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Natriuretic peptides are widely used in all types of heart failure. Previously, we defined heart failure with non-reduced ejection fraction as patients with heart failure symptoms and/or signs and who have left ventricular ejection fraction > 40%.1 For the diagnosis of heart failure with preserved ejection fraction, the presence of raised natriuretic peptides is one of the major components of the diagnosis, and raised natriuretic peptides make the diagnosis more likely in patients with heart failure with mildly reduced ejection fraction.2 The majority of the existing studies have described the utility of natriuretic peptides in patients with heart failure with reduced ejection fraction, but there is not enough data on natriuretic peptides in heart failure patients with heart failure with non-reduced ejection fraction. Despite the insufficient information regarding the usage of natriuretic peptides in heart failure with non-reduced ejection fraction, it is obvious that there is an unmet need to guide how to use natriuretic peptides in these patients. The main goal of this article is to discuss the role of natriuretic peptides in diagnosis, prognosis, and guidance of heart failure treatment in patients with heart failure with non-reduced ejection fraction. The present review discusses the role of natriuretic peptides in heart failure with non-reduced ejection fraction focusing on: the characteristics of natriuretic peptides, primary prevention of heart failure, diagnosis of heart failure with non-reduced ejection fraction in different patient characteristics and co-morbidities, prognosis of heart failure, monitoring of heart failure treatment and, how to use in worsening heart failure. [ABSTRACT FROM AUTHOR]

The article focuses on hypertension is one of the major cardiovascular risk factors, closely related to the major cardiovascular, neurological, and renal adverse events. Topics include the resistant hypertension (RHT) has characterized by uncontrolled blood pressure (BP) despite intensive treatment, the higher risk has not limited only to cardiovascular events, and the documented that effective control of high BP in patients with RHT provides a significant decrease.

In endocrine diseases, hormonal changes, electrolyte abnormalities, and the deterioration of heart structure can lead to various arrhythmias. In diabetic patients, hypoglycemia, hyperglycemia, and hypokalemia can trigger arrhythmias, and diabetic cardiomyopathy can also cause electrical and structural remodeling to form substrates for arrhythmias. The risk of atrial fibrillation (AF) increases in hyperthyroidism; however, the prevalence of ventricular arrhythmias in hypothyroidism is higher. Besides AF and ventricular tachycardias, bradycardias and atrioventricular blocks can also be seen in pheochromocytoma due to the desensitization of adrenergic cardiovascular receptors. The correction of metabolic and electrolyte disturbances in patients with adrenal cortex disease should be the main approach in the prevention and treatment of arrhythmias. Early initiation of treatment in patients with acromegaly seems to decrease the development of cardiac remodeling and ventricular arrhythmia. Early and late after depolarizations due to hypercalcemia in hyperparathyroidism can lead to life-threatening ventricular arrhythmias. This elegant position paper provides important recommendations regarding prevention and treatment of arrhythmias for specific endocrine disorders. [ABSTRACT FROM AUTHOR]

The article discusses the management of arrhythmia-induced cardiomyopathy (AIC), a form of cardiomyopathy characterized by left ventricular (LV) systolic dysfunction. Topics discussed include the association between AIC and heart failure (HF), the causes, clinical features and diagnosis of AIC, and the management of AIC in children and adults with congenital heart disease.

The article focuses on a position paper and narrative review from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists (TURCOSACT) regarding obstructive sleep apnea and its relationship with cardiovascular disease. It also addresses urinary angiotensinogen as a potential marker for prognosis in heart failure, a composite risk stratification index for acute pulmonary embolism, and other case reports and letters.

The article presents the discussion on evaluating the safety and effectiveness of using dTRA (distal transradial access). Topics include comparing the efficacy and safety of Catheter ablation (CA) combined with left atrial appendage closure (LAAC) and CA; and evaluating the relationship between LEAD anatomic and clinical features and various sitting patterns.

The article discusses the research study conducted that examines the causes of Arrhythmias accompanied with acute coronary syndromes (ACSs) and how to manage and treat challenging cases of arrhythmias in patients. Topics discussed include how to determine patients at risk for arrhythmias, direct current cardioversion (DCC) and catheter ablation, and atrial fibrillation.

The article focuses on a document on management of arrhythmias in patients with acute coronary syndromes (ACS), by the author, published in several journals such as 'Eurointervention" during European Society of Cardiology (ESC) Congress in Barcelona, Spain. Topics discussed include invasive approaches for treatment of arrhythmia, ways to identify ACS patients at risk of arrhythmia, and recommendations for management of ventricular arrhythmias and acute care.

Background: Perfect heart valve prostheses have optimized hemodynamics, reduced surgical morbidity, long-lasting durability, and extended patient survival with greater quality of life. Mechanical valves are recommended; however, young children may need anticoagulant medication for life. In this study, we looked at the success rate and viability of aortic valve neocuspidization (AVNeo) surgery for a variety of aortic disorders. Methods: A methodical search strategy was used to fully evaluate the AVNeo results. Boolean operators were used to combine important words like “Ozaki Procedure,” “Aortic Valve Neocuspidization,” “AVNeo,” and associated terms. Reputable databases such as PubMed, MEDLINE, Embase, Web of Science, and Scopus were the focus of our search. Study quality was assessed using a critical evaluation created with the Critical Appraisal Skills Programme tool. Results: The findings are summarized in the ”Results” section that contains descriptive and critical analysis, ramifications, and explanations. According to research, AVNeo improved valve function and had few side effects. Aortic valve neocuspidization has a lower mean pressure gradient and a larger mean efficient orifice area than Trifecta. Aortic valve neocuspidization surgery reduces aortic valve regurgitation and pressure gradients. Postoperative echocardiograms indicated a decrease in peak and a rise in mean pressure gradient. Conclusion: The Ozaki method restores a healthy laminar flow pattern while preventing bivalvular disease. Ozaki procedure should be explored for valve repair in infants with truncal valve and congenital aortic disease. Aortic valve tricuspidization with glutaraldehyde-treated autologous pericardium results in considerable effective orifice area, modest pressure gradients, and little regurgitation. [ABSTRACT FROM AUTHOR]

