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Coronary artery disease (CAD) is a widespread health issue globally, linked to significant morbidity and mortality. While oxidative stress, dysregulated lipid metabolism, and unhealthy lifestyle choices contribute to CAD, recent research highlights the role of immune responses and inflammation. Malnutrition, a modifiable risk factor, notably impacts CAD prognosis. The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, predicts outcomes in various diseases. This study aims to elucidate the relationship between malnutrition, as assessed by the PNI score, and the functional significance of coronary artery stenosis, evaluated by fractional flow reserve (FFR) measurements. A retrospective analysis involved 232 patients with single intermediate-grade coronary stenosis who underwent FFR measurement between January 2022 and January 2024. Prognostic nutritional index values were calculated from serum albumin and lymphocyte counts. Patients were divided into 2 groups based on FFR values. Patients with hemodynamically significant coronary stenosis (FFR ≤ 0.80) exhibited higher inflammatory markers and triglycerides, while those with FFR > 0.80 showed elevated albumin and PNI levels. Triglycerides and PNI emerged as independent predictors of significant coronary stenosis. This study demonstrates that PNI is independently associated with the functional significance of coronary artery stenosis as determined by FFR. Since lymphocytes, total protein and albumin values, which are readily available from routine blood tests, form the basis for PNI, this index can be easily used in clinical settings to predict hemodynamically significant coronary artery stenosis. However, the results of this study should be further expanded and validated through studies involving larger samples and prospective designs.

OBJECTIVEThis study evaluated the most effective scoring system for predicting new-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI). Identifying the best predictive tool may help clinicians select the most appropriate personalized treatment based on individual risk scores to prevent NOAF complicating AMI.METHODA total of 2,206 patients diagnosed with AMI between June 2021 and January 2023 were included in this study. After excluding cases with missing data, univariable and multivariable analyses were conducted on 1,672 patients to assess the association between baseline characteristics and the development of atrial fibrillation. The CHA2DS2-VASC (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke/TIA/thromboembolism, Vascular disease, Age 65-74 years, Sex category), C2HEST (Coronary artery disease, Chronic obstructive pulmonary disease, Hypertension, Elderly [age ≥ 75], Systolic heart failure, Thyroid disease), HAT2CH2 (Hypertension, Age > 75, Stroke/TIA, Chronic obstructive pulmonary disease, Heart failure), SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery), GRACE 2.0 (Global Registry of Acute Coronary Events), and SYNTAX II scores were calculated for each patient.RESULTSReceiver operating characteristic (ROC) analysis showed that the SYNTAX score (SxS) had the highest predictive value for NOAF during AMI, with an area under the curve (AUC) of 0.785 (95% confidence interval [CI]: 0.767-0.802, P < 0.001), followed by the SYNTAX II score (SxSII) with an AUC of 0.747 (95% CI: 0.728-0.765, P < 0.001), and the GRACE 2.0 risk score (RS) with an AUC of 0.740 (95% CI: 0.721-0.758, P < 0.001). It was shown that the modified scores (created by incorporating hemoglobin A1c [HbA1c] levels), the primary independent predictive parameter in this study, into the existing risk models demonstrated higher predictive value for NOAF (C-statistic: 0.784-0.794).CONCLUSIONCombining HbA1c levels with SxS yielded the highest diagnostic performance for predicting NOAF during AMI. In this study, while SxS outperformed other risk models, the GRACE 2.0 and SxSII scores also demonstrated relatively strong predictive value and were superior to the CHA2DS2-VASC, C2HEST, and HAT2CH2 scores for predicting NOAF in the setting of AMI.

Background: Hypertension is a major cause of cardiovascular diseases. Many studies have pointed out that the atherogenic index of plasma (AIP), which demonstrates plasma atherogenicity, is correlated with all-cause mortality, cardiovascular morbidity, atherosclerosis, and severity of coronary artery disease. Within this context, we tried to evaluate the correlation between nondipping circadian pattern and AIP. Methods: We enrolled 1,030 hypertensive patients (mean age: 53.6 ± 11.4) as part of the target population, separated into different groups based on the circadian blood pressure (BP) pattern taken from dipper and nondipper groups subsequent to 24-h ambulatory blood pressure monitoring (ABPM). We calculated the level of AIP using the log transformation of the ratio of triglyceride to high-density lipoprotein cholesterol. Results: The AIP observed in the nondipper group was remarkably higher than those of the dipper group (p < 0.001). After measuring the 24-h ABPM, we determined that AIP had a weak but significant correlation with nighttime systolic BP (r = 0.090, p = 0.004) and nighttime diastolic BP (r = 0.073, p = 0.019). As for the analysis based on the multivariate logistic regression, high AIP and age were found to be independently associated with the presence of the nondipping pattern. Conclusion: AIP levels are higher in patients with nondipping pattern compared to dipper patients. Additionally, higher levels of AIP are independently associated with the presence of the nondipping pattern in hypertensive patients.

