results: Patients in group III had a significantly higher in-hospital mortality rate compared with patients in groups I and II. These patients also had lower left ventricular ejection fraction and ST resolution ratios, higher maximum troponin, and higher frequency of three-vessel disease. Multivariate analysis indicated that group III (OR: 8.84, 95% CI: 2.73-28.62, p<0.001) was an independent predictors of in-hospital mortality., Conclusion: The combined use of QRS distortion and fQRS provides additional prognostic value compared with the presence of QRS distortion or fQRS alone for early risk stratification in patients with STEMI treated with pPCI., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: No study so far investigated fragmented QRS (fQRS) and neutrophil-to-lymphocyte ratio (NLR) together in ST segment elevation myocardial infarction (STEMI)., Objective: To investigate the relationship between NLR and fQRS, and determine the prognostic significance of the combined use of these two parameters in STEMI., Methods: We included 368 patients with first acute STEMI who successfully revascularized with primary percutaneous coronary intervention., Results: Patients with fQRS had significantly higher NLR, and in-hospital mortality rate compared to patients with no-fQRS. The best cut-off value of NLR to predict mortality was 5.47. Patients with NLR≥5.47 had a higher frequency of fQRS and in-hospital mortality rate. Multivariate analysis showed that NLR was an independent predictor of the presence of fQRS (OR: 1.095, 95% CI: 1.039-1.153, P=0.001). When patients were stratified by fQRS and cut-off value of NLR, in-hospital mortality gradually increased (P<0.001)., Conclusion: NLR is independently associated with the presence of fQRS in STEMI patients. Combined use of both parameters provides additional prognostic contribution for identifying patients at higher cardiac risk., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: QRS fragmentation (fQRS) is classically defined as the presence of slurred QRS morphology in at least two contiguous leads, and its prognostic importance has been shown in ST elevation myocardial infarction (STEMI). However, no study has investigated the significance of single lead fQRS (sl-fQRS) in surface electrocardiography (ECG)., Objectives: To evaluate whether sl-fQRS is as valuable as classical fQRS in patients with acute STEMI who had successful revascularization with primary percutaneous coronary intervention (pPCI)., Methods: We included 330 patients with a first STEMI who had been successfully revascularized with pPCI. The patient's electrocardiography was obtained in the first 48 hours, and the patients were divided into three groups according to the absence of fQRS (no-fQRS); fQRS presence in a single lead (sl-fQRS); and ≥2 leads with fQRS (classical fQRS)., Results: In-hospital mortality was significantly higher both in patients with sl-fQRS and in patients with ≥ 2 leads with fQRS compared to patients with no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a sensitivity of 75% and specificity of 57.4% for the prediction of in-hospital mortality. Multivariate analysis showed that sl-fQRS is an independent predictor of in-hospital mortality (OR: 3.989, 95% CI: 1.237-12.869, p = 0.021)., Conclusions: Although the concept of at least two derivations is mentioned for the classical definition of fQRS, our study showed that fQRS in only one lead is also associated with poor outcomes. Therefore, ≥1 leads with fQRS can be useful when describing the patients under high cardiac risk in acute STEMI.

Transcatheter aortic valve implantation (TAVI) with self-expandable Medtronic CoreValve (MCV; Medtronic, Minneapolis, MN) or balloon-expandable Edwards SAPIEN XT valve (ESV; Edwards Lifesciences, Irvine, CA) has been widely used for treatment of high-risk patients with severe aortic stenosis (AS). There is limited data comparing the long-term hemodynamic performance of these two valves. Therefore, this study aimed to compare the short and long-term hemodynamic performance of TAVI with either MCV or ESV. A total of 78 patients who underwent TAVI in our center between June 01, 2012 and January 01, 2014 were enrolled in this retrospective study. For each of the patients we recorded the preprocedural echocardiographic data as well as the post-TAVI echocardiographic outcomes at day one, 6 months and 1 year. The MCV group had lower transaortic gradients than the ESV group, with respect to both maximum (13.4 ± 5.8 vs 18.7 ± 8.1 mmHg, p = 0.001) and mean values (6.5 ± 3.2 vs 9.4 ± 4.3 mmHg, p < 0.001) at post-TAVI day one. These values continued to be significantly lower in the MCV group during post-TAVI 6 months (p < 0.001) and post-TAVI 1 year follow-up (p < 0.05). A paravalvular leak (PVL, grade ≥2) was observed in 6.4 % of patients after TAVI; however, this value decreased over time, and there was no significant difference between the MVC and ESV groups (8.2 vs 3.4 %, p = 0.646). The MCV bioprosthesis was associated with lower transaortic gradients than those of the ESV throughout 1 year of follow-up. The incidence of PVL grade ≥2 in MCV and ESV was comparable.