An introduction to the periodical is presented which discusses several articles within the issue on topics which include evaluation processes for the assessment of the article, social policy related to the research papers published in the journal, and techno-medicine.

Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea-associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context. [ABSTRACT FROM AUTHOR]

Stereotactic ablative body radiotherapy (SABR) allows the administration of ablative doses of radiation in a focused form with a low probability of side effects and is widely used for cancer treatment. However, in the recent years its usefulness in benign cardiac pathology is being studied. In this study, we aimed to guide the cardiologist in SABR and its applications in treatment of refractory ventricular tachycardia. In this review, we analyzed published literature on PubMed and MEDLINE with papers published in the past 5 years. We included papers in the English language with information about indications, radiotherapy plan, doses and fractionations, and outcomes. All citations were evaluated for relevant content and validation. [ABSTRACT FROM AUTHOR]

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices. [ABSTRACT FROM AUTHOR]

Up to 20% of patients with chronic kidney disease have atrial fibrillation, and 40%-50% of atrial fibrillation patients suffer from chronic kidney disease. The 2 diseases share several risk factors and frequently coincide with each other. Both entities are associated with a prothrombotic state, which contributes to increased thromboembolic risk. Atrial fibrillation patients with chronic kidney disease have elevated risk of stroke, major bleeding, and mortality. Clinical risk scores, including CHA2DS2-VASc score, HAS-BLED score, or ORBIT score have a limited value in adverse clinical outcome risk stratification in patients with severe chronic kidney disease. However, the inclusion of renal function in the R(2)-CHA2DS2-VASc score does not improve significantly thromboembolic risk prediction in atrial fibrillation. There is growing evidence suggesting that biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin, cystatin C, or growth differentiation factor-15, might be helpful in the assessment of thromboembolic, bleeding, and/or mortality risk in atrial fibrillation patients with chronic kidney disease. The first-choice anticoagulant therapy is based on direct oral anticoagulants in this subgroup. The highest risk of adverse events is observed in end-stage renal disease, and in Europe, in contrast to the USA, solely warfarin is recommended in such atrial fibrillation patients. Treatment of atrial fibrillation patients with chronic kidney disease should be closely monitored with the selection of right anticoagulant agents at the appropriate dose. The current review paper summarizes available evidence and the challenges of the management of atrial fibrillation patients with chronic kidney disease with practical implications. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) includes a range of disorders characterized by excess accumulation of triglycerides within the liver. While simple steatosis may be clinically stable, non-alcoholic steatohepatitis (NASH) can be progressive. Inflammation is believed to be the driving force behind NASH and the progression to fibrosis and subsequent cirrhosis. NAFLD is globally considered a significant health concern not only because of its incidence but also because of its economic impact. The fact that NAFLD is associated with cardiovascular disease is widely recognized, as well as the fact that NAFLD patient mortality rises when such an association is present. In particular, NAFLD is associated with coronary and carotid atherosclerosis, endothelial dysfunction and arterial rigidity, ventricles function, valves morphology, congestive heart failure, and arrhythmias (especially atrial fibrillation). Additionally, the hypercoagulability status in NAFLD patient may be suggested by the presence of inflammatory and coagulation markers. In order to differentiate between milder forms and the more severe ones that necessitate aggressive therapy, individualized risk scores may be used. This narrative review will analyze and interpret the papers published in PubMed in the last 16 years, in an attempt to expand our understanding of the NASH as a possible cardiovascular risk factor. [ABSTRACT FROM AUTHOR]

The co-existence of atrial fibrillation (AF) and acute heart failure (AHF) is frequently reported and can exacerbate either or both of them. Their combination leads to increased morbidity and mortality. Although there has been a lack of studies on the prevalence and significance, as well as the treatment, of AF in patients with AHF, a position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association has recently reviewed the latest evidence on AF in the setting of AHF. The purpose of this paper is to briefly overview the crucial aspects of this consensus document. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Perturbative decline in cardiovascular publications in recent years in Turkey" by Altan Onat in a 2013 issue, along with reply of the author.

Although various cardiac monitoring methods were developed to detect subclinical arrhythmias, guidelines do not address in detail the management of subclinical atrial fibrillation and tachyarrhythmias. The European Heart Rhythm Association recently published a consensus document that addresses the clinical importance, implications, and management of device-detected subclinical atrial tachyarrhythmias. This paper comprehensively reviews the diagnostic tools to detect subclinical atrial arrhythmias and discusses the pathophysiologic link between devicedetected subclinical atrial fibrillation and stroke. In this invited review, in the light of this paper and current scientific data, we aimed to summarize how to manage subclinical atrial arrhythmias. [ABSTRACT FROM AUTHOR]

The article expresses the author's concerns on the reliability of open access journals that accept and publish research papers within a short period of time, attracting young academians who wish to complete the academic upgrading criteria. Topics discussed include the case of a junior academic who inquired about the possible resubmission of her scientific paper to the "Anatolian Journal of Cardiology" or other scientific journals and the consequences of publishing in fake journals.