The systemic immune-inflammation index (SII) has recently been investigated for cardiovascular diseases. We aimed to evaluate the relationship between SII and left atrial thrombosis (LAT). This retrospective, case-control study recruited patients with nonvalvular atrial fibrillation (NVAF) who underwent transesophageal echocardiography (TEE) for LAT detection before cardioversion or catheter ablation at a tertiary hospital between 2012 and 2021. Demographic characteristics were obtained from the hospital data system. According to TEE findings, the patients were categorized into LAT (+) and (-) groups. Age, gender, history of chronic diseases, urea, creatinine, albumin, hemogram parameters, the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), SII, the CHADS score, the CHA DS -VASc score, echocardiographic parameters, antiaggregant-anticoagulant use, and nonparoxysmal atrial fibrillation were included and analyzed. The study population consisted of 403 patients, including 228 men (56.6%), at a mean age of 60.84±12.26 years. A high white blood cell count (WBC) (OR, 1.26; 95% CI, 1.05 to 1.51; P=0.013), a high SII (OR, 1.00, 95% CI, 1.00 to 1.00; P=0.003), and a low ejection fraction (OR, 0.95; 95% CI, 0.90 to 0.99; P=0.018) were independent predictors of LAT (+). A spontaneous echo contrast (OR, 2.43; 95% CI, 1.35 to 4.39; P=0.003) was associated with LAT (+). SII values above 693.6 predicted LAT (+) with 71.6% sensitivity and 71.7% specificity (AUC, 0.77; P<0.001). The predictiveness of SII was similar to that of NLR (0.77 vs 0.74, P=0.093) but higher than PLR (0.77 vs 0.67; P<0.001) and WBC (0.77 vs 0.69; P=0.031). SII is an independent predictor of LAT in patients with NVAF.

Uygarlığın doğuşundan bu yana ve özellikle deniz felaketlerini izleyen süreçte, deniz rizikoları ve gemi maliklerinin üçüncü kişilere karşı artan sorumlulukları giderek karmaşık bir hâl almıştır. Bu yüzden, P&I sigorta ilişkisinin üçüncü kişisi konumundaki ve gemi malikleri ile kulüpler karşısında görece güçsüz olan kişileri koruyabilmek adına, bu hususta hukuki bir düzenlemeye ihtiyaç olduğu fark edilmiş ve sonucunda uluslararası sözleşmeler akdedilerek bu sözleşmeler iç hukuklara entegre edilmiştir.İlk olarak, gemi maliklerine bu uluslararası sözleşmelerden doğan sorumlulukları için finansal güvence sağlama yükümlülüğü getirilmiştir ki bu uygulamada çoğunlukla P&I kulüpleri tarafından sigorta sözleşmesi şeklinde sağlanmaktadır. Bunun yanı sıra, gemi maliklerinin ödemede acze düşmesi hâlinde üçüncü kişiler ödemesiz kalabilecektir. Dahası, kulüpler ve üçüncü kişiler arasında sözleşmenin nispiliği prensibi gereği bir sözleşme ilişkisi yoktur. Diğer bir deyişle, üçüncü kişiler kulüpleri dava edememektedir. Dolayısıyla zorunlu sigortaya ilaveten, üçüncü kişilerin finansal yönden gemi maliklerine ve (hatta karşılıklılık ilkesi uyarınca) diğer sigortacılara nazaran daha güçlü konumdaki kulüplere dava açabilmesinin temini amacıyla onlara doğrudan dava hakkı tanınmıştır.Ne sigortayı zorunlu kılmak ne de doğrudan dava hakkı tanımak bu sorunu gereği gibi çözmeyecektir zira kulüpler, üyelerinin önce ödemekle yükümlü oldukları ödemeleri yaptıktan sonra ancak kulüpler tarafından masraflarının karşılanacağına ilişkin olan “önce ödeme” kuralını doğrudan davalarda üçüncü kişilere karşı bir def’i olarak ileri sürebileceklerdir. Bu yüzden “önce ödeme” kuralından deniz hukukunun bazı alanlarında vazgeçilmiştir. Ancak bunun mefhum-u muhalifinden çıkan sonuç, bu kuralın hâlen diğer bazı alanlarda geçerliliğini koruduğudur. İdeal çözüm kulüpler ve üçüncü kişiler arasında kulüplerin bu savunmayı ileri süremeyecekleri doğrudan bir bağlantı kurmaktır. Ancak o zaman bile, hangi taleplerin ne ölçüde bu şekilde korunması gerektiği tespit edilmelidir. Özetle, P&I sigortasınca teminat altına alınan talepler bu doğrultuda analiz edilmiştir.