Background: The aim of this study is to determine whether the presence of fragmented QRS (fQRS) and QRS distortion on admission ECG can be used to predict the success of treatment before beginning thrombolytic therapy (TT)., Patients and Methods: Two hundred and three eligible patients with acute ST elevation myocardial infarction who received TT consecutively between 1 January 2009 and 1 July 2013 were enrolled. The presence of fQRS and QRS distortion was analyzed at admission ECG. The electrocardiographic criteria of reperfusion were defined as 50% or more of ST resolution (STR), whereas the angiographic criteria of reperfusion were defined as thrombolysis in myocardial infarction 2/3 flow in the infarct-related artery., Results: fQRS was detected in 63 (31%) patients. Compared with patients with non-fQRS, STR was lower (46.1±17.7 vs. 73.6±20.9, respectively; P<0.001), thrombolysis failure was higher (44.4 vs. 9.3%, respectively; P<0.001), and thrombolysis in myocardial infarction 0/1 flow was more common (39.7 vs. 10.7%, respectively; P<0.001) in patients with fQRS. Higher numbers of fQRS derivations were significantly related to low percentages of STR (r=-0.615, P<0.001). In predicting occluded infarct-related artery, we found no difference between the negative predictive values of fQRS and inadequate STR after TT (89.3 vs. 95.1%; P>0.05). However, there was no relationship between QRS distortion and failed thrombolysis., Conclusion: fQRS was detected in just 31% of the patients, but we found that it can be used to predict thrombolytic failure. Patients who have this simple marker on admission ECG may be directed to percutaneous interventions as a first-line therapy without any delay.

Background: P-wave dispersion (PWD), a measure of heterogeneity of atrial refractoriness, is defined as the difference between the maximum and minimum P-wave duration. In patients with severe aortic stenosis (AS), P-wave duration and PWD were shown to be increased, indicating atrial electrical remodeling. However, the effect of transcatheter aortic valve replacement (TAVR) on P-wave morphology has not been established yet. The aim of this study is to assess the short and long-term effects of TAVR with two types of bioprosthetic valves on P-wave duration and PWD in association with left atrial (LA) size., Methods: Fifty-two (36 female) eligible patients in sinus rhythm who underwent transfemoral TAVR between June 01, 2012 and July 31, 2014 with either a Medtronic CoreValve (MCV) (n = 32) or an Edwards SAPIEN XT Valve (n = 20) were enrolled. Standard 12-lead electrocardiogram and echocardiographic evaluations were performed pre-procedurally, post-TAVR day one and 6 months post-TAVR. P-wave duration and PWD were measured and correlation analyses with echocardiographic variables were performed., Results: P-wave duration and PWD were significantly decreased on post-TAVR day one (P < 0.05). They continued to decrease during the six month follow-up period, but were not significantly different from short-term values (P > 0.05). The decrease of LA diameter was found significant at the sixth-months of follow-up (P < 0.05). These changes were independent from the types of bioprosthetic valves implanted (P > 0.05). A positive correlation was detected between minimum P-wave duration and maximum aortic valve gradients at post-TAVR day one (r = 0.297, P = 0.032)., Conclusions: P-wave duration and PWD were significantly reduced early after TAVR indicating early reverse atrial electrical remodeling. Moreover, structural reverse remodeling of atrium was detected at the 6-months of follow-up. The effects of two types of bioprosthetic valves on atrial remodeling were similar.