Mitral paravalvular leaks (PVLs) commonly occur in patients with prosthetic valves. Paravalvular defects may be clinically inconsequential and may aggravate hemolysis or cause heart failure through regurgitation. Accordingly, patients may eventually require intervention such as redo surgery or a transcatheter closure of the defects. The introduction of purpose-specific closure devices and new steerable catheters has opened a new frontier for the transcatheter PVL closure. This mode of treatment is an initial therapy in most centers with experienced structural heart team. However, head-to-head data comparing two treatment modalities (surgery and transcatheter closure) are limited, and the world-wide experience is based on nonrandomized studies. Multimodality imaging, including three-dimensional transesophageal echocardiography, facilitates the delineation of mitral PVLs and provides essential data that aids the communication between the members of the structural heart team. In the near future, the success of interventional therapies will most probably increase in patients with mitral PVLs with the introduction of hybrid imaging modalities (echocardiography, cardiac computed tomography, and fluoroscopy). In conclusion, this paper summarizes the etiopathogenesis, clinical characteristics, diagnosis, and treatment of mitral PVLs. [ABSTRACT FROM AUTHOR]

Myocardial ischemia resulting from psychological stress [mental stress-induced myocardial ischemia (MSIMI)] refers to the condition wherein psychosocial and psychological stimulations cause myocardial ischemia in patients with coronary heart disease, which is different from druginduced myocardial ischemia. Therefore, this condition often escapes diagnosis, portends clinical risk, and affects the quality of life of MSIMI survivors. MSIMI is closely related to the poor prognosis of cardiovascular diseases, especially in young women, according to recent randomized, controlled trials (RCTs) on MSIMI. These RCTs involved different sample sizes, interventional measures, and detection techniques. Moreover, differences exist regarding the prevalence rate, distribution characteristics, possible pathogenesis, and clinical significance. Nevertheless, currently, the diagnostic criteria, pathogenesis, and treatment of MSIMI are still in the clinical exploration stage. Hence, considering recent RCTs, this paper summarizes the research status of MSIMI from the aspects of pathogenesis, diagnosis, and treatment strategies to provide a theoretical basis for the follow-up diagnostic methods and treatment guidelines for MSIMI. [ABSTRACT FROM AUTHOR]

Supraventricular arrhythmias are frequent, and symptomatic patients often need medical therapy or catheter ablation. The recently published 2019 European Society of Cardiology (ESC) Guidelines for the management of patients with supraventricular tachycardia (SVT) give a comprehensive overview of current developments in the field and provides recommendations for the management of adults with SVT. In this paper, we briefly summarized major new recommendations and significant changes from the former ESC guideline published 16 years ago. [ABSTRACT FROM AUTHOR]

The article discusses the contributions and collaborations of Turkey in the global medicine world including the indispensable scientific research for human development, appropriate disposition of national resources, and growing proportion of publications with international collaboration. Topics discussed include longevity in conjunction with a healthy life, medical institutions in Turkey contributing globally, and promotion of in-depth research.

Background: We aimed to investigate the clinical and angiographic characteristics of patients with acute coronary syndrome (ACS) who survived this devastating earthquake and were admitted to our hospital in Antakya/Türkiye. Methods: We retrospectively examined the impact of the earthquake on the occurrences of acute coronary syndromes in Antakya/Türkiye. All 248 consecutive patients with ACS, also survivors of the earthquake in Antakya, were enrolled as the earthquake group. The earthquake group was created from patients hospitalized between February and June in 2023 after the earthquake. In total, 209 consecutive ACS patients who were hospitalized in our cardiology clinic in similar months of 2022 named as the control group. Results: Patients admitted before the earthquake were more hospitalized with multivessel disease compared to after the earthquake group (P < .001). Myocardial infarction with non-obstructive coronary artery disease (MINOCA) was the main reason for the significant increase rate of ACS after the earthquake. The earthquake patient group had lesser diabetes mellitus than the control group (P < .001). The risk of men suffering from ACS after an earthquake is approximately 2.1 times higher than women (P = .023). Those with a history of revascularization are approximately 1.8 times more likely to have ACS after an earthquake (P=.05). The risk of experiencing ACS after an earthquake is approximately 3.5 times higher for those with a family history than for those without (P < .001). Conclusion: Effects of the devastating earthquake on the heart are the increase in MINOCA patients triggered by great sudden environmental stress and the decrease in diabetes due to worsening nutritional conditions, respectively. [ABSTRACT FROM AUTHOR]