Blood viscosity and aortic sclerosis (AS) are strong predictors of cardiovascular events. The effects of blood viscosity on AS have not been studied adequately. We aimed to investigate the potential connection between whole blood viscosity (WBV) and AS. AS was detected by transthoracic echocardiography. The estimation of WBV was carried out at both high shear rate (HSR) (208/s) and low shear rate (LSR) (0.5/s) by previously validatedformulae using hematocrit (HcT) and total protein (TP) in g/L. WBV at HSR (208/s) is: (0.12 x HcT) + 0.17 (TP - 2.07) and WBV at LSR (0.5/s) is: (1.89 x HcT) + 3.76 (TP - 78.42). Comparisons of WBV at both HSR and LSR were made between patients with and without AS. We included 94 patients with AS (male = 30.9%, mean age = 67.5 y) and 97 control subjects without AS (male =26.6%, mean age = 69.1 y). Almost all of the clinical, echocardiographic, and biochemical characteristics were similar, but TP values were significantly higher in the AS group than in the control group (72.9 ± 5 g/L vs. 75.8 ± 6.1 g/L; p value < 0.001). Hemoglobin and HcT levels were similar (p value = 0.604 and p value = 0.431, respectively). In the AS group, WBV at LSR and HSR was higher than that in the control group (p value = 0.001 for both LSR and HSR). In multiple stepwise logistic regression analysis, WBV was an independent predictor of AS (p value < 0.001). We found higher WBV in patients with AS than in patients without AS at both LSR (0.5/s) and HSR (208/s). WBV at both LSR and HSR was independently associated with AS.