Mendelian forms of renin–angiotensin–aldosterone system (RAAS)-related hypertension, commonly referred to as monogenic hypertension, represent a rare but significant subset of hypertensive disorders characterized by genetic mutations that disrupt the normal physiological mechanisms of blood pressure regulation. This review focuses on elucidating the germline mutations affecting RAAS pathways that lead to distinct forms of heritable hypertension. By understanding the pathophysiological basis of conditions such as Gordon’s syndrome, Liddle syndrome, congenital adrenal hyperplasia, and familial hyperaldosteronism types, this review aims to highlight the unique clinical features, diagnostic challenges, and therapeutic implications associated with these disorders. Recognizing specific clinical presentations and family histories indicative of monogenic hypertension is crucial for diagnosis, particularly as it often manifests as early-onset hypertension, abnormalities in potassium and blood pH, and occasionally, abnormal sexual development or related syndromes. Therefore, employing a targeted diagnostic approach through next-generation sequencing is essential to pinpoint the responsible genetic mutations, enabling accurate and individualized treatment plans. The critical importance of certain readily available specific channel blockers, such as thiazides or low-dose corticosteroids, in managing these disorders must be emphasized, as they play a key role in preventing serious complications, including cerebrovascular events. As advancements in genetic and molecular sciences continue to evolve, a deeper comprehension of the mechanisms underlying RAAS-related monogenic hypertension promises to revolutionize the management of this complex disorder, offering hope for more effective and individualized treatment options. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the use of current communication facilities, the sharing of science knowledge and the scientific content of the medical journals.

Anemia associated with heart failure is a frequent condition, which may lead to heart function deterioration by the activation of neuro-hormonal mechanisms. Therefore, a vicious circle is present in the relationship of heart failure and anemia. The consequence is reflected upon the patients' survival, quality of life, and hospital readmissions. Anemia and iron deficiency should be correctly diagnosed and treated in patients with heart failure. The etiology is multifactorial but certainly not fully understood. There is data suggesting that the following factors can cause anemia alone or in combination: iron deficiency, inflammation, erythropoietin levels, prescribed medication, hemodilution, and medullar dysfunction. There is data suggesting the association among iron deficiency, inflammation, erythropoietin levels, prescribed medication, hemodilution, and medullar dysfunction. The main pathophysiologic mechanisms, with the strongest evidence-based medicine data, are iron deficiency and inflammation. In clinical practice, the etiology of anemia needs thorough evaluation for determining the best possible therapeutic course. In this context, we must correctly treat the patients' diseases; according with the current guidelines we have now only one intravenous iron drug. This paper is focused on data about anemia in heart failure, from prevalence to optimal treatment, controversies, and challenges. [ABSTRACT FROM AUTHOR]

The recently published consensus document by the European Heart Rhythm Association presents a patient-tailored pharmacological antiarrhythmic treatment approach targeting the arrhythmia mechanism. This document comprehensively reviews the indications, side effects, and contraindications of antiarrhythmic drugs. In this paper, we reviewed novel treatment concepts offered by the consensus document. [ABSTRACT FROM AUTHOR]

Objective: To identify "genuine" publications from Turkey's institutions since 1992 that have cumulatively contributed the most to global cardiovascular medicine. Methods: Based on data from the Web of Science, 146 publications from Turkey were identified having received =50 citations as of late July, 2017. Papers with more than a minor share by international authors were excluded. Results: Hundred and ten primary authors generated 147 medical papers which received =50 (interquartile range, 54; 86) citations. These articles corresponded in quality to the top 12% global papers. Half of the articles were published from 2002 to late 2007, with a median exposure period of 12 years. Peak performance was reached in 2004-'07, with a mean of 15-20 papers annually, which then regressed to five papers in 2008-'13, representing an estimated 50% decline. Cardiology generated 105 articles (20 in collaboration with other branches), cardiovascular surgery generated 27 articles, and pediatric cardiology generated 5 articles. Publications arose from 26 medical faculties, Gülhane Military Academy, and 9 hospitals not which were not academically affiliated. The performance of many related Turkish institutions was disappointing. Conclusion: Turkey's contribution to cardiovascular medicine has further declined slightly in the current assessment, particularly since 2007. To prevent a further gap in Turkey's contribution to the field, an undelayed return is needed by building an environment that allows focusing on research with a potential to contribute to medicine. [ABSTRACT FROM AUTHOR]

Background: Myocardial infarction has been recognized globally as a serious problem featured with high mortality and morbidity. In addition, hypoxia represents the central feature of myocardial infarction. Recently, it has been reported that circular RNAs can exert critical functions in the biological processes of diseases. However, the functions of most circular RNAs remain unclear in cells cultured under hypoxic conditions. In this study, we focused on exploring the role of circ_SMAD7 (namely hsa_circ_0000848 in this study) in cardiomyocyte cells cultured under hypoxic conditions to provide a novel insight for future myocardial infarction studies. Methods: Firstly, a real-time quantitative polymerase chain reaction assay was adopted to analyze hsa_circ_0000848 expression. Functional assays were performed to detect the functions of hsa_circ_0000848 in cardiomyocyte cells cultured under hypoxic conditions. Furthermore, mechanism assays were implemented to explore the regulatory mechanism of hsa_circ_0000848. Results: Hsa_circ_0000848 was notably downregulated in hypoxia-induced cardiomyocytes. The silencing of hsa_circ_0000848 hindered the proliferation while accelerating the apoptosis of hypoxia-induced cardiomyocytes cells. Moreover, hsa_circ_0000848 interacted with ELAV-like RNA-binding protein 1 protein to stabilize SMAD family member 7 mRNA. Moreover, SMAD family member 7 overexpression could reverse the suppressive effect of hsa_circ_0000848 knockdown on myocardial infarction progression. Conclusions: Our research was the first in the field to confirm that the hsa_circ_0000848/ELAV-like RNA-binding protein 1/SMAD family member 7 axis could affect the development of cardiomyocyte cells cultured under hypoxia, indicating that hsa_ circ_0000848 might function as a novel biomarker in cells under hypoxia thus laying the groundwork for future study on myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: Myocardial ischemia-reperfusion injury (I/R) has been improved with drugs and effective reperfusion, but it still cannot be prevented. Methods: To investigate whether renal denervation (RDN) reduces cardiomyocyte apoptosis by ameliorating endoplasmic reticulum stress, 60 male specific pathogen-free (SPF) Wistar rats were randomly divided into 6 groups (n = 6). We established the I/R rat model by ligating the left anterior descending artery. The I/R+ angiotensin receptor neprilysin inhibitors (ARNI) group received ARNIs for 2 weeks until euthanasia. Results: The I/R+RDN and I/R+ARNI groups have signifiantly ameliorated left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) and reversed expansion of the left ventricular end-systolic diameter (LVSD) and left ventricular end diastolic diameter (LVDD) compared to the I/R group. The levels of norepinephrine (NE), angiotensin II, and aldosterone (ALD) increased signifiantly in the I/R group, but decreased signifiantly after RDN and ARNI intervention. In the I/R+RDN and I/R+ARNI groups, the myocardial tissue edema was alleviated. The infarct size was smaller in the I/R+RDN and I/R+ARNI groups compared to the I/R group. Apoptosis of cardiomyocytes and fib oblasts in myocardial tissue increased signifiantly in the I/R group, which was greatly diminished by RDN and ARNI. The expression of Bax, caspase-3, CHOP, PERK, and ATF4 protein was signifiantly increased in the I/R group, which compared to other groups, and the level of CHOP, PERK, and ATF4 gene expression increased. After RDN intervention, these expression levels recovered to varying degrees. Conclusion: The effect of RDN may be associated with regulating the endoplasmic reticulum stress PERK/ATF4 signaling pathway. [ABSTRACT FROM AUTHOR]

Background: The aim was to analyze the correlation between serum microRNA (miR)- 18a level, endothelial function, and prognosis in female coronary heart disease (CHD) patients. Methods: One hundred sixtyfemale patients admitted to our hospital for the first occurrences of chest pain and tightness were divided into CHD and non-CHD groups based on the coronary angiography results. Clinical data, laboratory indexes, serum miR-18a level, and endothelial function [flow-mediated dilation (FMD) function, endothelin 1 (ET-1), and nitric oxide (NO)] were compared. Results: There were no significant differences in clinical data (except CHD family history) between 2 groups. Coronary heart disease group had significantly lower levels of NO and FMD, while significantly higher levels of miR-18a and ET-1 than non-CHD group (P < .05). Pearson correlation showed that serum miR-18a level was positively correlated with ET-1 (r = 0.492, P < .001), and negatively correlated with NO and FMD (r = -0.504, -0.307, P < .001). The receiver operating characteristic) curve showed that the area under the curve of serum miR-18a level in predicting the occurrence of CHD in women was 0.878 (95% CI: 0.828-0.928). Compared with good prognosis group, poor prognosis group had significantly lower NO, and FMD levels, while higher proportions of acute coronary syndrome, multi-vessel disease, miR-18a, and ET-1 levels (P < .05). Conclusion: The expression of serum miR-18a in female CHD patients was high, which was related to endothelial function. The increase in serum miR-18a level was a risk factor for the occurrence of MACE in female CHD patients during follow-up, and the serum miR-18a level could effectively predict the occurrence of CHD in female patients. [ABSTRACT FROM AUTHOR]

Background: Women are often neglected in cardiovascular health prevention. Age at menarche (AAM) has been linked to cardiovascular (CVD) disease in women and is potentially identified as one of the significant CVD risk factor. However, there is still limited comprehensive evidence addressing this issue. This systematic review and meta-analysis aimed to investigate how early menarche affects the outcome of all-cause mortality, CVD mortality, total cardiovascular disease event, stroke (ischemic, hemorrhagic, and total stroke), and coronary heart disease (CHD). Method: The Cochrane Library, MEDLINE, Embase, ScienceDirect, and Google Scholar databases were searched from March 2013 to March 2023 for cohorts investigating the effect of early onset of menarche on CVD events with a minimum follow-up period of 5 years. Studies that observed specific population and/or included women with a history of CVD at baseline were excluded. The Newcastle-Ottawa scale was used for risk of bias assessment for each cohort included. The data were presented as dichotomous measure using risk ratios. I2 statistics were utilized to evaluate the heterogeneity of presented data. Results: Thirteen cohorts included 18 626 799 female patients with ages ranging from 43 to 62.6 years. These reported 6 estimates each for CHD (5 483 298 patients) and all-cause mortality (1 595 878 patients), 5 estimates each for total stroke (2 941 321 patients) and CVD mortality (1 706 742 patients), 4 estimates each for total CVD events (3 988 311 patients) and ischemic stroke (2 434 580 patients), and 1 estimate for hemorrhagic stroke (66 104 patients). Our study found that events of CHD were significantly lower in early menarche (RR 0.57; 95% CI 0.41-0.78; P < .00001), as well as total stroke (RR 0.51; 95% CI 0.35-0.73; P = .0003), CVD mortality (RR 0.47; 95% CI 0.22-0.98; P = .04), total CVD events (RR 0.44; 95% CI 0.25-0.76; P = .003), ischemic stroke (RR 0.31; 95% CI 0.15-0.61; P < .0008), and hemorrhagic stroke (RR 0.12; 95% CI 0.07-0.20; P < .00001); and insignificantly higher in all-cause mortality (RR 0.90, 95% CI 0.76-1.06, P = .20). Conclusion: In our study, cardiovascular events are lower in women with early menarche; hence, the later age of menarche is a potential risk factor to be considered when assessing CVD risk in a patient. However, our sample characteristics were heterogenous, and we did not consider other female hormonal factors that might potentially contribute to the CVD outcomes observed; thus, further studies are needed to clarify. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the adherence to the current European Society of Cardiology dyslipidemia guidelines, the ratio of reaching target values according to risk groups, and the reasons for not reaching LDL-cholesterol (LDL-C) goals in patients on already statin therapy in a cardiology outpatient population. Methods: The AIZANOI study is a multi-center, cross-sectional observational study including conducted in 9 cardiology centers between August 1, 2021, and November 1, 2021. Results: A total of 1225 patients (mean age 62 ± 11 years, 366 female) who were already on statin therapy for at least 3 months were included. More than half (58.2%) of the patients were using high-intensity statin regimens. Only 26.2% of patients had target LDL-C level according to their risk score. Despite 58.4% of very high-risk patients and 44.4% of highrisk patients have been using a high-intensity statin regimen, only 24.5% of very-highrisk patients and only 34.9% of high-risk patients have reached guideline-recommended LDL-C levels. Most prevalent reason for not using target dose statin was physician preference (physician inertia) (40.3%). Conclusion: The AIZANOI study showed that we achieved a target LDL-C level in only 26.2% of patients using statin therapy. Although 58.4% of patients with a very high SCORE risk and 44.4% of patients with a high SCORE risk were using a target dose statin regimen, we were only able to achieve guideline-recommended LDL-C levels in 24.5% and 34.9% of them, respectively, in cardiology outpatients clinics. Physician inertia is one of the major factors in non-adherence to guidelines. These findings highlight that combination therapy is needed in most of the patients. [ABSTRACT FROM AUTHOR]