Objective: This study evaluated the most effective scoring system for predicting new-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI). Identifying the best predictive tool may help clinicians select the most appropriate personalized treatment based on individual risk scores to prevent NOAF complicating AMI. Method: A total of 2,206 patients diagnosed with AMI between June 2021 and January 2023 were included in this study. After excluding cases with missing data, univariable and multivariable analyses were conducted on 1,672 patients to assess the association between baseline characteristics and the development of atrial fibrillation. The CHA.sub.2]D[S.sub.2]-VASC (Congestive heart failure, Hypertension, Age [greater than or equal to] 75 years, Diabetes mellitus, Stroke/TIA/thromboembolism, Vascular disease, Age 65-74 years, Sex category), [C.sub.2]HEST (Coronary artery disease, Chronic obstructive pulmonary disease, Hypertension, Elderly [age [greater than or equal to] 75], Systolic heart failure, Thyroid disease), HA[T.sub.2]C[H.sub.2] (Hypertension, Age [greater than or equal to] 75, Stroke/TIA, Chronic obstructive pulmonary disease, Heart failure), SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery), GRACE 2.0 (Global Registry of Acute Coronary Events), and SYNTAX II scores were calculated for each patient. Results: Receiver operating characteristic (ROC) analysis showed that the SYNTAX score (SxS) had the highest predictive value for NOAF during AMI, with an area under the curve (AUC) of 0.785 (95% confidence interval [CI]: 0.767-0.802, P < 0.001), followed by the SYNTAX II score (SxSII) with an AUC of 0.747 (95% CI: 0.728-0.765, P < 0.001), and the GRACE 2.0 risk score (RS) with an AUC of 0.740 (95% CI: 0.721-0.758, P < 0.001). It was shown that the modified scores (created by incorporating hemoglobin A1c [HbA1c] levels), the primary independent predictive parameter in this study, into the existing risk models demonstrated higher predictive value for NOAF (C-statistic: 0.784-0.794). Conclusion: Combining HbA1c levels with SxS yielded the highest diagnostic performance for predicting NOAF during AMI. In this study, while SxS outperformed other risk models, the GRACE 2.0 and SxSII scores also demonstrated relatively strong predictive value and were superior to the CHA.sub.2]D[S.sub.2]-VASC, [C.sub.2]HEST, and HA[T.sub.2]C[H.sub.2] scores for predicting NOAF in the setting of AMI. Keywords: Acute myocardial infarction, atrial fibrillation, hemoglobin A1c, SYNTAX score Amac: Bu calisma, akut miyokard enfarktusu (AMI) sirasinda ortaya cikan yeni baslangicli atriyal fibrilasyonu (NOAF) ongormede en etkili skorlama yontemini belirlemeyi amaclamistir. Bu sayede, AMI'ye eslik eden NOAF'nin onlenmesi icin, ongorulen risk skorlarina gore hekimlerin en uygun kisisellestirilmis tedaviyi secmesine rehberlik edilebilir. Yontem: Haziran 2021 ile Ocak 2023 arasinda toplam 2206 AMI hastasi bu calismaya dahil edilmistir. Eksik veri nedeniyle, 1672 hasta icin baslangic faktorleri ile atriyal fibrilasyon gelisimi arasindaki iliskileri degerlendirmek uzere tek degiskenli ve cok degiskenli analizler kullanilmistir. Her bir hasta icin CH[A.sub.2][D.sub.2]-VASC, [C.sub.2]HEST, HA[T.sub.2]C[H.sub.2], SYNTAX, GRACE 2.0 ve SYNTAX II skorlari hesaplanmistir. Bulgular: AMI surecinde NOAF'i ongormek amaciyla yapilan ROC analizinde, SYNTAX skoru (SxS) icin egri altinda kalan alan 0.785 (GA %95 0.767-0.802, P < 0.001) olarak bulunmus; bunu sirasiyla SYNTAX II skoru (SxSII) 0.747 (GA %95 0.728-0.765, P < 0.001) ve GRACE 2.0 risk skoru (rS) 0.740 (GA %95 0.721-0.758, P < 0.001) izlemistir. Calismanin bagimsiz en guclu ongorucu parametresi olan HbA1c duzeyinin, bu risk skorlarina bir puanlama parametresi olarak eklenmesiyle olusturulan \"modifiye\" skorlarin NOAF'i ongormedeki degerinin daha yuksek oldugu gosterilmistir (C istatistigi, 0.784-0.794). Sonuc: HbA1c duzeyinin SxS ile birlestirilmesi, AMI sirasinda NOAF tahmini acisindan en iyi tanisal performansi saglamistir. Bu calismada, SxS diger risk skorlarindan daha iyi performans gosterirken, GRACE 2.0 risk skoru ile SxSII skorunun da gorece yuksek bir ongoru degeri oldugu ve NOAF tahmini acisindan CH[A.sub.2][D.sub.2]-VASC, [C.sub.2]HEST ve HA[T.sub.2]C[H.sub.2] skorlarindan daha basarili oldugu saptanmistir. Anahtar Kelimeler: Akut miyokard enfarktusu, atriyal fibrilasyon, hemoglobin A1c, SYNTAX skoru

The patient was heterozygos for factor V Leiden and he was experiencing a second attack of DVT. [...]he had a lifelong oral anticoagulation (OAC) therapy indication. Hemogram before AF attack was normal, but when he was hospitalized for warfarin overdose he had 10% (appr. 800/mm3) eosinophils in the peripheral blood.

Blood viscosity and aortic sclerosis (AS) are strong predictors of cardiovascular events. The effects of blood viscosity on AS have not been studied adequately. We aimed to investigate the potential connection between whole blood viscosity (WBV) and AS. AS was detected by transthoracic echocardiography. The estimation of WBV was carried out at both high shear rate (HSR) (208/s) and low shear rate (LSR) (0.5/s) by previously validated formulae using hematocrit (HcT) and total protein (TP) in g/L. WBV at HSR (208/s) is: (0.12 × HcT) + 0.17 (TP - 2.07) and WBV at LSR (0.5/s) is: (1.89 × HcT) + 3.76 (TP - 78.42). Comparisons of WBV at both HSR and LSR were made between patients with and without AS. We included 94 patients with AS (male = 30.9%, mean age = 67.5 y) and 97 control subjects without AS (male =26.6%, mean age = 69.1 y). Almost all of the clinical, echocardiographic, and biochemical characteristics were similar, but TP values were significantly higher in the AS group than in the control group (72.9 ± 5 g/L vs. 75.8 ± 6.1 g/L; p value < 0.001). Hemoglobin and HcT levels were similar (p value = 0.604 and p value = 0.431, respectively). In the AS group, WBV at LSR and HSR was higher than that in the control group (p value = 0.001 for both LSR and HSR). In multiple stepwise logistic regression analysis, WBV was an independent predictor of AS (p value < 0.001). We found higher WBV in patients with AS than in patients without AS at both LSR (0.5/s) and HSR (208/s). WBV at both LSR and HSR was independently associated with AS.