Background: Type A aortic dissection is a fatal disease. However, the role of endoplasmic reticulum stress-related genes (ERSRGs) in type A aortic dissection has not yet been fully clarified. Methods: Differentially expressed genes in the aorta of type A aortic dissection patients were analyzed based on the GSE52093 database. The ERSRGs were downloaded from the GeneCards website. Functional enrichment analysis and protein-protein interaction analysis were performed on the acquired differentially expressed ERSRGs. The mRNA expression of the 5 top key differentially expressed ERSRGs was further explored in GSE153434 and clinical samples. Immune infiltration correlation analysis was performed on the validated key genes. Finally, we constructed regulatory networks of transcription factors, miRNAs, and chemicals. Results: Twelve differentially expressed ERSRGs were identified, of which 8 genes were downregulated and 4 genes were upregulated. GeneMANIA was adopted to analyze these genes and their interacting proteins, and the results showed that the main function was calcium ion transport. Four key genes, ACTC1, CASQ2, SPP1, and REEP1, were validated in GSE153434 and clinical samples. The area under the ROC curve values for ACTC1, CASQ2, SPP1, and REEP1 were 0.92, 0.96, 0.89, and 1.00, respectively. ACTC1 and REEP1 correlated with multiple immune cells. Many transcription factors, microRNAs, and chemicals were identified with the potential to regulate these 4 key genes. Conclusion: In this study, we identified 12 differentially expressed ERSRGs by analyzing the Gene Expression Omnibus database. Four key genes may influence the development of type A aortic dissection by regulating endoplasmic reticulum stress. These results expand our understanding of type A aortic dissection, and the 4 key genes are expected to be diagnostic markers and potential therapeutic targets. [ABSTRACT FROM AUTHOR]

Background: Empagliflozin (EMPA) demonstrates cardioprotective effects on the patients with heart failure, but its effects in cardiorenal syndrome (CRS) remain unspecified. The purpose of the exploratory study was to investigate the effect of EMPA on patients with type 2 CRS and type 2 diabetes mellitus (DM). Methods: This study was a randomized trial of patients with type 2 CRS and DM done between December 2020 and January 2022. Patients were randomly allocated to the control group and the EMPA group using EMPA as an add-on treatment. Serum interleukin 6 (IL-6), janus kinase 2 (JAK-2), and signal transducer and activator of transcription 3 (STAT-3) concentrations were measured in 102 patients with CRS and healthy individuals without any disease using enzyme-linked immunosorbent assay before and after treatment. The evaluation of renal function was measured by immunoturbidimetry, and cardiac function was estimated by doppler echocardiography. Rates of adverse events and major adverse cardiac events (MACE) were documented. Results: The results showed that EMPA decreased the level of IL-6 but increased the level of JAK-2 and STAT-3 in patients. Additionally, the results suggest EMPA significantly reduced the incidence of MACE compared to the control group, while the rate of adverse events did not significantly differed. Conclusions: Our study suggested that the cardiorenal benefits conferred by EMPA might be driven by anti-inflammatory effects, cooperated with the activation of JAK2/STAT3 signaling pathways, leading to modest short-term improvements in patients with type 2 CRS. The overall safety and low complication make EMPA a significant choice for clinical application. [ABSTRACT FROM AUTHOR]

Background: The risk of contrast-associated acute kidney injury is relatively higher in patients with diabetes mellitus compared to non-diabetics. Recent trials have revealed the renoprotective effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We aimed to investigate the possible preventive effect of SGLT2 inhibitors against contrastassociated acute kidney injury in the diabetic population who underwent coronary angiography with a diagnosis of stable angina or acute coronary syndrome. Methods: This was a cross-sectional and single-center study. We enrolled 345 patients with type II diabetes mellitus who were divided into 2 groups: using an SGLT2 inhibitor (group 1; n = 133) in addition to other antidiabetic medication and not using an SGLT2 inhibitor (group 2; n = 212). Both groups were compared in terms of contrast-associated acute kidney injury incidence. We also compared groups for the duration of hospitalization. Results: Baseline characteristics (age, sex, risk factors and medications) and laboratory findings were similar between the 2 groups. The means of administered contrast volume were also similar (160.42 (± 70.31) mL vs. 158.72 (± 81.24) mL, P = 0.83) between groups 1 and 2, respectively. We found that contrast-associated acute kidney injury incidence was significantly higher in group 2 compared to group 1 (n = 56 (26.4%) vs. n = 12 (9.0%), P < 0.001). The duration of hospitalization was significantly longer in group 2 (3.25 (± 2.03) days) than in group 1 (2.54 (± 1.39) days) (P = 0.001). Conclusion: We found that contrast-associated acute kidney injury was significantly lower, and the duration of hospitalization was significantly shorter in diabetic patients using SGLT2 inhibitors compared to non-users. [ABSTRACT FROM AUTHOR]

This Almanac highlights recent papers on congenital heart disease in the major cardiac journals. Over 100 articles are cited. Subheadings are used to group relevant papers and allow readers to focus on their areas of interest, but are not meant to be comprehensive for all aspects of congenital cardiac disease. [ABSTRACT FROM AUTHOR]

An interview with medical personnel Navin C. Nanda is presented. When asked about his life history he refers to his birthplace Kenya where his father worked as a physician. Nanda discusses his medical career development and informs that he completed his medical studies at Seth G.S Medical College of Bombay University. He comments on his first published medical research paper related to hyperglycemia after myocardial infarction and its relationship to diabetes mellitus.

Pulmonary arterial hypertension (PAH) is an uncommon disorder that may be hereditable, idiopathic or associated with conditions like drug exposure, connective tissue disease, HIV infection or congenital heart disease. Familial disease are usually due to mutations in the bone morphogenic protein receptor type 2 (BMPR2), activin-like kinase-type 1 (ALK1) and endoglin (ENG). Functional and structural changes in the pulmonary vasculature lead to increased pulmonary vascular resistance. Vascular remodeling involves endothelial dysfunction, activation of fibroblasts and smooth muscle cells and recruitment of circulating progenitor cells. Vasoconstriction has also been shown to affect the remodeling process. Genetics, cellular and molecular basis of PAH are discussed in the paper. [ABSTRACT FROM AUTHOR]

Left ventricular functions are among the most important predictors of prognosis in cases with coronary artery disease. Cases with moderate or high degree of left ventricular function are at high risk of death and correct evaluation of myocardial viability is clinically important while they are under medical therapy. In a considerably high percent of these patients, significant improvements occur in left ventricular functions after successful revascularization. In both left ventricular function and viability assessment there are many invasive and non-invasive (echocardiography, nuclear imaging, computerized tomography, magnetic resonance imaging, etc.) diagnostic methods. Here in this paper we will discuss solely role of echocardiography in the assessment of viability in patients with left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

Background: Major cardiovascular events (MACE) are more common in type 2 diabetes mellitus (T2DM) patients, and early diagnosis can prevent significant morbidity and mortality. The aim of this study was to investigate the predictiveness of fragmented QRS (fQRS) showing MACE in T2DM patients. Methods: A total of 227 T2DM patients (mean age 52, 51% male) without any cardiovascular disease who came to the cardiology outpatient clinic between March 01 and July 31, 2019, were included in the study. The patients were divided into 2 groups according to fQRS on electrocardiography (ECG), and 36 months of follow-up was done. The development of acute coronary syndrome, coronary revascularization, and cerebrovascular accident were accepted as MACE. Results: More MACE was seen in the group with fQRS on ECG (P = .026). Although there were more fQRS in patients with proteinuria, it was not statistically significant (P = .069). More myocardial infarcts (7.9%) and more cerebrovascular events (6.3%) were seen in the group with fQRS. While revascularization was performed on 3 patients in the fQRS group, revascularization was not performed on the patients in the non-fqrs group. In multiple Cox regression analysis, fQRS showed an independent predictor of MACE [P = .025, hazard ratio = 2.42 (1.117-5.221)], more MACE was seen in the fQRS (+) group in the kaplanmeier analysis (P = .022). Conclusion: More MACE was seen in the fQRS group in T2DM patients without a previous history of cardiovascular events. Fragmented QRS was found to be an independent predictor in showing MACE. Care should be taken in terms of MACE development in T2DM patients with fQRS. [ABSTRACT FROM AUTHOR]

Background: This study aimed to analyze trends in the burden of myocarditis in the Chinese population during 1990-2019. Methods: The Global Burden of Disease (GBD) database aims to assess the burden of various diseases and injuries on a global scale, and the contribution of relevant risk factors to the burden of disease was also included. In this study, we collected age-standardized incidence and mortality rates for myocarditis in China from 1990 to 2019 using GBD 2019. The age-period-cohort model was utilized to calculate local drift, longitudinal age patterns, as well as the ratios of period and cohort. Results: The age-standardized incidence and mortality rates of myocarditis in both men and women presented a decreasing trend during 1990-2019 [average annual percentage change (AAPC) of men = -0.202 (95% CI: -0.213 to -0.191); AAPC of women = -0.263 (95% CI: -0.27 to -0.256) for incidence; AAPC of men = -0.233 (95% CI: -0.371 to -0.094); AAPC of women = -0.872 (95% CI: -1.112 to -0.631) for mortality]. Longitudinal age curves showed that myocarditis incidence and mortality rates elevated with age among individuals aged 15-95+ years, with a higher growth rate in men than in women. The period and cohort ratios for both men and women showed similar decreasing trends. Local drift values for the incidence and mortality rates of myocarditis showed an increasing trend among individuals aged 70-75 years and above. Conclusion: Although the overall burden of myocarditis in China presented a decreasing trend during 1990-2019, the male and elderly populations still have a higher risk of incidence and mortality. Therefore, it is essential for the health-care system to introduce effective prevention and treatment measures for myocarditis. [ABSTRACT FROM AUTHOR]

Background: Endocan is an indicator of many pathologies accompanied by inflammation, endothelial cell activation, and dysfunction. In this study, we examined the relationship between degenerative aortic sclerosis, which progresses in a similar pathophysiologic mechanism as atherosclerosis, and serum inflammatory markers and endocan levels. Methods: A total of 155 patients without known coronary artery disease, aged between 65 and 80 years, were consecutively included in the prospective cross-sectional study. The study population was analyzed in 4 different groups. The control group consisted of patients with normal aortic valve structure, while patients with aortic stenosis were classified as mild aortic stenosis (2-2.9 m/s), moderate aortic stenosis (3-3.9 m/s), and severe aortic stenosis (= 4 m/s) according to their aortic velocity. While there were 39 patients in the control group, there were 58, 24, and 34 patients in the mild, moderate, and severe aortic stenosis groups, respectively. Results: There was no statistically significant difference between the groups in terms of patient distribution and characteristics. History of dyspnea and angina was correlated with the severity of aortic stenosis (P < .001). In this study, no statistically significant correlation was found between serum endocan levels and the severity of aortic stenosis (control group: 17.3 ± 6.3 ng/mL, mild aortic stenosis: 17.6 ± 8.7 ng/mL, moderate aortic stenosis: 16.3 ± 3.8 ng/mL, severe aortic stenosis: 15.2 ± 5.9 ng/mL, P = .396). However, it was figured out that there was a positive correlation between endocan levels and hemoglobin (Hg) (r = 0.308, P = .001), platelet (PLT) (r = 0.320, P < .001), and albumin (Alb) (r = 0.206, P = .026). Conclusion: In this study, no significant correlation was found between serum endocan levels and the severity of aortic stenosis. On the other hand, there was a positive correlation between endocan levels and Hg, PLT, and Alb. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Unconscious plagiarism and author-s request for withdrawal of his paper under consideration" in the 2012 issue.

Objective: Heart rate recovery (HRR) is a recognised marker used in clinical practice for assessing the risk of sudden cardiac death. Physical exercise leads to an improvement in HRR and has a proven beneficial effect on erection quality (EQ) related to the activity of the autonomic nervous system in men with ischaemic heart disease (IHD). This paper evaluates the relationship between HRR and EQ in patients with IHD and erectile dysfunction (ED) who underwent cardiac rehabilitation. Methods: The main analysis was based on the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman correlation coefficient, Pearson's chi-square test, chi-square test, with the Yates correction and (if possible) parametric tests were used. This prospective, non-randomised intervention study included 124 men with IHD and ED [International Index of Erectile Function (IIEF-5) scores of ≤21]. Of these, 89 patients underwent a 6-month cardiac rehabilitation phase III programme, whereas 35 did not. The results of the participants' total IIEF-5 scores and their HRR, demographic and clinical data were analysed. Results: The results of the 89 rehabilitated patients (mean age: 60.44±9.29 years) and 35 controls (mean age: 61.43±8.81 years) were analysed. In the rehabilitated patients, the mean baseline IIEF-5 score was 13.15±5.76 (95% CI: 11.93-14.36) and HRR was 16.49±7.68/min (95% CI: 14.88- 18.11). After cardiac rehabilitation, the parameters of ED and HRR improved significantly and were significantly higher than those of the controls; the mean IIEF-5 score of the rehabilitated group increased to 15.36±6.51 (95% CI: 13.99-16.73), while HRR increased to 21.40±7.25/min (95% CI: 19.88-22.93). A significant correlation was found between ΔHRR and ΔEQ (r=0.409791) as a result of the 6-month cardiac training programme Conclusion: Cardiac rehabilitation assessed by HRR has a sizable effect on autonomic balance in patients with IHD and ED, which plays a significant role in the mechanism of erection improvement. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 59-year-old male patient with palpitations and a systolic murmur grade 3/6 heard at the tricuspid area. The patient was diagnosed with a giant right atrium dissecting aneurysm, initially mimicking Ebstein's anomaly, and was successfully treated through surgical procedures.

In this paper, we reviewed the atrial fibrillation screening strategies in a stepwise manner and discussed the uncertainties in the assessment of the need for anticoagulation in light of the recently published European Heart Rhythm Association consensus document. We reviewed not only the methods and tools but also the role of health care professionals and patient organizations in addition to cost-effectiveness issues. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature. [ABSTRACT FROM AUTHOR]